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Heel pain

What is heel pain?

Heel pain is a condition where the heel of the foot becomes gradually more painful over time and is usually worst whenever the affected heel is in use. Although it can occur in both feet, more typically it will only affect one foot at a time and will usually be most painful after periods where the heel has not been in use or after the heel has been walked on for a substantial amount of time.

As expert chiropodist Margaret Dabbs explains, there are a number of different types of heel pain which can occur, including:

  • Talalgia - Generalised pain in the heel because of overloading or fatigue.

  • Plantar Fasciitis - The syndrome of inflammation of the band of tissue that runs from the heel along the arch of the foot.

  • Accessory ossicles - Extra bone structures on the foot that may be associated with painful syndromes due to various pathologies, including trauma, infection, inflammtion and degeneration.

  • Calcaneal/Heel spur - A calcium deposit formed when the plantar fascia gets partially detached from the heel.

  • Achilles tendonitis - Inflammation or wear and tear of the Achilles tendon.

  • Sever's disease/Calcaneal apophysitis - A benign condition in children aged 7-15 that consists of damage caused by repeated microtraumas.

  • Haglund's Syndrome - A benign bony growth at the back of the heel bone usually caused after having Achilles tendonitis or bursitis.

  • Achilles Bursitis - The inflammation of the bursa at the back of the heel bone that causes pain at the back of the heel especially when running or walking uphill or on soft surfaces.

"From these," Margaret explains, "the most common for causing specific heel pain when walking round is the calcium heel spur or plantar fasciitis, which create generalised pain with a spontaneous onset. Generally speaking, Achilles pain is most typically brought on by injury or overuse while something like Haglund's syndrome will usually cause pain at the back of the heel where a lump or overhang can cause shoes to rub."

The Plantar Fascia

The tough band of tissue running underneath the sole of your foot is known as the plantar fascia. It is used to absorb vibrations and shock when you walk and also acts to connect the heel bone to the bones in the rest of the foot.

When your plantar fascia becomes thickened as a result either of sudden damage or of small tears developing in the tissue over time, heel pain can occur.

While sudden damage can be caused by an injury to the heel during a period of physical activity like running or working out, damage that develops over time is more down to general wear and tear. However, it is thought to be more common in people over the age of 40, as well as people who are overweight or who spend a lot of time standing or walking.

How can heel pain be treated?

Using a mixture of techniques that relieve pain while aiming to improve the affected area, the condition usually clears within 12 months. In a small number of cases, improvement over this period of time may be only slight and surgery will be required to properly treat the problem.

  • Rest. If you are suffering from heel pain you should avoid walking long distances or standing for long periods of time. Putting a cold compress such as an ice pack over the affected area can also help to reduce swelling and numb the pain.

  • Pain relief. Painkillers such as paracetamol and ibuprofen can also help to ease the discomfort of heel pain if you find a cold compress is not enough.

  • Stretching. In order to relieve sensitivity and improve flexibility in the affected foot, certain exercises involving both the calf muscle and the plantar fascia may be suggested to you. Try stretching both feet even if only one is affected by heel pain as this will help to aid balance as well as preventing further foot problems from occuring in the future. One good exercise to try is standing on the stairs with your heels hanging off the back of the step, then slowly lowering your heels until your calves go tight and holding for about 40 seconds. Use the wall or banister to support yourself, and try repeating the exercise five or six times a couple of times a day.

  • Footwear. If you tend to wear flat, unsupportive footwear then a change to a more suitable kind may help when trying to relieve heel pain. Running shoes, or trainers which cushion the heel and support the arches of the feet, are usually best. If these don’t work, supportive devices such as orthoses which fit inside your shoes may help.

How can we prevent heel pain?

Although the risk of developing heel pain can never be completely avoided, there are things you can do to help yourself and lessen your chances of suffering from it.

Being a healthy weight can help reduce your risk of developing heel pain as well as a number of other foot conditions. As being overweight puts an extra strain on your feet and heels, the risk of damaging them is far higher, so keeping fit and staying a healthy weight can really help to reduce this risk.

Wearing sensible footwear can also help you to avoid heel pain. Shoes with a slight heel and support for the arches of the feet are best, and cushioning is also important. Avoiding walking barefoot for long periods of time (such as when on holiday) can also help, as this may cause sudden damage to feet not used to the extra pressure of having no support when in use.

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