Heel Pain / Heel Spur – What is it and how do you treat it?

Heel pain is a common problem at any age but mostly between ages 40 and 60. It is also common in children. It affects men and women alike. The pain may or may not involve the development of a heel spur. The good news is, treatment can be very successful.

What causes heel pain?

There are a number of possible causes depending on where the heel pain presents.

  • Pain under the heel – may be due to
    • A tight plantar fascia (the structure which supports the long arch under the foot), The fascia becomes taut and pulls at its’ attachment to the bone causing pain. Sometimes people call this plantar fasciitis, but that is not a true description of the pain. See Plantar Fasciitis to understand why this may not be an accurate diagnosis.
    • heel spur, so should be treated as early as possible.
    • Boney bruising or a stress fracture
  • Pain behind the heel – may be due to
    • A tight calf pulling from the tendon attachment to the bone
    • Severs disease
    • Achilles tendonitis pulls at its’ insertion into the heel bone
    • Hagland deformity
  • Pain in the inside of the heel- may be due to
    • Severely pronated feet (flat feet)
    • Tarsal coalition

What causes heel pain?

  1. Biomechanical Deviations are undoubtedly the biggest cause of heel pain as they put an adverse strain on some structures for a prolonged period of time – flat feet being the main offender.
  2. Sometimes it will be trauma such as jumping on to a hard surface or repetitive landing in your sport.
  3. It may also be due to a sudden increase in activity for example when you get a mid life crises and make a burst to get fit.
  4. Another big influence is footwear, especially slip on sandals or flip flops, we are usually inundated with middle aged holiday makers in September when they return from 2 weeks in the sun. We expect a huge increase in years to come from today’s teenagers as the slop around in ill fitting shoes.
  5. As you get older the fat pad under your heel thins and can be a factor.

What is a heel spur?

A heel spur is a small boney growth under the heel at the attachment of the plantar fascia.

It occurs as a result of repeated trauma to the bone as the fascia repetitively pulls at its insertion into the bone, this causes micro bleeds which eventually become calcified and cause a little boney growth out from the bone.

This can take about a year for this to happen and then it may remain painful for another year. If left untreated it will usually become less painful after a few years as the body adjusts to this. It’s important to realise though that it may recur as the causes will not have altered.

Treatment for Heel Pain / Heel Spur
Using Deep transverse frictions in the treatment of heel pain

As with all pains and aches, a detailed thorough assessment is required to determine the exact cause of your heel pain and hence the course of treatment.

We frequently see people who have literally “tried everything” and are exasperated by the whole process. The issues often are that the diagnosis was not accurate, the treatment performed was inadequate or that the exercises given were not specific enough.

In our clinic we always gear the treatment towards the assessment findings:

  1. Relieving your pain using electrotherapy, soft tissue release, hot and cold therapy, vibration therapy and exercise.Manual release of the plantar fascia is useful in the treatment of heel pain
  2. Addressing the underlying causes of your heel pain, such as tight calves, tight plantar fascia, tight hip flexors etc.
  3. Correcting the foot biomechanics by prescribing insoles or orthotics if required.
  4. Giving you a long term management programme to help prevent recurrence.
  5. Heels spurs may ultimately require an injection, but do generally resolve with physiotherapy treatment.
  6. Shock Wave Therapy has been advocated for the treatment of heel spurs and plantar fascia pain. While we do not offer this treatment, any patients who have received it in the past say that they feel they get more benefit from our treatment which involves all of the above.

When we treat and diagnose the cause of the heel pain, most people will ask us – why is it only giving me bother now. That’s the thing with biomechanically related issues, they are like an overuse injury and can take years to develop.

What should you do if you have heel pain?

Here are some tips to help you should you suffer from heel pain.

  • Use ice rather than heat
  • Stretch the sole of the foot before you get out of bed in the morning
  • Massage the plantar fascia
  • wear a night splint
  • wear comfortable supportive shoes
  • Apply anti-inflammatory gel.
  • See a chartered physiotherapist with a special interest in foot pain for a full thorough assessment.

What should you not do if you have heel pain?

  • Wear flip flops or loose slip on shoes
  • Excessive walking