Heel pain

People experiencing plantar fasciitis will typically feel heel pain after standing or walking for long periods, with the discomfort usually lessening after taking several steps. Pain is often experienced in the front and bottom of the heel, and can feel like a throb, burn or ache.

Pain will often be at its worst the longer you are on your feet, and can be exacerbated by certain movements such as climbing stairs or standing on your toes. It is also often at its most severe with the first steps of the day or following a period of sitting. Discomfort for people experiencing plantar fasciitis is often triggered by bending the foot and toes towards the shin and can be aggravated by a tight Achilles tendon.

The disorder is often characterised by pain felt at the beginning of exercise that improves as exercise continues but returns after it is completed.

Plantar fasciitis is caused when the ligaments supporting the arch of the foot are repeatedly strained. Typically the planter fascia will stretch excessively and develop small tears where it attaches to the heel that causes the foot pain when standing or walking.

The most common causes of the condition are:

• Factors affecting how the feet work such as abnormal inward twisting or rolling of the foot, high arches, flat feet, tight calf muscles or tight tendons at the back of the heel.
• Repetitive activities that require long walks or excessive periods of standing on hard or different surfaces, or running.
• Being overweight.
• Shoes that don’t fit properly, are worn out or lack the required support needed.
• The ageing process.

To establish whether a person’s pain is caused by Plantar Fasciitis, a podiatrist would ask you questions about your symptoms and past health, perform a Biomechanical Assessment to study your range of movement, and may also recommend a foot X-ray and/or an ultrasound scan.

Around 90 per cent of plantar fasciitis cases resolve themselves in six months to a year when treated correctly. Below is a selection of the methods Dan Everson Podiatry would typically recommend, alone or in combination, for patients experiencing plantar fasciitis:

• Rest your feet. Limit or stop activities aggravating your heel pain. Refraining from running or walking on hard surfaces is essential.
• Apply ice to the affected area to reduce inflammation.
• Use pain-relief medication.
• Stretch in the morning or during the day – toe stretches, calf stretches and towel stretches are particularly helpful.
• Invest in shoes that have great support for the arches of the feet, and cushioning for the heel.
• Orthotics may be prescribed to help treat this condition and prevent a recurrence. Dan Everson recommends its range of Kinetic Orthotics, which is designed using patent-protected technology that optimises the way force is transferred as you move.
• Put on your shoes as soon as you get out of bed, and avoid walking barefoot or in slippers.
• Night splints to stretch your foot and lower leg at night.

Dan Everson Podiatry would recommend the following activities to help prevent plantar fasciitis.

• Regularly relax your lower legs during periods when you are walking, running, sitting or standing, particularly your calves and ankles. Tension held anywhere in the legs and glutes can help trigger this condition.
• Avoid pulling yourself forward with your legs when moving. Let your upper body lead and legs follow.
• Always land evenly on the middle of your foot when walking or running instead of striking heavily with the heel.
• Never walk barefoot on hard surfaces such as concrete or tiles.
• Walk and run on flat surfaces as much as possible.
• Stretch your feet and calves regularly.
• Enjoy regular foot massages.

A person with Achilles tendinopathy may experience a burning pain in the affected area at the beginning of exercise that improves as exercise continues then returns afterwards. This is most common with runners.

A tender, red and inflamed lump may be present on the tendon and it may feel especially stiff and weak in the morning and during the night. Severe pain that comes on suddenly and causes difficulty walking may indicate a severe case of Achilles tendinopathy, potentially involving a complete rupture of the Achilles tendon.

This condition is a result of the overuse of muscles that can lead to inflammation and microtears of the Achilles tendon. Over time, scar tissue can develop on the tendon that contributes to pain and stiffness.

The most common causes of this condition are:

• Engaging in sports that require strenuous stop and start motions.
• Running on uneven surfaces.
• A sudden or dramatic increase in the intensity of physical exercise or activity.
• Little or no warm up before exercise.
• Abnormal foot mechanics.
• Wearing shoes with poor heel or arch support.

To determine if a patient’s pain is caused by Achilles tendinopathy, a podiatrist would typically ask questions about your symptoms and health history. The patient may be asked to stand and hop on one foot or to raise their heel off the ground to fully assess the capability and range of motion of the lower limbs. These observations will provide clues about possible damage to the tendon. In some cases it may be necessary to conduct an MRI or ultrasound to understand the severity of the injury.

If treated correctly, Achilles tendinopathy should not have any long-term effects. Below is a selection of the methods Dan Everson Podiatry would typically recommend, alone or in combination, for patients suffering from this condition:

• Rest your feet, although too much rest can slow recovery time.
• Strap the affected area after seeking professional advice.
• Apply ice to the affected area to reduce inflammation.
• Use pain-relief medication.
• Avoid high impact activities.
• Slowly return to physical activity or exercise routines as pain permits.
• Perform Achilles tendon exercises after consulting with your podiatrist.
• Invest in shoes that have great support for the arches of the feet, and cushioning for the heel.
• Orthotics may be prescribed to help treat this condition and prevent a recurrence. Dan Everson recommends its range of Kinetic Orthotics, which is designed using patent-protected technology that optimises the way force is transferred as you move.
• Night splints to stretch your feet at night.

Dan Everson Podiatry would recommend the following activities to help prevent Achilles Tendinopathy:

• When increasing your exercise and activity levels, do so gradually.
• Walk and run on flat surfaces as much as possible.
• Warm up – exercise at a slower pace and perform dynamic and static stretching before exercise.
• Seek advice from a podiatrist on the most appropriate footwear or footwear modifications for your needs.
• Strengthen your calf muscles with bodyweight and resistance training.
• Stretch your feet and calves regularly.
• Enjoy regular foot massages.