What are the signs of heel pad pain?

Heel pad pain is most commonly felt directly in the middle of the heel bone. It is usually described as a deep and dull aching that feels like a permanent bruise. Walking barefoot on hard surfaces, such as concrete or tiles makes the pain worse.

Heel pad pain is a pain that occurs in the middle of the heel at the base of the foot. In this area of the foot, there is a fat pad called the ‘corpus adiposum’. It’s purpose is to function as a shock absorber and protect the heel bone (calcaneus) and the foot arch from impact injury. This fat pad is dense and thick, making it just perfect for its function. Over a period of time, the fat pad can atrophy (shrink) and become thin and worn all over, or in particular places, or it may become inflamed and painful. This type of heel paid pain is known as heel pad syndrome.

What causes heel pad pain?

 Heel pad syndrome, and consequently heel pad pain, develops as a result of overuse, injury, atrophy, or strain. Some of the most common causes are:

• Inflammation of the fat pad

When the heel pad is placed under repeated forceful activity for prolonged periods of time, inflammation can occur. Commonly, this occurs with activities such as gymnastics, basketball or volleyball, where lots of jumping is required.

• Thinning or displacement of the fat pad

The heel fat pad may become displaced or thinned. This occurs more commonly in the elderly, as the aging process leads to some natural loss in elasticity. The heel pad pain feels like bruising, and is a result of the exposed heel bone bearing force.

• Overweight and obesity

Carrying excess body weight puts undue pressure and extra stress on the heel fat pad, which may lead to it deteriorating more quickly.

• Walking on hard surfaces (force)

When walking or running barefoot, the force that has to be absorbed by the heel is most extreme. This is especially true when walking or running on hard surfaces. This type of pressure placed on the heel can quickly lead to thinning and straining of the heel fat pad, or bruising of the heel bone.

• Plantar fasciitis

When the plantar fascia ligament becomes inflamed or even begins to degenerate, it has a reduced ability to absorb and distribute impact in the foot from walking or running. In this case, the heel fat pad may become strained, worn or injured much more quickly than it would otherwise.

• Improper gait (manner of walking)

Having overpronated or underpronated feet (feet which lean inwards or outwards, respectively) can cause heel pad pain, because with walking or running, the heel strikes the ground in a suboptimal way. This can lead to the heel fat pad thinning or becoming inflamed in the particular areas where it strikes the ground most forcefully.

• Fat pad atrophy due to medical conditions

There are some medical conditions that may contribute to the shrinking of the heel fat paid, causing heel pad pain. These include type 2 diabetes, lupus, and rheumatoid arthritis.

• Heel spurs

Heel spurs can contribute to heel pad pain by physically digging into the heel fat pad.

The health of the foot arch and gait are the two biggest factors in contributing to heel pad pain. During walking, the feet absorb the impact of approximately two times the weight of the person’s body. When running or jumping, this force is even greater. The way the heel strikes the ground surface as a person moves will generally determine where the heel pad will wear down most quickly. Likewise, the arch of the foot functions to prop the foot up correctly, and if that arch is strained or injured (such as what happens with plantar fasciitis), this puts extra pressure on the heel pad.

How is heel pad pain diagnosed?

 During your consultation for your heel pad pain, your sports podiatrist will conduct a thorough physical examination. They will also collect a comprehensive exercise and physical activity history from you. Your sports podiatrist may order a medical imaging test, such as an x-ray or ultrasound to assess the thickness and elasticity of the heel fat pad. A typical healthy heel pad is usually between 1-2cm thick. To assess the heel’s elasticity, your podiatrist may compare the heel’s thickness when standing (bearing the weight of the foot) compared to when it is not. The heel fat pad should be pliable and should adequately compress when you stand; if it is stiff and does not, it may indicate low elasticity.

