Heel Pain

Heel pain is a common and often debilitating condition. The pain can begin mildly, keeping you away from sport and activity, but without treatment this can worsen, commonly leading to time off work as a result of constant pain leading to a loss of income. There are many different causes of heel pain, with some of the more common diagnoses including:

  • Plantar fasciitis (also referred to as a ‘heel spur’)
  • Achilles tendinopathy
  • Retrocalcaneal Bursitis
  • Sever’s disease (in children)

In order to accurately diagnose your problem your podiatrist will conduct a thorough physical examination, watch you walking and may require you to get x-rays or other types of scans. Prahran Foot Clinic sees new cases of heel pain on a daily basis and can provide effective treatment during your first consultation.

Prahran foot clinic
These X-Rays display heel spurs on the bottom of the heel (centre image) and on the back of the heel (right image)

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Plantar Fasciitis

Plantar fasciitis (also known as heel spurs) is a very common cause of pain under either one or both heels. It affects a wide age group, having been seen in children, the elderly, and all in between. Symptoms commonly present as a feeling of bruising or sometimes sharp pain under the heel or along the arch of the foot. Commonly patients report pain with the first few steps in the morning in mild cases, or even pain with each step as it progresses. Plantar fasciitis can be absolutely debilitating and requires expert treatment to resolve completely.    

Whether you’ve had a recent onset of similar symptoms, or have been suffering for months or even years, imaging to confirm the diagnosis is often utilised, as other symptoms can mimic plantar fasciitis – routinely an X-Ray and diagnostic ultrasound. Once a definitive diagnosis is achieved, a specific treatment plan for your condition is formulated.  

Treatment is aimed at addressing your immediate pain, as well as rectifying the underlying cause and repairing your injured tissue. Radial shockwave therapy, in conjunction with custom foot orthotics, targeted exercises and pain relieving activities are fundamental to resolving plantar fasciitis (1). 

1) Gerdesmeyer et al

Above: Radial Shockwave Therapy is an excellent treatment for plantar fasciitis

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Retrocalcaneal Bursitis

A not infrequently seen condition often mistaken for Achilles pathology, retrocalcaneal bursitis is usually (and thankfully) quicker to resolve than its tendinous neighbour. Once again owing to excessive pronation/poor foot posture, a naturally occurring lubricating structure between the heel bone and the Achilles tendon (known as the retrocalcaneal bursa) becomes inflamed, causing pain just behind the Achilles and deeper towards the back of the ankle joint.

This diagnosis is usually made clinically (i.e. in the office on the day of your appointment), but can be confirmed using diagnostic ultrasound. Treatment by way of therapeutic ultrasound, taping and custom orthotics are very effective in eliminating pain from retrocalcaneal bursitis. Click on the image below to see detailed anatomy of the rearfoot.

Sever’s Disease

Most commonly seen in active boys aged 8-13, Sever’s Disease is a self-limiting condition (meaning it will always resolve in time) affecting one or both heels. During this period of growth, pain can be experienced if excessive forces travel through the growth plate of the heel. Unsurprisingly, children that participate in jumping sports are among the most common patients seen with this condition.

While the condition will resolve when the growth plate fuses with the heel bone (see image below), active treatment is still essential to ensure normal pain free participation in sports and activity. Stretches, taping, heel raises and custom orthotics are all conservative treatments that yield excellent results.

Sever's_Disease_X-ray
An X-Ray of a child’s foot shows the unfused growth plate of the heel bone (calcaneus).

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