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Heel Pain Clinic

Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst.

Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is able to distinguish between all the possibilities and determine the underlying source of your heel pain.

Plantar Fasciitis and Heel Spur

What Is Plantar Fasciitis?
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.

Causes
The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.

Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.

Symptoms
The symptoms of plantar fasciitis are:

  • Pain on the bottom of the heel
  • Pain in the arch of the foot
  • Pain that is usually worse upon arising
  • Pain that increases over a period of months

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.

Diagnosis
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis.

In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Non-Surgical Treatment
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:

  • Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
  • Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
  • Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.
  • Limit activities. Cut down on extended physical activities to give your heel a rest.
  • Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
  • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches:

  • Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
  • Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
  • Injection therapy. In some cases, injections are used to help reduce the inflammation and relieve pain.
  • Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
  • Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
  • Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.

When Is Surgery Needed?
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.

Long-term Care
No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

CURE YOUR HEEL PAIN TODAY. GET A FOOT SPECIALIST TO RULE OUT THE CAUSES AND CURE OF YOUR HEEL PAIN. CALL US +65 64712744 OR SMS TO +65 92357641 FOR APPOINTMENT

Sever’s Disease (Heel Pain in Children)

What Is Calcaneal Apophysitis?
Calcaneal apophysitis is a painful inflammation of the heel’s growth plate. It typically affects children between the ages of 8 and 14 years old, because the heel bone (calcaneus) is not fully developed until at least age 14. Until then, new bone is forming at the growth plate (physis), a weak area located at the back of the heel. When there is too much repetitive stress on the growth plate, inflammation can develop.

Calcaneal278Calcaneal apophysitis is also called Sever’s disease, although it is not a true “disease.” It is the most common cause of heel pain in children, and can occur in one or both feet.

Heel pain in children differs from the most common type of heel pain experienced by adults. While heel pain in adults usually subsides after a period of walking, pediatric heel pain generally doesn’t improve in this manner. In fact, walking typically makes the pain worse.

Causes
Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. The heel’s growth plate is sensitive to repeated running and pounding on hard surfaces, resulting in muscle strain and inflamed tissue. For this reason, children and adolescents involved in soccer, track, or basketball are especially vulnerable.

Other potential causes of calcaneal apophysitis include obesity, a tight Achilles tendon, and biomechanical problems such as flatfoot or a high-arched foot.

Symptoms
Symptoms of calcaneal apophysitis may include:

  • Pain in the back or bottom of the heel
  • Limping
  • Walking on toes
  • Difficulty running, jumping, or participating in usual activities or sports
  • Pain when the sides of the heel are squeezed

Diagnosis
To diagnose the cause of the child’s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child’s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.

Treatment
The surgeon may select one or more of the following options to treat calcaneal apophysitis:

  • Reduce activity. The child needs to reduce or stop any activity that causes pain.
  • Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue.
  • Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile.

Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

Can Calcaneal Apophysitis Be Prevented?
The chances of a child developing heel pain can be reduced by:

  • Avoiding obesity
  • Choosing well-constructed, supportive shoes that are appropriate for the child’s activity
  • Avoiding or limiting wearing of cleated athletic shoes
  • Avoiding activity beyond a child’s ability.

GET PROFESSIONAL OPINION AND TREATMENT ABOUT YOUR CHILD HEEL PAIN. CALL US +65 6471 2744 OR SMS TO +65 92357641 FOR APPOINTMENT

Plantar Fasciitis (Heel Pain / Sole Pain)

Plantar Fasciitis is a painful condition resulting in pain under the heel. It is often caused by overuse of the plantar fascia or arch tendon of the foot. We explain symptoms, treatment, exercises, sports massage and more.

The Plantar Fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot.  It is also known as a heel spur although they are not strictly the same. A heel spur is a bony growth that occurs at the attachment of the plantar fascia to the heel bone (calcaneus). A heel spur can be present (through repetitive pulling of the plantar fascia) on a foot with no symptoms at all and a painful heel does not always have a heel spur present.

