Heel pain is a very common symptom and normally resolves within a very short period of time without any formal treatment. However, if the pain continues, you should see a specialist to get a formal diagnosis so that the actual cause of the pain can be treated promptly.
There are several different causes of heel pain and they can all be identified based on an expert examination and possible imaging such as an ultrasound scan or MRI.
Plantar fasciitis:
The most common cause of heel pain is plantar fasciitis. It is caused by inflammation of a strong structure running along the sole of the foot. It is normally worst first thing in the morning and after periods of rest. Treatment is based around addressing tightness in the calf muscle.
Physiotherapy is normally all that is required but several other treatments are available if symptoms persist. These include orthotics, minor surgical procedures (Proximal Medial Gastrocnemius Release), shockwave therapy or injections.
In general, injections should be used only as a last resort because of the damage that can be caused to the fat pad under the heel. Injections should never be performed blind without an imaging modality like X-ray or Ultrasound.
Insertional Achilles Tendinopathy:
This is typically associated with the development of bone spurs at the location of the insertion of the Achilles on th heel. This often leads to the feeling of a bulky heel that may well rub on footwear.
If the bulkiness of the heel is not the primary problem then symptoms can be improved with physiotherapy and reducing calf tightness. If the lumps on the heel are the main problem then surgery may be required to ‘debulk’ the area.
Non-insertional Achilles Tendinopathy:
This pain is often just above the heel and is caused by inflammation around the Achilles tendon itself. You may have noticed some swelling around the tendon which is tender to touch. Treatment is focused on physiotherapy to address calf tightness, orthotics and injection therapy if persistent.
Other casues:
Achilles tendon rupture, calcaneal stress fractures, rheumatological conditions.
If you are experiencing heel pain and need an accurate diagnosis, please contact our team to arrange an initial consultation.
