What is the cause of Heel Pain?
The nature of heel pain can be complicated as there are many potential causes of heel pain. From a biomechanical perspective heel pain may result from an underlying back injury or foot injury which may be the result of poor alignment of the foot, ankle, leg and pelvis when weight bearing. However, a biomechanical assessment is required in order to understand whether changes in foot or pelvic alignment are contributing to heel pain, or are the sole reason for the onset of the heel pain.
Examples of common differential biomechanical diagnosis of heel pain includes:
- Plantar fasciitis
- Heel Bone Spur
- Insertional Achilles Tendinopathy
Treatment of Heel Pain
Examples of the range of treatments which help reduce and/or eliminate heel pain include; rest, stretching, strengthening, change in footwear, foot orthotics (arch supports), Foot Mobilisation, injection therapy, and shock wave therapy.
Treatment of Heel Pain: Rest
Reduced loading of the heel, for example avoiding weight bearing exercise and long walks, is recommended to help reduce heel pain. In the more acute cases it may be essential that the sufferer significantly reduces heel loading and this may require the use of walking crutches in order to ensure partial weight bearing, to promote healing and a reduction of heel pain. In the situation of sudden onset of heel pain, the sufferer should attend their local Accident and Emergency department to rule out a fracture of the heel bone.
Treatment of Heel Pain: Ice
Application of an ice pack to the heel for short amount of time will help to reduce heel pain. Other sufferers find relief from rolling an ice bottle (keep a bottle of water in the freezer) under the arch of the foot and heel.
The application of ice can help to slow down the rush of blood and fluids which travel to the heel when it is injured, and this helps to reduce heel pain. In addition, the cold temperature may reduce nerve sensations, thus reduce heel pain further.
It is important not to apply ice directly to the skin or to apply the ice pack for periods longer than 15 to 20 minutes. If you are experiencing changes in sensation from the application of the ice pack then remove the ice and consult a doctor should your sensation not return to normal within 30 minutes.
Treatment of Heel Pain: Stretching and Strengthening
Stretching of the arch of the foot and the calf is advisable in order to help relieve heel pain, however it is important not to over stretch. It may be advisable to advise to stretch more gently, but more often.
It is important to strengthen the foot although this must be carried out at the appropriate point during the rehabilitation process. The clinician will be able to offer advice on how to strengthen the foot and lower leg in order to reduce heel pain.
Treatment of Heel Pain: Restoring Foot Position
Other that rest and reduced weight bearing, the most obvious solution when treating heel pain is to restore the position of the foot, as this will reduce the stress applied to the area of injury. Foot posture is restored either by wearing prescribed foot orthotics or following Foot Mobilisation treatment in conjunction with a foot and lower leg strengthening programme.
Treatment of Heel Pain: Restoring Foot Position in the Over Pronated Foot
An over-pronated foot tends to present as lowering of the arch of the foot, inward tilt of the heel and outwards splay of the forefoot. These changes to the foot’s position will result in an increase in the stress applied along the arch of the foot. In particular the plantar fascia band which runs underneath the arch of the foot, will pull on its insertion at the heel bone. Ultimately this increased strain may result in damage to the tissue under the heel of the foot, resulting in heel pain.
By wearing foot orthotics the foot’s arch height will rise and the inwards tilt of the heel and outwards splay of the forefoot will reduce. Therefore, the stress applied under the arch of the foot and the heel when walking will reduce, promoting tissue healing and a reduction of heel pain.
Similarly, Foot Mobilisation treatment will restore foot position and promote healing and a reduction of heel pain. This more natural method of treatment avoids the need for the sufferer to wear foot orthotics.
Clinicians at The Foot and Leg Clinic will carry out a biomechanical assessment in order to advise whether foot orthotics are required or whether your heel pain can be resolved by Foot Mobilisation treatment alone.
How long will it take for heel pain to go away?
It is difficult to determine how long it will take for heel pain to go away, however an accurate clinical diagnosis will allow the clinician to provide the patient with a strong estimation with regards to when they expect their symptoms to begin to improve.
The time expected to recover from heel pain largely depends on the nature of the injury. For example, some low grade injuries may resolve fairly quickly with appropriate treatment such as rest, foot orthotics, foot mobilisation treatment or injection therapy. Whilst other injuries such as more severe cases of plantar fasciitis, may take up to 18 months to 3 years to resolve, however these cases are less common.
If you have heel pain or foot pain please get in touch and we can help relieve the pain.
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