The condition is traditionally thought to be inflammation. This is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain is now thought to be degeneration of the collagen fibres close to the attachment to the calcaneus (heel bone).

Plantar fasciitis symptoms

Symptoms of the plantar fasciitis include pain under the heel and usually on the inside, at the origin of the attachment of the fascia.  There can be pain when pressing on the inside of the heel and sometimes along the arch.  The pain is usually worse first thing in the morning as the fascia tightens up overnight and after a few minutes it eases as the foot gets warmed up.

As the condition becomes more severe the pain can get worse throughout the day if activity continues.  Stretching the plantar fascia may be painful and sometimes there may also be pain along the outside border of the heel. This may occur due to offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet.

Tarsal tunnel syndrome symptoms can be very similar. If you have any shooting pain or tingling / numbness then consider this as an alternative diagnosis.

Causes

Plantar fasciitis or heel spurs are common in sports which involve running, dancing or jumping. Runners who overpronate (feet rolling in or flattening) are particularly at risk as the biomechanics of the foot pronating causes additional stretching of the fascia.

The most common cause is very tight calf muscles which leads to prolonged and / or high velocity pronation of the foot. This in turn produces repetitive over-stretching of the plantar fascia leading to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength

Some practitioners think overpronation can always be determined by the dropping and rolling in of the arch. This is not always the case. Sometimes it can only be seen with foot scans, especially if the patient has a high arched foot.

Other causes include low arch or high arched feet (pes planus / cavus) and other biomechanical abnormalities including oversupination which should be assessed by a podiatrist / physiotherapist / biomechanist.

Excessive walking in footwear which does not provide adequate arch support has been attributed. Footwear for plantar fasciitis – both prevention and treatment – should be flat, lace-up and with good arch support and cushioning.

Overweight individuals are more at risk of developing the condition due to the excess weight impacting on the foot.

Plantar fasciitis treatment

Although there is no single cure, many treatments can be used to ease pain.  In order to treat it effectively for the long-term, the cause of the condition must be corrected.

What can the athlete do?

  • Rest until it is not painful. It can be very difficult to rest the foot as most people will be on their feet during the day for work. By walking on the painful foot you are continually aggravating the injury and increasing inflammation.
  • A good plantar fasciitis taping technique can help support the foot relieving pain and helping it rest
  • Apply ice or cold therapy to help reduce pain and inflammation. Cold therapy can be applied regularly until symptoms have resolved.
  • Plantar fasciitis exercises in particular stretching the fascia is an important part of treatment and prevention. Simply reducing pain and inflammation alone is unlikely to result in long term recovery. The fascia tightens up making the origin at the heel more susceptible to stress
  • A night splint is an excellent product which is worn overnight and gently stretches the calf muscles preventing it from tightening up overnight.

What can a Sports Injury Professional do?

  • Prescribe anti-inflammatory medication.
  • Perform gait analysis to determine if you overpronate or oversupinate and prescribe orthotics or insoles. An insole can restore normal foot biomechanics if overpronation is a problem.
  • Tape the foot and instruct the athlete how to apply taping, this is an excellent way of allowing the foot to rest.
  • Apply sports massage techniques to reduce the tension and also stretch the calf muscles.
  • Prescribe exercises to help stretch the fascia and strengthen it once pain free.
  • Use a corticosteroid injection – usually best combined with biomechanical correction with orthotics.
  • X ray to see if there is any bone growth (calcification). An X-ray may be able to show bone growth which may be a cause of pain but research has shown that the presence of a bony growth does not necessarily mean the athlete will feel pain. Bony growth can worsen even after symptoms have completely resolved.
  • Use Extracorporeal Shock Wave Therapy.
  • Operate if symptoms do not resolve. This is more common for patients with a rigid high arch where the plantar fascia has shortened to benefit from surgery.

