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HEEL PAIN

Welcome to the Mobility Plus Chiropractic patient resource for heel pain & plantar fasciitis causes, diagnosis, management and relief

 

Often termed heel spur syndrome when a boney projection along the line of the plantar aponeurosis is present. This condition may be related to other causes, including stress fractures, tendonitis, arthritis, nerve irritations or cysts. As a result of the high number of potential causes of this debilitating pain, having a proper diagnosis is key. An expert in assessing and treating this condition will be capable of distinguishing between the various possible sources of you heel pain.

Common Causes

The most common causes of heel pain in adults are plantar fasciitis or fasciosis (near bottom of the heel bone) and Achilles tendonitis (back of the heel). However, many potential causes exist including:

  • Plantar Fasciitis (#1)
  • Achilles Tendonitis (#2)
  • Bone Spur
  • Heel Spur (chronic plantar fasciosis)
  • Bursitis (joint inflammation)
  • Osteomyelitis (bone infection)
  • Haglund’s deformity
  • Paget’s disease of bone
  • Peripheral neuropathy
  • Calcaneal Apophysitis (Sever’s Disease)
  • Reactive arthritis
  • Retrocalcaneal bursitis
  • Rheumatoid arthritis (inflammatory joint disease)
  • Sarcoidosis (inflammatory cells collected in areas of the body)
  • Stress fractures
  • Tarsal tunnel syndrome
  • Fat pad syndrome (centre of heel)
  • Gout

Plantar Fasciitis

 

Plantar fasciitis is an inflammation in a thick band of tissue (the plantar aponeurosis) that traverses across the bottom of the foot from the heel to the toes. The fascia is first irritated, then inflames (resulting in heel pain). If the condition is not properly treated and addressed, and inflammation in the area becomes chronic, your body may begin to deposit calcium near the plantar fascial attachment to the heel bone (calcaneous). When these calcium deposits remain present for an extended period of time, this tissue may signal osteoblasts (bone forming cells) to become recruited to the area. Your body is attempting to establish a more permanent solution to the problem, so bone becomes laid down where the calcium deposits settled. This is referred to as a bone spur and is the reason plantar fasciitis is also often interchangeably termed heel spur syndrome.

Causes

Faulty structure of the foot and ankle is often the cause of the development of plantar fasciitis. It has been shown the overly flat feet or overly high-arched feet, are more prone to the development of plantar fasciitis. Unsupportive footwear, on hard surfaces places excessive strain and elevated workload on the plantar fascial tissues and can also lead to plantar fasciitis. This is a quite common condition in those that are on their feet for prolonged periods of time. Obesity adds an increased demand on the delicate tissues under our feet and therefore increases the likelihood of this condition developing.

Common Signs/Symptoms

  • Pain on the bottom of the heel, especially along the inner edge closest to the toes
  • Pain along the arch of the foot
  • Pain that is often worse with the first steps in the morning, gradually lessening
  • Pain that increases over months
  • Swelling on the bottom of the heel
  • Pain that is exacerbated by prolonged walking and running

Our patients often describe the pain of plantar fasciitis as worse first thing in the morning or after they’ve been sitting for prolonged periods of time. With movement, the pain begins to decrease, as the act of walking stretches the plantar aponeurosis. Less often, our patients have indicated that the pain subsides initially, but then returns after spending long periods of time on their feet.

Diagnosis

A proper diagnosis first requires a thorough medical history and biomechanical examination of your foot. We would assess and interpret imbalances in a patient’s gait and movement habits, as well as a an orthopaedic and biomechanical assessment of the foot. Palpation of the tissues often reveal tenderness at the medial attachement of the plantar fascia to the anterior calcaneous. Throughout this process, we rule out all other possible causes for your heel pain.

Diagnostic imaging studies including x-rays may be requested to distinguish the different types of heel pain. Heel spurs will be identified with this imaging modality, yet often heel spurs themselves are not painful or the source of a patients pain. However, if present, the patients condition will be described as plantar fasciosis (absent inflammation) or heel spur syndrome.

