Heel pain generally either occurs under the heel (plantar heel) at the point of origin of the plantar fascia, or at the back of the heel (posterior heel), in the region of the Achilles tendon and where it joins the heel bone.
The most common cause of plantar heel pain is ‘plantar fasciitis’. The condition is very common but fortunately usually responds to relatively non-invasive treatment. You will find many treatments available in shops, magazines and on the internet, but the simple measures of appropriate footwear, insoles and stretches are the most effective. When the condition fails to respond to these measures, further investigation may be required.
Occasionally a steroid (cortisone) injection, night splints or a full assessment by a Podiatrist are required. Increasingly, Shockwave therapy is used in this condition and is offered when appropriate at the clinic. In very rare cases, surgery is necessary.
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Posterior Heel Pain
Pain at the back of the heel is often associated with a prominent hard lump known as ‘Haglund’s deformity’ or more correctly ‘Insertional Achilles tendinopathy’. The lump is uncomfortable and sometimes very painful and inflamed. The condition is caused by a bony prominence on the heel-bone (calcaneum), which can cause problems by ‘impinging’ on the Achilles tendon, leading to marked swelling (‘retro-calcaneal bursitis’) and degeneration of the tendon itself.
Often the symptoms settle with simple measures, such as shoe modification, rest or specialised padded appliances. Sometimes a podiatrist can help with a custom-made insole, and occasionally an injection is indicated for retro-calcaneal bursitis (although not into the tendon itself). Recently, Shockwave therapy is increasingly used in this condition and can have very good results.
If these measures fail, surgery is required, and involves removal of the retro-calcaneal bursa and prominent bone, along with any degenerate tendon tissue. This is called a Haglund’s excision operation, and in some cases can be done endoscopically (keyhole surgery). The success rate of surgery is 85 – 90%.
Pain at the back of the heel in children is almost always due to a condition known as ‘Sever’s disease’, which is less of a disease and more a form of ‘growing pain’. Assessment of this is quite straightforward and the long term prognosis excellent, but rest is always required, often combined with simple orthotics and stretching exercises.
In older children and young adults, a prominence at the back of the heel may be due to a ‘Pump bump’. This is simply due to the shape of the back of the calcaneum in some individuals, which can rub on the heel counter of certain shoes, causing discomfort, inflammation and sometimes blistering and skin breakdown. If shoe modifications fail then surgery is sometimes necessary.