London Foot Surgery Specialists & Podiatrists - Heel Pain & Plantar Fasciitis

Heel Pain & Plantar Fasciitiis Treatment at our Foot Clinic


What causes pain in the heel? Pain in the heel can be caused by many things. The commonest cause is plantar fascitis (which will be discussed more in the next section). Other causes include: - being overweight - constantly being on your feet, especially on a hard surface like concrete and wearing hard-soled footwear - thinning or weakness of the fat pads of the heel - injury to the bones or padding of the heel - arthritis in the ankle or heel (subtalar) joint - irritation of the nerves on the inner or outer sides of the heel - fracture of the heel bone (calcaneum) What is plantar fasciitis? First you need to know a bit about what the heel does when you walk. It absorbs the shock of your foot striking the ground as it is put down and to start springing you forward on the next step. It contains a strong bone (the calcaneum). Under the bone are a large number of small pockets of fat in strong elastic linings, which absorb much of the shock (fat pads). The heel is attached to the front of the foot by a number of strong ligaments which run between the front part of the calcaneum and various other parts of the foot. The strongest ligament is the plantar fascia, which attaches the heel to the toes and helps to balance the various parts of the foot as you walk. It therefore takes a lot of stress as you walk. In some people the plantar fascia becomes painful and worn. This usually happens where it is attached to the heel bone, although sometimes it happens in the mid-part of the foot. This condition is called plantar fascitis. I've been told my pain is caused by a bone spur. Is this likely? At the site of the worn plantar fascia attachment some extra bone may form, producing a small "spur". These heel spurs are commoner in people with plantar fascitis, but they can be found in people with no heel pain. The heel spur is caused by the same process as the heel pain, but the spur is not itself the cause of the pain. Can I do anything about heel pain myself? You can try to avoid the things that cause heel pain to start: avoid getting overweight where your job allows, minimise the shock to your feet from constant pounding on hard surfaces reduce the shocks on your heel by choosing footwear with some padding or shock-absorbing material in the heel if you have high-arched feet a moulded insole in your shoe may reduce the stresses on your feet if you have an injury to your ankle or foot, make sure you exercise afterwards to get back as much movement as possible to reduce the stresses on your foot and your heel in particular. If you start to get heel pain, doing the above things may enable the natural healing process to get underway and the pain to improve. How will my specialist tell what is wrong? Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away. However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray is not usually very useful, but it can show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a bone scan may be used to help spot arthritis or a stress fracture. What can be done about heel pain? It’s difficult to know which treatment will work for you, as there isn’t very much good research on heel pain and the results are a bit confusing. We normally start with simple treatments and try others if the simple things don’t work. As heel pain is basically a stress and wear problem in the tissues of the heel, the main treatment is to reduce stress. a soft heel pad is useful to wear in your shoe to act as a shock-absorber when you walk. if you have a stiff ankle or tight Achilles tendon a physiotherapist can advise on exercises for these. Stretching the Achilles tendon and plantar fascia is very effective general treatment for many patients. if you have a high-arched or very flat foot, a podiatrist may advise an insole to reduce stress. If you still have pain after simple treatment, your specialist may want to investigate your problem a bit further. If no other medical problem or cause of stress in your heel is found, a number of other treatments can be tried: Specialist Orthotic/Insole an injection of steroid and local anaesthetic into the painful area pain control treatments such as transcutaneous nerve stimulation (TENS) or acupuncture treatment with shockwaves to stimulate healing. Only if all non-surgical treatments fail would an operation be considered. Do I need an operation? It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation. Wouldn't it just be better to take out my heel spur? As you will have seen from reading the section above I’ve been told my pain is caused by a bone spur the pain is not caused by the spur. Rather, both the pain and the spur are caused by wear in the plantar fascia. Simple removal of the spur has been known not to help relieve the pain since the 1960s. However, if you are one of the rare people who do not respond to simple treatment and end up having an operation to release the plantar fascia, the surgeon may also remove any bone spur at the same time.

