HEEL PAIN
Conditions
Overview
HEEL PAIN
The heel bone (calcaneus) is the largest bone in the foot. It can handle the impact of thousands of steps per day. Each time the heel contacts the ground it absorbs the equivalent of 110% of your weight with walking to 3 to 5 times your body weight with running.
Heel pain is the most common problem seen at our clinic. In fact, it is probably the most common foot problem your doctor will see.
Heel pain can be caused by several factors including poor foot mechanics, improper footwear, uneven or hard ground surfaces, aging, or being overweight.
PLANTAR FASCIITIS
The plantar aspect of your foot is the bottom of your foot. The plantar fascia is a strong band of connective tissue that essentially creates your arch, spanning from your heel to the toes. It functions as both a shock absorber and creates a propulsive force during gait.
Plantar fasciitis is the most common form of heel pain seen at our clinic. According to the Pedorthic Association of Canada, it affects one in ten adults at some point in their lives. Because fascia is very inelastic, it can be easily damaged, inflamed or torn.
Common Issues
- Walking, running and prolonged standing can irritate the fascia to the point of tissue damage
- Sudden increases in activity, like the resolution to get fit, or the simplest trauma from walking in sling backed sandals can be the cause
- It can appear in only one foot or both
- It may develop without any known cause or defined injury
Symptoms & Signs
- Intense or sharp pain on the bottom of the heel, often at the inside aspect and the beginning of the arch of the foot
- Typically most painful on your first few steps when getting out of bed or after sitting for a short period (the telltale sign)
- The pain will subside within a few minutes of being up and about, but quickly returns by the end of a long day of standing or walking
- Often the pain is accompanied by swelling, heat and tenderness on the inner aspect of the heel into the arch
- Often very tender in the centre of the bottom of your heel
Treatment
- Modifying or reducing your activity (possibly for weeks)
- Wearing supportive sandals or shoes at all times, even in the house
- Specific exercises to stretch the fascia and the calf muscles, and strengthen the foot muscles. See our Plantar Fasciitis Exercises guide here.
- Physiotherapy
- Custom foot orthotics are often successful by controlling foot motion and reducing stresses on the damaged tissue
- Proper footwear will complement the orthotic treatment
SEVER’S DISEASE
Sever’s disease is fairly common in children, and affects boys (from age 10-14) more often than girls (from age 9-12). It is an injury to a growth plate within the heel and not a disease. Growth plates are made of cartilage and become bone as we age. Children who have Sever’s will most often grow out of it.
Common Issues
- The medical term is calcaneal apophysitis
- It is diagnosed with a physical exam but occasionally your physician may send your child for an x-ray to rule out other conditions
- Continuing to be active during Sever’s disease has no long term side affects
- Children who are active in high impact activities or running and jumping sports may be more prone as are overweight children
Symptoms & Signs
- Generally exquisitely painful at the back and sides of the heel
- Applying pressure to these areas will elicit pain
- Typically not painful on the bottom of the heel, unlike plantar fasciitis
- The pain worsens with activity
Treatment
- Rest often reduces the pain; refraining from vigorous activity for several weeks may be necessary
- Ice therapy and possibly children’s pain relief medications may be appropriate
- Calf and hamstring stretches and massage can be helpful
- Physiotherapy can combine stretching and cold therapy with modalities like laser or ultrasound
- Custom foot orthotics with deep heel cups and added cushioning
Specific Heel Pain Conditions We Treat
Knee Health
- ARTHRITIC KNEE
- JUMPER'S KNEE
- MENISCUS TEARS
- PATELLOFEMORAL PAIN
- OSGOOD-SCHLATTER'S
- GENERAL HEALTH
Ankle Health
- ACHILLES TENDINOPATHY
- ARTHRITIC ANKLE
- POSTERIOR TIBIALIS TENDINOPATHY
- PLANTAR FASCIITIS
- SEVER’S DISEASE
Feet Health
- DIABETIC FEET
- ULCER
- CHARCOT DEFORMITY
- CALLUSES
- METATARSAL FRACTURES
- METATARSALGIA
Toes / Veins Health
- HAMMER TOES
- CLAW TOES
- CORNS
- VARICOSE VEINS
- TIRED LEGS
- SWELLING
How does it work?
Heel pain is quite common. Generally, the symptoms are not so painful that they are disabling, but they certainly affect lifestyle and enjoyment in everyday life, putting limits on walking, standing, and running. While the pain can occur quite suddenly, the treatment can take a long time and effort. There are several reasons for heel pain and your doctor may refer you to Ortho-Kinetics to see the Canadian Certified Pedorthist to explore pedorthic treatment options.
Step 1
BOOK AN ASSESSMENT
- Call us or book a pedorthic assessment online
- An assessment typically takes 30 to 45 minutes
- If you have shorts, bring them (we also have shorts at the clinic)
- Bring 2 or 3 pairs of the shoes you wear most often, for work and play
- Bring your prescription if you have one and x-ray CD or report
step 2
DURING YOUR ASSESSMENT
step 3
ENJOY A BETTER QUALITY OF LIFE
- Typically, you will receive your orthotics in about 2 weeks
- Within a few weeks of wearing them, your heel pain should be improving
- If necessary, we will have you come back for a follow up
- Follow ups are for further modifications, and/or to review exercises and stretches, and footwear recommendations
- At any point in the future, we encourage you to return for any necessary adjustments and service the orthotics if necessary
Frequently Asked Questions
You can have arthritis in the joints of your feet, but plantar fasciitis is not arthritis. It is damage to the ligament-like structure that stretches from your heel to your toes.
You can have plantar fasciitis pain and not have a heel spur. You can also have a heel spur, seen on an x-ray, but not have any heel pain. Your doctor may prescribe an x-ray to rule out a fracture or arthritis.
Plantar fasciitis can occur the day after some trauma to your heel area. But the recovery can last several weeks or even months. Orthotics, rest, ice, reduced activity and physiotherapy can all help to speed up healing time
While Sever’s disease can be quite painful, especially with activity, there is no evidence that being active will cause any permanent damage. The pain may make it difficult to continue to play so adjusting the activity level to your child’s comfort level is important in how you help him/her manage the pain. Orthotics, rest, ice, reduced activity and physiotherapy can all help to speed up healing time. Ultimately, the condition will resolve on its own, but may take several months or longer.
Once the Achilles tendon is damaged, there is risk in prolonging the condition, worsening the condition, or, if you are middle-aged, suffering a rupture of the tendon.