Understanding Heel Pain: Insights from Dr. Derek Park, Senior Consultant Orthopaedic Surgeon
Why do I have a pain in my heel?
Heel pain is one of the most common musculoskeletal complaints affecting people. It can be due to a variety of causes including plantar fasciitis, Achilles’ tendon problems, calcaneal (heel bone) fractures, sural neuritis, and entrapment of the nerve that runs on the inside of the heel.
Plantar Fasciitis: The most common cause of heel pain
What causes plantar fasciitis?
Plantar fasciitis is the most common cause of heel pain. It is a chronic
overuse injury that leads to small (microscopic) tears in the plantar
fascia origin where it attaches to the heel bone. The surrounding small
muscles of the foot can also be inflamed and cause pain.
Plantar fasciitis is often associated with tightness in the calf
muscle, and can also occur with Achilles’ tendon problems. Bony heel
spurs are often found incidentally, You could be more prone to developing plantar
fasciitis if you:
- Are between the age of 40 to 60 years old
- Have excess body weight placing additional stress on your feet
- Do a job that requires long hours of standing on your feet
- Do a lot of weight bearing endurance activities like running or dancing
- Have tightness in the foot and calf muscles
- Have flat feet (pes planus) or high arches (pes cavus)
What are the symptoms to look out for in plantar fasciitis?
Heel pain from plantar fasciitis is typically sharp and well localised to a particular area near the inner heel bone. It is often felt when first getting out of bed, and worse at the end of the day after prolonged standing or sitting. The pain tends to be relieved after walking a certain distance, and people often experience it in both feet, although one foot tends to be more painful than the other.
What does your doctor look for when examining you?
Plantar fasciitis typically causes tenderness to the inner area of the heel bone (the medial calcaneal tuberosity), which is increased with toe and foot extension. The ankle may have limited range of motion, particularly upwards (dorsiflexion), due to a tight Achilles’ tendon or calf muscle. Your doctor may also check for anything pressing on the nerve in ankle (in the tibial tunnel) or further down in the inner heel area that can also mimic heel pain.
Are any further tests required?
Although plantar fasciitis is mostly a clinical diagnosis, these tests may help to provide more insights on one’s condition.
- X-Ray: Radiographs (x-rays) of the foot are helpful to rule out other possible causes of pain like calcaneal stress fractures. It may also show a plantar heel spur, a feature commonly associated with plantar fasciitis. The x-rays also can also show other structural issues like flat feet or high arches.
- Ultrasound: An ultrasound scan can define thickening of the plantar fascia due to inflammation, and rule out other causes of heel pain e.g. cysts pressing on the nerve in the ankle.
- Magnetic Resonance Imaging: An MRI scan may be useful as well, particularly for surgical planning.
What are the treatment options for plantar fasciitis?
The first line of treatment is initial rest to relieve pain, and
pain-relieving anti-inflammatory medication. Stretching programs
including plantar fascia-specific stretching and Achilles tendon stretching are the
mainstay of treatment. The majority of people who do regular stretching should
experience relief of their symptoms after 6 to 8 weeks. It should
be emphasised however, that it can take time for the stretching exercises to show
benefit in relieving pain.
Foot orthosis such as cushioned heel inserts, pre-fabricated shoe
inserts, and night splints can also help in the initial period.
If symptoms do not improve then other treatment options include corticosteroid
injections to the plantar fascia, and shock wave treatment. Surgical
options are usually reserved for chronic heel pain lasting longer than 6 months and
include procedures like gastrocnemius (calf muscle) recession and surgical
debridement and/or release of the plantar fascia. These procedures can be done with
an open incision or endoscopically (keyhole surgery).
Recovery after surgery is relatively quick and most people can return to
work between 2 to 6 weeks following surgery. Your doctor may advise you
not to drive or resume sporting activities until after 6 weeks.
About Dr. Derek Park
Dr. Derek Park
Senior Consultant Orthopaedic SurgeonMRCS, Royal College of Surgeons of England, UK 2005
FRCS (Tr & Orth) Royal College of Surgeons of England, UK 2010
Dr. Derek Park is a Senior
Consultant Orthopaedic Surgeon at Park Orthopaedics in Singapore,
specialising in foot and ankle surgery. He brings a wealth of experience
from his previous roles as a Senior Consultant at Khoo Teck Puat Hospital
and a visiting consultant at Tan Tock Seng Hospital.
Dr. Park’s expertise encompasses various orthopaedic conditions, with a
particular focus on performing reconstructive and minimally invasive
procedures to address complex deformities in diabetic patients.
Get in Touch With Dr. Derek Park, Park Orthopaedics
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