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the incidence of heel pain is on the rise

Plantar Fasciitis, Heel Spur, Achilles, Childhood Sever's & more...

Heel pain strikes all age groups

THE leading CAUSE OF FOOT PAIN

Plantar Fasciitis / Plantar Heel Spur

A heel pain pathology induced by an excessive and most often repetitive strain on the Plantar Fascia - a long, wide ligament-like band found on the bottom of the foot

Affecting up to15% of the population, (primarily in the 40-75 age group), Plantar Fasciitis used to be known as Plantar Heel Spur Syndrome. It is now generally accepted that Plantar Heel Spurs (as seen on X-Ray) are generally NOT a cause of pain (studies show that around 30% of the population in the 40-70 age group have asymptomatic Plantar Heel Spurs). The actual cause of the pain, (which is often in exactly the same area as the spur) is the damaged/torn Plantar Fascial attachments - at their insertions into the Calcaneus/heel bone -(evident under Ultrasound as a thickened Plantar Fascia).

As previously mentioned, the Plantar Fascia is a long, wide band of fibrous, connective tissue that runs nearly the entire length of the bottom of the foot. Its function is to support, strengthen and reinforce the foot and the arch, and to provide shock absorption.

Excessive and repetitive strain on the Plantar Fascia can cause micro-tearing or actual tears to occur in the heel/arch area, leading to inflammation and pain. This initial acute (inflammatory) form of Plantar Fasciitis, can then develop into a more chronic (degenerative) form if it doesn't resolve within a period of approximately 3 months. Fortunately, more than half of acute cases will settle and resolve within this time period, however, those that don't and then become chronic cases often require much more comprehensive and tailored treatment to overcome them. This may require several months for full healing and pain relief to occur.

The pain of Plantar Fasciitis is often only experienced first thing out of bed in the morning, and/or upon rising after a prolonged period of rest ("start-up pain"). This can quickly progress, however, to a more constant pain throughout the day, particularly during and/or after long periods on one’s feet. The level of pain experienced by sufferers can also vary greatly from case to case, (depending on the nature and extent of the damage to the fibres that make up the Plantar Fascia) - from mild discomfort, through to debilitating, relentless pain.

The excessive strain which brings about Plantar Fasciitis can be caused by a repetitive, overuse type of movement, (eg: prolonged periods of standing, walking, running) OR it may be brought about by one specific incident (eg: landing heavily or awkwardly on your foot/feet).

Tension on the Plantar Fascia may also be greatly increased by a myriad of environmental, biomechanical, and other factors. Hard, flat, modern-day surfaces, certain activities such as running and jumping, extended periods on one’s feet, inadequate footwear, tight calves, inefficient foot and lower limb biomechanics (mainly overpronation - a foot that rolls inwards too much) are all leading contributing factors. In fact, research and studies show that the vast majority of long-term/chronic Plantar Fasciitis sufferers have inefficient foot structures/lower limb biomechanics, which are simply unable to cope with the demands of weight-bearing on hard, flat, modern-day surfaces, such as concrete, tiles, and asphalt.

Plantar Fasciitis induced by a repetitive strain (ie: simply by the action of too much standing, walking or running for example) is by far more prevalent, harder to resolve, and much more likely to become chronic/degenerative/longstanding than Plantar Fasciitis which has been caused by a specific incident/injury. When you first acquire the symptoms of Plantar Fasciitis, there is no way of really knowing how long you will have it for. Research has shown that the longer you endure it for, or defer treatment, the longer it can take to resolve.

Our tailored treatment plans (whether for acute or chronic Plantar Fasciitis), are based on our 3 fundamental principles to heal your heel (Plantar Fascia):

  1. Inform/educate the patient as much as possible about Plantar Fasciitis and how to best resolve it (using verbal and visual means, along with printed reference material)
  2. Reduce the stress & strain on the Plantar Fascia as much as possible to facilitate the healing process as effectively as possible
  3. Stimulate/accelerate the healing response and reduce the pain as effectively as possible (without any complications or side effects)

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

With Heal My Heel you can do just that!

How we do this
a debilitating childhood growing pain

Sever's Disease

An inflammatory disorder of the Calcaneus/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 heel bone/Calcaneus is responsible for the bone's growth and development. The Calcaneus fully matures and stops growing at an average age of 12 in girls, and boys at around 14.

Sever's is triggered by a kind of 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 (minutes to days). It can also become significantly more painful once the activity is completed and the area "cools down". The stress of the Achilles Tendon pulling and twisting on the back of the heel bone during certain weightbearing activities (especially running/jumping) is responsible for the irritation and inflammation of the growth plate inside the bone.

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 period of development of the Calcaneus bone (several years).

Other contributing factors are hard, flat surfaces (this includes very firm grass surfaces), inadequate footwear, tight calves, and inefficient foot structures/lower limb biomechanics (mainly over-pronation - a foot that rolls inwards too much). In fact, research and studies show that the vast majority of children that suffer from the pain of Sever's Disease have inefficient foot structures/lower limb biomechanics. Treatment for Sever's is really a case of managing the pain rather than "healing" it as such. That is because it is essentially a "growing pain" which inevitably must run its course. The symptoms of Sever's can last anywhere from days to several years (although usually intermittent if for this long a period). The pain associated with Sever's, however, (even if debilitating), can be significantly reduced if the underlying causes are first identified, and then  effectively targeted.

Heal My Heel's management of Sever's Disease is based on our 3 fundamental principles for treatment:

  1. Inform/educate the patient (& parents) as much as possible about Sever's and how to best manage its symptoms
  2. Reduce the stress & strain on the Achilles Tendon as much as possible (both longitudinal AND torsional) in order to reduce the irritation to the growth plate which will then reduce the inflammation and pain
  3. Reduce the pain and inflammation (if applicable) as effectively as possible (without any complications or side effects)

This 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.

With Heal My Heel you can do just that!

How we do this
the heel takes a real pounding

Other Heel Pain Pathologies

The heel area is a complex system of bones, joints, ligaments, muscles, tendons and nerves, and bears the full weight and impact of our bodies, step after step after step...

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. Bursitis occurring in the heel often occurs concurrently with Achilles Tendinitis/Tendinosis.

Retrocalcaneal 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 a Subcutaneous Calcaneal Bursitis and Insertional Achilles Tendinopathy (forming the triad of symptoms known as Haglund's Deformity). The spur itself doesn't generally cause any pain as such, unless as a result of friction and pressure from footwear.

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 Oedema:

Often associated with long-term Planar Fasciitis and caused by micro-fractures at the insertion of the Plantar Fascia to the Calcaneus causing swelling of the marrow inside the bone. Sometimes the oedema can manifest inside a Plantar Heel Spur and can be the cause of extreme pain with associated heat and swelling.

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 extend to the bone membrane and even the bone itself. 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, unless associated with bone marrow oedema (see above), however, was once thought to cause the pain that we now know as Plantar Fasciitis. Evident through X-Ray in about 30% of the population (asymptomatic)

sides of the heel

Baxter's Nerve Entrapment:

Entrapment of the first branch of the Lateral Plantar Nerve causing pain a few millimetres above the medial (inner) edge of the heel, directly below the inner ankle. Can often occur simultaneously with longstanding cases of Plantar Fasciitis.

Tarsel 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 sometimes a little 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 outer edge of the foot.

Treatment options
step on the road to recovery!

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