Podiatry: Persistent heel pain in adults

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Persistent heel pain in adults.

Persistent heel pain in adults is a common problem. Except in very unusual circumstances it is not a serious medical condition, but the nuisance value is high. It can take the pleasure out of training, walking or running, and is often at its worst first thing on a morning, necessitating carefully placed steps until the heel has "loosened off".

The causes can be varied, but as a general rule, given the correct advice and treatment, most persistent heel pain can be cured.

The two most common sites of heel pain are directly under the heel (often accompanied by mild swelling), and slightly forward of the heel, sometimes radiating into the arch. Because the pain is normally present all the time, most patients tend not to seek professional help until the condition has been present for some considerable time, often years.

Heel pain directly under the heel may be the result of thinning of the natural fatty padding of the heel due to ageing, or an episode of high, or repeated trauma to the heel, damaging the soft tissues. Pain just in front of the heel, sometimes radiating into the arch is almost certainly a condition called Plantar Fasciitis. This is strain of a large supporting structure, the Plantar Fascia, which lies on the sole of the foot, running from heel to toes.

A quick mention about Heel Spurs. Heel Spurs are a common finding on X-ray. They may even be a normal finding, which is to say that if we bothered to X-ray patients with no heel pain we may find Heel Spurs present. The spur is actually a tiny part of the heel bone which has become elongated due to abnormal pulling of the Plantar Fascia, which is attached to it. Patients come in complaining of "Heel Spurs" when in fact they have heel pain which has probably nothing to do with the spur. Certainly surgery to remove the spur does not have a good track record in reducing or curing heel pain.

What to do

Try simple remedies first. If the pain is directly under the heel then cushioning may help, and cushion pads are readily available from chemists. If the pain is forward of the heel, radiating into the arch, it is worth trying a simple arch support, again available from a good chemist. If the heel pain improves you are on the right track, but you may want to try some physiotherapy to help it along.

If you've tried self-help with no success, you should seek professional help. An experienced podiatrist will be able to diagnose the condition and give the relevant treatment. This will often include prescription orthoses (shoe inlays) to help reduce strain on the feet. Even in persistent cases, where the condition has been present for years rather than months, you should expect to gain some relief relatively quickly. Very persistent heel pain may also need a cortisone injection, to help dampen areas of deep, chronic inflammation. The injection, which should be administered by someone skilled at placing the cortisone precisely, should be given after foot orthoses have been fitted, and the strain has been taken off the feet and their supporting structures.

David Holland BSc(Hons), MSc(Dunelm), MChS