Being an expert in diagnosing the cause of heel pad pain, your sports podiatrist will be able to differentiate the condition from plantar fasciitis, which is the main differential diagnosis with this type of pain. In a patient with heel pad syndrome, the heel pain is typically most concentrated in the middle of the base of the heel, and tender all over the heel. In comparison, if the problem is plantar fasciitis, the patient will likely be experiencing pain in the part of the heel that is closest towards the toes (ie where the plantar fascia attaches at the heel).

 

Heel Pad Syndrome vs Plantar Fasciitis

Heel pad syndrome

Characteristic signs of heel pad syndrome include:

• Pain feels like a bruise and is close to the centre of the heel
• Pain is worse when walking on hard surfaces such as concrete or tiles
• Pain is worse when walking barefoot
• Pain can be recreated by pressing a finger into the middle of the heel.

Heel pad pain is caused by the wearing down or damage to the heel fat pad.

Plantar fasciitis

Characteristic signs of plantar fasciitis include:

• Pain in the heel, closest to the edge of the heel (toward the toes) and in the foot instep
• Pain may be sharp or dull and achy, and usually worse in the morning
• Pain generally improves with rest and appropriate stretching.

Pain is caused by damage and sometimes deterioration of the plantar fascia ligament, located in the arch of the foot, joining the heel and the ball of the foot.

A healthy foot arch is able to absorb the impact and distribute the force of physical activities adequately through the foot, however a flat or injured arch can ultimately lead to heel pad syndrome due to the added pressure at the heel. Sometimes heel spurs may develop, which also contribute to the development of heel pad syndrome and causing heel pad pain, as they physically dig into the fat pad, causing pain.

 How is heel pad pain treated?

 The aim of treating heel pad pain is to reduce the pain and inflammation itself, as unfortunately there is no cure for heel fat pad syndrome. Your sports podiatrist may suggest one or more of the following treatments:

• Rest: if you can, stay off your feet completely, or avoid doing activities cause heel pad pain or make it worse
• NSAIDs: over-the-counter non-steroidal anti-inflammatory drugs such as ibuprofen can be effective in reducing inflammation and reducing pain
• Ice: applying a covered ice pack to the sore heel for up 20 minutes at a time, at regular intervals throughout the day or immediately after activities that make the heel pad pain worse, can reduce inflammation and relieve pain
• Taping: sports tape may be used to hold the heel pad in place and provide more ‘cushioning’ or protection for the heel bone
• Heel pads, cups or orthoses: there are different types of implements that may be recommended by your sports podiatrist to either hold the fat pad in place, provide extra cushioning (usually foam or gel) for the heel, or to stabilize the bones of the foot and contain the fat pad
• Stretching and strengthening: your sports podiatrist may recommend particular exercises that are appropriate for your condition to improve flexibility and strength in areas where it is required.

Please be advised that the information provided in this article should not be taken as general advice and is for educational purposes only. If you are suffering with heel pad pain, then you should consult with a qualified sports podiatrist to discuss your concerns. Appointments can be made online at sydneyheelpain.com.au or by calling 02 93883322.

Karl Lockett – sports podiatrist.

 
Written by Karl Lockett

A Common Question: What are the Best Shoes for Plantar Fasciitis

Many patients will attend the Sydney heel Pain clinic reporting chronic discomfort in the heel, and one of the typical questions they ask is what are the best shoes for plantar fasciitis. Plantar fasciitis is one of those conditions that causes pain first thing in the morning when your heel hits the ground. There is also start up pain where by there is significant discomfort after long periods of being seated or driving. Many patients will report the feeling of a stone bruise in the bottom of the heel which can also be described as a pebble in the she. More often than not, patients suffering with plantar fasciitis turn to their footwear and wonder what are the best shoes for plantar fasciitis. In addition to modifying their footwear many people with this chronic heel pain condition will attempt of variety of home remedies in order to reduce the pain and accelerate healing. If you are suffering with plantar fasciitis you have probably tried rolling your foot on a hard object like a frozen water bottle or a spiky ball. You may have attempted plantar fasciitis massage in addition to the variety of foot stretches. Many people will sleep with a plantar fasciitis brace also known as a Strasbourg sock. Most of the home remedies that people try will reduce the symptoms temporarily but often they do not contribute to healing in the long term. Due to the temporary relief when self treating, patients will continue with the home remedies that they have selected before falling short of the mark. Eventually, after several weeks or months they begin to explore professional help as the home remedies have not resolved that plantar fasciitis.

