Are you suffering from heel pain? Is heel pain interfering with how you move, how you feel and how you live?
If you dread those painful first steps in the morning or when standing after resting, it’s time to get help.
In this article, our orthopedic doctor and specialist Dr Ananda, who has years of experience treating patients in Singapore, will share all you need to know about heel pain. We’ll look at the types of heel pain, the causes of heel pain and treatment options for heel pain.
What Are The Symptoms Of Heel Pain?
- Pain under the heel which may extend into the arch
- Pain at the back of the heel where the Achilles tendon attaches to the heel bone
- Pain that is usually worse the first few steps in the morning and while standing after sitting for long periods during the day
- Pain that is often aggravated by prolonged standing, walking or running, especially on hard surfaces
- Burning, numbness and throbbing around the heel when resting at night
What Causes Heel Pain In The First Place?
The location of the pain often provides an important clue to the diagnosis and source of the pain.
Often times, when pain is at the back of the heel, the achilles tendon and calf muscles may be the source of the problem.
When pain is located under the heel where the heel touches the ground, the pain is usually from the plantar fascia.
Plantar Fasciitis and heel spurs are two terms frequently used when discussing the causes of heel pain.
Causes Of Plantar Fasciitis
Plantar Fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes.
Often there is an increase in load placed on your lower limbs that your body has not had the capacity to deal with, resulting in injury. However, this increased load is secondarily caused due to a tight and dysfunctional calf muscle that is not able to offload the stresses going through the foot. Therefore, leading to inflammation of the plantar fascia.
This increase in load may include:
- Jobs that require lots of walking on hard surfaces
- Prolonged barefoot on hard surfaces (often happens when people are on holiday for a few weeks)
- Starting a new exercise program; or increasing your training intensity/volume or style
- Weight gain
- Wearing old, worn out footwear; high heels
- Certain foot types may increase your likelihood of developing heel pain – or to put more simply – feet that do not work too well.
- Whether that be collapsed arches, tight calf muscles, weak intrinsic foot muscles, high arch rigid feet with poor shock absorption etc.
Causes Of Heel Spurs
Heel spurs (calcaneal spurs) are bony bumps of calcium deposits that form on the heel bone.
They are often the result of high prolonged periods (months and years) of stress being placed on the tendons or fascia that attach to the heel bone.
These forces cause micro-trauma and the body attempts to heal itself by creating more bone, becoming these calcified protrusions known as heel spurs. They usually coexist with plantar fascitis and achilles tendinitis.
Heel spurs often develop from:
- Overuse and over-training
- Inadequate footwear for activity, worn out footwear and high heels
- Poor levels of strength, mobility and flexibility in the lower limbs
- Muscle imbalances and dysfunction
- Rigid feet with poor mobility and flexibility that are inadequate to absorb shock
- Excessive pronation of the ankle and feet
- Leg length difference
- Bowed or knocked knees
- Abnormal walking and running patterns that place extra stress on the heel bone and ligaments
If you’re experiencing heel pain, your doctor will examine your foot and may recommend an X-ray to confirm the diagnosis.
Although plantar fasciitis and heel spurs are the most common causes of heel pain, it’s important to rule out other causes like Achilles tendinitis, stress fractures, a broken heel, or tarsal tunnel syndrome.
With a diagnosis of either plantar fasciitis and/or a heel spur, non-surgical treatments are always recommended first and are usually successful.
These include:
Rest, Ice, and Pain Relievers – When heel pain occurs, decrease or stop any activities that might be making the pain worse, and try icing the bottom of your foot with a frozen water bottle for about 20 minutes 3-4 times per day. Pain-relieving medications like ibuprofen or acetaminophen may also help alleviate your pain temporarily.
Change your Footwear – Make sure all of your footwear fits well, is not worn out, and provides sufficient support for your feet, and try to reduce or eliminate your time in high heels.
Heel Cups – These plastic, gel or silicone pieces are inserted into just about any pair of shoes. Heel cups address foot pain by lifting the heel slightly, which reduces tension on the Achilles tendon, in turn alleviating pressure on the plantar fascia. They also provide shock absorption for the heel, which reduces stress on the plantar fascia even more.
Arch Support Insoles – By providing extra support for your arches, you can reduce the pressure on the plantar fascia. Wearing insoles regularly will help to both relieve heel pain from plantar fasciitis and prevent it from returning.
Night Splints – Designed to treat plantar fasciitis related heel pain throughout the night, these hold the foot and toes back so that the calf muscles, Achilles tendon, and plantar fascia are kept slightly stretched. Available in a boot style cast, sleep supports, and sock style supports, these are a simple and effective way to alleviate morning heel pain.
Physical Therapy – Physical therapy is one of the most commonly used treatments for heel pain. Treatment usually consists of stretching both the calves and plantar fascia thoroughly, as well as manual—or hands-on—techniques.
For those whose pain doesn’t improve after 6-12 months of trying these non-surgical treatments, surgery is an option.
Dr. Ananda Vella is a Singapore and Swiss-double-fellowship-trained MOH-accredited orthopaedic specialist consultant surgeon, As a former consultant from the Singapore General Hospital and Sengkang General Hospital and with more than 20 years of experience, Dr Ananda treats a variety of orthopaedic bone and joint conditions, including in his subspecialty focus of foot and ankle conditions, hip and knee pains, as well as sports injuries. Dr Ananda is also well-versed in minimally invasive surgical techniques, including having performed the first lateral total ankle replacement surgery in South-east Asia to improve outcomes for patients with severe arthritis.
Dr Ananda regularly practices in 3 clinics across Singapore and is accredited to operate in all private hospitals in Singapore. Should you have any queries or need any further assistance, please do not hesitate to schedule an appointment with our Dr Ananda by WhatsApp at 8860 0642 for assistance. Alternatively, please leave us a message via the enquiry form and we will get back to you as soon as possible.
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