The most common cause is plantar fasciitis. There are, however, other conditions that can cause heel pain, including compression of the tibial nerve or its branches around the inner part of the ankle (known as tarsal tunnel syndrome), arthritis, stress fractures and infection of the heel pad (particularly in diabetics). It is clearly important, when treating heel pain, to ensure the correct diagnosis is made in order that the appropriate treatment is begun.
Figure 1 – The Ankle
What is Plantar Fasciitis?
Plantar fasciitis is a common condition that begins with pain in the heel whilst weight-bearing. The plantar fascia acts as a support to the bottom of the foot and runs from the heel bone (the calcaneum) to the toes. Overload of the fascia results in inflammation, which causes pain. Occasionally, an x-ray will demonstrate a heel spur. It is, however, generally accepted that the spurs themselves are not painful and that it is the inflammation in the plantar fascia that causes the symptoms.
How is heel pain investigated?
As well as a thorough history and clinical examination, it may be appropriate to arrange x-rays, nerve studies (if nerve compression is suspected) or an MRI scan to confirm the cause of the heel pain.
What is the treatment of plantar fasciitis?
Treatment of plantar fasciitis is almost always non surgical. A combination of orthotics (insoles), biomechanical assessment, cushioned heel pads, activity modification and physiotherapy stretches to stretch both the Achilles tendon and the plantar fascia, will usually be sufficient to settle symptoms. Occasional use of anti-inflammatory tablets or injections may be needed to help with symptom control. we may also recommend a course of shockwave therapy.
Further information about shockwave therapy can be found at www.shockwavesouth.co.uk