Risk Factors for Heel Pain

Heel pain originates deeply inside the foot, directly on the heel bone or within the heel's connective tissues, called the plantar fascia. Different layers of fatty tissue surround the heel bone, designed to cushion the impact of walking and running and protecting the bones and muscles of the foot. Below this padding a fibrous band of connective tissue extends from the heel bone into the ball of the foot and it supports the arch and reaches across to the toes. Pain and inflammation normally results when these tissues become irritated or inflamed, or when small spurs grow on the heel bone, as well as micro-teraing of the fascia tissue. Heel Spurs are a projection or growth of bone may be called a spur, and can grow where the muscles of the foot attach to bone. While most heel spurs are painless others that are determined to be the cause of chronic heel pain may require surgical removal. Other causes include overuse or mechanical causes (over-pronation, fallen arches) can cause discomfort in the heel. A painful heel may also accompany a more serious condition such as gout, osteo-arthritis, nerve injuries, or heel bone abnormalities, collagen disorders or tumours etc. Heel Pain (also known as Plantar Fasciitis) is one of the most common soft-tissue foot disorders in the UK, yet not a lot is known about its medical aetiology. To determine which risk factors are involved for heel pain we examined factors including limited ankle dorsi-flexion, being overweight as well as weight-bearing time during walking. Individuals with more than 0 degrees of dorsiflexion showed an odds ratio of of 25 compared to the reference group who displayed more than 10 degrees of ankle dorsi-flexion. People with a body mass index of more than 30 kg/m 2 had an odds ratio of 6 compared with the reference group of less than 25 kg/m 2. People who spent the majority of their workday on their feet had an odds ratio of 4 when compared to those who did not. Therefore the risk of foot pain increases as the range of ankle dorsi-flexion decreases. Individuals who spend the majority of their workday on their feet and over-weight people are also at a much higher risk level to suffer from this condition.

Non-operative Treatment options for heel pain

Heel cord and plantar fascia stretching: in patients with mild heel cord contracture heel cord stretching has shown great benefits in several retrospective studies. Heel cord stretching will unload stress over the midfoot and will alleviate plantar fascial strain in the majority of patients. Dorsiflexing and stretching of the fascia itself can be initially very painful, but the patient should persist to experience the full benefits of this treatment. Casting forces the ankle to remain in a neutral position and places the heel cord in a stretched position. Night splints can often be effective, as are oral steroids or steroid injections. Doctors will employ an injection of 1 to 2 ml of corticosteroid from the medial side of heel; in some patients repeated steroid injections are required, even though this doesn't address any of the biomechanical causes of heel pain and spurs. Foot orthotics in conjunction with a stretching program, a prefabricated shoe insert is likely to produce more improvement in symptoms than a customized polypropylene devices.

Symptoms

The Sambafoot Clinic offers all standard conservative treatment options for heel pain such as anti-inflammatory drugs, cortisone-steroid injections, foot massage, physiotherapy, fascia stretching, night splints, taping and padding as well as rest, immobilisation, acupuncture, application of ice or heat etc. We also provide biomechanical treatment options such as orthotics, and arch supports to release plantar fascial tension. Adults over 40 will develop this problem most frequently, especially athletes. Also children can be affected which is part of the growing process (Sever's Disease).

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