What causes pain in the heel?
Pain in the heel can be caused by many things. The commonest cause is plantar fascitis (which will be discussed more in the next section). Other causes include:

- being overweight
- constantly being on your feet, especially on a hard surface like concrete and wearing hard-soled footwear
- thinning or weakness of the fat pads of the heel
- injury to the bones or padding of the heel
- arthritis in the ankle or heel (subtalar) joint
- irritation of the nerves on the inner or outer sides of the heel
- fracture of the heel bone (calcaneum)

What is plantar fasciitis?
First you need to know a bit about what the heel does when you walk. It absorbs the shock of your foot striking the ground as it is put down and to start springing you forward on the next step. It contains a strong bone (the calcaneum). Under the bone are a large number of small pockets of fat in strong elastic linings, which absorb much of the shock (fat pads). The heel is attached to the front of the foot by a number of strong ligaments which run between the front part of the calcaneum and various other parts of the foot. The strongest ligament is the plantar fascia, which attaches the heel to the toes and helps to balance the various parts of the foot as you walk. It therefore takes a lot of stress as you walk.

In some people the plantar fascia becomes painful and worn. This usually happens where it is attached to the heel bone, although sometimes it happens in the mid-part of the foot. This condition is called plantar fascitis.

I've been told my pain is caused by a bone spur. Is this likely?
At the site of the worn plantar fascia attachment some extra bone may form, producing a small "spur". These heel spurs are commoner in people with plantar fascitis, but they can be found in people with no heel pain. The heel spur is caused by the same process as the heel pain, but the spur is not itself the cause of the pain.

Can I do anything about heel pain myself?
You can try to avoid the things that cause heel pain to start:
avoid getting overweight where your job allows, minimise the shock to your feet from constant pounding on hard surfaces
reduce the shocks on your heel by choosing footwear with some padding or shock-absorbing material in the heel if you have high-arched feet a moulded insole in your shoe may reduce the stresses on your feet if you have an injury to your ankle or foot, make sure you exercise afterwards to get back as much movement as possible to reduce the stresses on your foot and your heel in particular.

If you start to get heel pain, doing the above things may enable the natural healing process to get underway and the pain to improve.

How will my specialist tell what is wrong?
Your doctor will listen to your complaints about your heel and examine you to see what is causing the pain, and whether anything else has started it off. If the cause of your pain seems obvious, your doctor may be happy to start treatment straight away.

However, some tests may be helpful in ruling out other problems. Blood tests may be done for arthritis. An Xray is not usually very useful, but it can show any arthritis in the ankle or subtalar joint, as well as any fracture or cyst in the calcaneum. (It will also show a spur if you have one, but as we know this is not the cause of the pain.) Occasionally a bone scan may be used to help spot arthritis or a stress fracture.

What can be done about heel pain?
It’s difficult to know which treatment will work for you, as there isn’t very much good research on heel pain and the results are a bit confusing. We normally start with simple treatments and try others if the simple things don’t work. As heel pain is basically a stress and wear problem in the tissues of the heel, the main treatment is to reduce stress.
a soft heel pad is useful to wear in your shoe to act as a shock-absorber when you walk.

if you have a stiff ankle or tight Achilles tendon a physiotherapist can advise on exercises for these. Stretching the Achilles tendon and plantar fascia is very effective general treatment for many patients.

if you have a high-arched or very flat foot, a podiatrist may advise an insole to reduce stress.

If you still have pain after simple treatment, your specialist may want to investigate your problem a bit further. If no other medical problem or cause of stress in your heel is found, a number of other treatments can be tried:

Specialist Orthotic/Insole
an injection of steroid and local anaesthetic into the painful area
pain control treatments such as transcutaneous nerve stimulation (TENS) or acupuncture treatment with shockwaves to stimulate healing. Only if all non-surgical treatments fail would an operation be considered.

Do I need an operation?
It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear.
The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.

Wouldn't it just be better to take out my heel spur?
As you will have seen from reading the section above I’ve been told my pain is caused by a bone spur the pain is not caused by the spur. Rather, both the pain and the spur are caused by wear in the plantar fascia. Simple removal of the spur has been known not to help relieve the pain since the 1960s.

However, if you are one of the rare people who do not respond to simple treatment and end up having an operation to release the plantar fascia, the surgeon may also remove any bone spur at the same time.

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Heel Pain & Plantar Fasciitiis Treatment at our Foot Clinic