STOP YOUR HEEL PAIN TODAY. CALL +65 6471 2744 or SMS to +65 9235 7641 for Appointment now.

Plantar Fasciitis (Heel Pain)

Plantar Fasciitis is a painful condition resulting in pain under the heel. It is often caused by overuse of the plantar fascia or arch tendon of the foot. It is a very common condition and can be difficult to treat if not looked after properly.

Plantar Fasciitis and Heel Spurs

Plantar Fasciitis and Heel Spurs

What are the Signs and Symptoms?

  • Heel pain, under the heel and usually on the inside, at the origin of the attachment of the fascia.
  • Pain when pressing on the inside of the heel and sometimes along the arch.
  • Pain is usually worse first thing in the morning as the fascia tightens up overnight. After a few minutes it eases as the foot gets warmed up
  • As the condition becomes more severe the pain can get worse throughout the day if activity continues.
  • Stretching the plantar fascia may be painful.
  • Sometimes there may also be pain along the outside border of the heel. This may occur due to the offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet.

What is Plantar Fasciitis?

The Plantar Fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot.

Plantar fasciitis can also be known as a heel spur although they are not strictly the same. A heel spur is a bony growth that occurs at the attachment of the plantar fascia to the heel bone (calcaneus). A heel spur can be present (through repetitive pulling of the plantar fascia) on a foot with no symptoms at all and a painful heel does not always have a heel spur present.

Plantar fasciitis is traditionally thought to be an inflammatory condition. This is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain and dysfunction is now thought to be degeneration of the collagen fibres close to the attachment to the calcaneus (heel bone).

What Causes Plantar Fasciitis?

  • Plantar fasciitis or heel spurs are common in sports which involve running, dancing or jumping. Runners who overpronate (feet rolling in or flattening) are particularly at risk as the biomechanics of the foot pronating causes additional stretching of the plantar fascia.
  • The most common cause of plantar fasciitis is very tight calf muscles which leads to prolonged and / or high velocity pronation of the foot. This in turn produces repetitive over-stretching of the plantar fascia leading to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength.
  • Some practitioners think overpronation can always be determined by the dropping and rolling in of the arch. This is not always the case. Sometimes it can only be seen with foot scans, especially if the patient has a high arched foot.
  • Other causes include low arch or high arched feet (pes planus / cavus) and other biomechanical abnormalities including oversupination which should be assessed by a podiatrist / physiotherapist / biomechanist.
  • Excessive walking in footwear which does not provide adequate arch support has been attributed to plantar fasciitis. Footwear for plantar fasciitis – both prevention and treatment – should be flat, lace-up and with good arch support and cushioning.
  • Overweight individuals are more at risk of developing the condition due to the excess weight impacting on the foot.

Plantar Fasciitis Treatment

There is no single cure for plantar fasciitis. Whilst many treatments can be used to ease pain, in order to treat it effectively long-term, the cause of the condition must be corrected.

What can the athlete do?

  • Rest until it is not painful. It can be very difficult to rest the foot as most people will be on their feet during the day for work. By walking on the painful foot you are continually aggravating the injury and increasing inflammation.
  • A good plantar fasciitis taping technique can help support the foot relieving pain and helping it rest.
  • Apply ice or cold therapy to help reduce pain and inflammation. Cold therapy can be applied regularly until symptoms have resolved.
  • Plantar fasciitis exercises such as stretching the plantar fascia is an important part of treatment and prevention. Simply reducing pain and inflammation alone is unlikely to result in long term recovery. The plantar fascia tightens up making the origin at the heel more susceptible to stress.
  • A plantar fasciitis night splint is an excellent product which is worn overnight and gently stretches the calf muscles and plantar fascia preventing it from tightening up overnight.

CURE YOUR HEEL PAIN TODAY. Call +65 6471 2744 (24 Hours) FOR APPOINTMENT OR EMAIL TO: info@boneclinic.com.sg