Best Strategies for Management

  • Stretch: Exercises that stretch out the calf muscles, plantar fascia and posterior kinetic chain help ease pain and assist with recovery. We’ve put together an expert at-home physical therapy program together for relief from plantar fasciitis.
  • Avoid being barefoot: When you walk without shoes, you put undue stress on the plantar fascia.
  • Cooling your heels for 10 minutes intervals can help limit the buildup of inflammation.
  • Limit current activities. Reduce any physical activities in your life that could stress the plantar fascia.
  • Wearing supportive shoes that have stable arch support and a slightly raised heel can reduce help
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be advised to reduce pain related to inflammation.
  • Taping and pading. Place soft pads or insoles in your shoe to lessen the impact of walking and running. Athletic taping could support your arch and foot enough to reduce stress on the fascia and help alleviate pain.
  • Corticosteroid injections. In certain cases, corticosteroid injections will be administered to help reduce inflammation and reduce pain.
  • Night splint. To help with the morning pain experienced by some patients. Night splints allow you to maintain an extended length in the plantar fascia while sleeping, however are often reported to be uncomfortable and interruptive of quality sleep.
  • Manual Therapy. Massage and advanced manual therapy techniques performed by a skilled Chiropractor, Physiotherapist or Massage Therapist can often be very helpful at alleviating pain and improving recovery.
  • Custom orthotics. Custom orthotics are devices that fit into your shoe, that properly reposition your foot and ankle, to help correct the underlying structural abnormalities causing the plantar fasciitis. This is the gold standard treatment modality. Learn more about our custom orthotics here.

Achilles Tendonitis

The large tendon that runs along the back of your lower leg, attaching to the heel bone (calcaneous), is called the Achilles tendon; the largest tendon in the human body. It connects your calf muscles (gastrocnemeus and solues muscles) to your calaneous and is active whenever you walk, run, jump, and stand up on your toes. And simply defined, a tendinitis is the inflammation of a tendon. Inflammation is a natural response our body’s have to injury and disease, and often results in swelling, pain, and/or irritation.

 

The Achilles tendon is strong. It can withstand great stress from everyday and sporting activities. However, it’s prone to tendinitis (inflammation of the tendon), a condition most typical associated with overuse and degeneration. There are two primary forms of Achilles tendinitis, dependent upon which part of the tendon is involved.

 

If you’ve experienced a sudden “pop” in the back of your calf or heel, it is possible that you have torn (ruptured) your Achilles tendon. Please see a specialist immediately if this is the case and you suspect that your Achilles tendon has ruptured.

Noninsertional Achilles tendinitis

In noninsertional Achilles tendinitis, tendinous fibers along the middle portion of the tendon break down and degenerate from microscopic tears. This results in swelling and thickening. This form most commonly affects younger and active people.

Insertional Achilles tendinitis

In Insertional Achilles tendinitis, the lower portion of the tendon is involved. More specifically, the attachment (insertion) to the heel bone.

In both cases, the damaged Achilles tendon fibers may also harden (when calcium deposits within the irritated portion of the tendon). Further progression results in boney deposits or bone spurs being produced.

Causes

Achilles tendinitis results from repetitive stress to the tendon and is more often not related to a specific injury. This occurs when we place undue stress on our bodies. For example:

  • Sudden increased intensity level of specific physical activity. For example, increased running distance or intensity.
  • Tight calf muscles are a risk factor. Tight calf muscles and accelerated stress levels on the Achilles tendon causing it to become unable to withstand the demand and it is unable to adapt quickly enough.
  • Bone spurs at the Achilles tendon insertion can rub against and irritate the tendon and cause pain.
  • People with excessive pronation in the foot (flattened arch profile) are more likey to develop Achilles tendonitis and tendonosis as a result of the increased demand placed on the tendon while walking. Shoes with adequate stability and/or custom orthotic devices can limit further aggravate the Achilles tendon.

Common symptoms

  • Pain and stiffness along the Achilles tendon, most pronounced in the early morning
  • Pain along the length of the tendon, back of the heel, or specific location along the tendon, that worsens with activity.
  • Increased pain the day following exercise
  • Thickening of the tendon