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the incidence of heel pain is on the rise

There are numerous pathologies that cause heel pain

Heel pain strikes all age groups

the most common cause of all foot pain

Plantar Fasciitis / Plantar Heel Spur

A disorder of the heel induced by excessive tension on the Plantar Fascia - a long wide ligament-like band found on the bottom of the foot

Affecting up to 15% of the population, Plantar Fasciitis used to be known as Plantar Heel Spur Syndrome. Whether you have a Plantar Heel Spur or not (on X-Ray), the spur itself is not the cause of the pain - around 30% of the population have Plantar Heel Spurs visible on X-Ray (without having any heel pain). The source of the pain is actually the Plantar Fascial attachments to the Calcaneus (heel bone). This pain is felt in exactly the same location as the heel spur, but is caused by these frayed and damaged Plantar Fascial attachments.

The Plantar Fascia is a wide fibrous connective tissue that runs nearly the entire length of the bottom of the foot. It's function is to support and reinforce the arch and provide shock absorption for the foot.

Excessive tension on the Fascia can cause micro-tearing or actual tears to occur in the heel and/or the arch areas, bringing about inflammation, pain, and ultimately degeneration in the fibres (Plantar Fasciitis). This pain is often only experienced first thing out of bed in the morning, or upon rising after a prolonged period off your feet (start-up pain). This can quickly progress to a more constant pain thoughout the day, particularly after long periods on your feet.

This tension or strain on the Plantar Fascia can be created by a repetitive action (eg: walking, standing, running, jumping) or from one specific incident (eg: landing heavily or awkwardly) and both types are are exacerbated by a combination of environmental and biomechanical factors. Hard, flat, modern-day surfaces, certain activities such as running and jumping, long periods on your feet, poor footwear, tight calves, inadequate lower limb biomechanics (mainly overpronation - a foot that rolls inwards too much) are all contributing factors.

Plantar Fasciitis brought about by a repetitive strain (ie: simply by the mechanics of standing, walking or running) is much more prevalent, harder to resolve, and more likely to become chronic / degenerative / longstanding.

When you first acquire the symptoms of Plantar Fasciitis, there is no way of knowing how long you will have it for. Research has shown that the longer you endure it for, or defer treatment, the longer it will take to resolve.

Heal My Heel's treatment options, whether for acute (early stages) or chronic (long-standing) Plantar Fasciitis, ALWAYS come under one of our three essential tenents for treatment:

  1. Attempting to reduce the weight bearing tension on the Plantar Fascia as much as possible
  2. Attempting to stimulate and accelerate the healing process as much as possible
  3. Attempting to educate and inform the sufferer as much as possible about Plantar Fasciitis and how best to resolve it permanently

A combination of all three will give the best chance of complete healing and staying permanently pain free.

At Heal My Heel we do just that!

How we do this
a debilitating childhood growing pain

Sever's Disease

An inflammatory disorder of the heel bone, often referred to as a "growing pain", it is the most common cause of foot pain in children

Also known as Calcaneal Apophysitis, Sever's Disease affects about 15% of children in the 7 - 15 age group. The growth plate inside the Calcaneus is responsible for the bone's growth and development. The Calcaneus fully matures and stops growing in girls around age 12 and boys around age 14.

Sever's is triggered by a disruption to the growth plate which is exacerbated by certain activities, running and jumping in particular. The consequent inflammation and pain is often not experienced until well after the commencement of the activity (up to an hour), and often then lasts for some time after its completion before settling down (hours to days). It can also become significantly worse once the activity is completed and the body starts to cool down. The stress of the Achilles Tendon pulling and twisting on the back of the heel during certain weightbearing activities is responsible for the irritation of the growth plate.

The pain associated with Sever's can often be linked to periods of accelerated growth ("growth spurts"), and therefore pain is often felt intermittently over the years and during the period of the development of the Calcaneus bone.

Other contributing factors are hard surfaces (this can include very firm grass areas), poor footwear, tight calves, and inadequate lower limb biomechanics (mainly overpronation - a foot that rolls inwards too much). Treatment for Sever's is more a case of managing the pain rather than "healing" it as such. This is because it is a natural growing pain disorder which inevitably has to run its course. The symptoms of Sever's therefore, can last anywhere from days to several years (although usually intermittent over that period). The pain and symptoms of Sever's, however (even if debilitating), can be effectively managed and reduced dramatically.

Heal My Heel's treatment options for Sever's Disease ALWAYS come under one of our three essential tenents for treatment:

  1. Attempting to reduce the weight bearing tension on the Achilles Tendon as much as possible (both longitudinal and torsional - twisting)
  2. Attempting to reduce the pain / inflammation as much as possible
  3. Attempting to educate the sufferer (and his / her parents) as much as possible about Severs and how to best manage its symptoms

A combination of all three will give the best chance of reducing the pain and inflammation as much as possible, while still allowing the sufferer to participate in sporting activities.

At Heal My Heel we do just that!

How we do this
the heel takes a pounding

Other heel pain pathologies

The heel area is a complex system of bones, joints, ligaments, muscles, tendons and nerves, bearing the full impact and weight of the body

Back of the heel

Retrocalcaneal Bursitis/Subcutaneous Calcaneal Bursitis:

Bursas are fluid filled cushioned sacs found all over the body where tendons insert into bone. They aid in a smoother gliding mechanism for the tendon and can become irritated by trauma or overuse. This causes inflammation and pain and is known as Bursitis. On the heel they are often associated with Insertional Achilles Tendinitis/Tendinopathy.

Retrocalcaneal Calcaneal Spur (Haglund's Deformity):

A bone spur that forms over time on the back of the heel bone (as seen on X-Ray) and often occurring concurrently with Subcutaneous Calcaneal Bursitis and Insertional Tendinitis/Tendinopathy (forming the triad of symptoms known as Haglund's Deformity). The spur itself doesn't generally cause the pain.

bottom of the heel

Calcaneal Fracture:

Caused through sudden trauma to the bone or a stress fracture due to overuse (mainly in runners). Often causes extreme pain, swelling and heat.

Calcaneal Odema:

Sometimes associated with Planar Fasciitis and caused by micro-fractures at the insertion of the Plantar Fascia to the Calcaneous causing swelling of the marrow inside the bone. Can often cause extreme pain, swelling and heat.

Baxter's Nerve Entrapment:

Entrapment of the first branch of the Lateral Plantar Nerve causing pain on the inside of the bottom of the heel. Often occurs concurrently with longer standing cases of Plantar Fasciitis.

Bruising or atrophy of the Fat Pad:

Trauma to the heel or loss of the normal cushioning provided by the Plantar Fat Pad can lead to bruising which can even extend to the bone and the bone lining. Atrophy is often linked to the ageing process and the type of bruising caused by repetitive trauma is often seen in runners.

Plantar Calcaneal Spur:

Not generally a cause of pain, but once upon a time it was thought to cause the pain that we now know as Plantar Fasciitis. Evident through X-Ray in about 30% of the population.

sides of the heel

Tursel Tunnel Syndrome:

Entrapment of the Tibial Nerve often causing pain, tingling and/or burning just behind and below the inside ankle.

Posterior Tibial Tendon Disorders:

Pain from stress to this tendon is usually felt just below the inside ankle, and possibly up higher also.

Peroneal Tendon Disorders:

Pain from stress to these tendons can be felt just below the outside ankle, and can extend further along the outside edge of the foot.

Treatment options
step onto the road to recovery

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