Shoes for Plantar Fasciitis – Robust Vs Soft

Different types of shoes for plantar fasciitis have been trialed and these will range from soft and flexible to stiff and robust. Regardless of foot type, it is important that the foot is supported as much as possible in order that the plantar fascia is unloaded. One of the most common troublesome shoes for Plantar fasciitis symptoms is the skecher – a problematic shoe due to the lack of support. Skechers have been the cause of plantar fasciitis in many patients who attend the Sydney heel Pain clinic. Other shoes for plantar fasciitis pain come from Nike free which are also very flat, flexible and non-supportive. This type of shoe causes the foot to work much harder which can be one of the causes of the condition.

The Sydney heel Pain clinic has a strong working relationship with Asics and can provide a range of functional shoes that offer excellent levels of support. These shoes for plantar fasciitis can be matched to a specific person‘s foot type and body weight. And occasionally, the liner of these shoes is removed and replaced with a customised prescription orthotic made from carbon fibre. These shoes for plantar fasciitis while supportive remain comfortable and lightweight.

Asics Gel Fortitude – Firm Neutral shoes for plantar fasciitis

 

Footwear is only one part of a much larger treatment plan and if you are wondering which are the best shoes for plantar fasciitis then it is important that other contributing factors are analysed and treated.

The Sydney heel pain clinic podiatrists will install their mobile phone application, which contains a list of shoes for plantar fasciitis, in addition to other important treatments, on to the patients phone at the end of their consultation. The mobile phone application contains a diagram and explanation of one very specific supinated calf stretch which releases the heal without straining the plantar fascia. The mobile phone application also contains a list of every day things that patients do unknowingly that can affect the plantar fasciitis negatively. Patients are encouraged to avoid these things and are also advised on things that they can do to help the fascia to heal. In addition to wearing the correct shoes for plantar fasciitis, patients are advised that on rare occasions there maybe the need for a small injection of Cortisone, if their condition is complicated by a small Superficial bursa.

If you have plantar fasciitis or chronic heel pain and you would like advise on shoes for plantar fasciitis you can consult with the podiatrists at the Sydney Heel Pain Clinics – help@sydneyheelpain.com.au / 93883322.

 

Podiatrist – Karl Lockett

 
Written by Karl Lockett

WHAT CAUSES HEEL PAIN IN KIDS?

One of the most common causes of heel pain in kids is a condition known as severs. Severs disease, or Severs syndrome is a condition that occurs in children between the age of 7 and 14 years. This condition is known to be a growth plate problem and is associated with inflammation and irritation around the posterior aspect of the heel. Not all active children will develop Severs, but heel paid in kids is common who participate in lots of sporting activity. These children are sometimes going through a growth spurt. Heel pain and kids can lead to lack of participation and can cause the child to refrain from physical activity. These children will experience pain under the base of the heel and also around the back of the heel, and the discomforts can be relentless. The children will describe pain when walking and in particular when running or playing sports. Mums and dads are sometimes at a loss as they do not know what to do. There is nothing to see on the heel and bruising or inflammation are not associated with this condition. The condition seems to affect boys and girls similarly.

Quite often parents will visit the local doctor in order to seek advice and guidance, and they are often anxious to remove the pain from the child’s foot. Some doctors will refer for an x-ray of the foot but this is thought to be of little use. X-ray imaging does not lead to a specific treatment plan and is not always thought to be the correct approach when treating heel pain in kids. The x-ray images do reveal the growth plate and shows non-union of the heel bone, but this is normal for children in this age bracket.

TREATMENT FOR HEEL PAIN IN KIDS

The treatment for heel pain in kids should be a multi-factorial approach as there is more than one contributing factor to the pain. Footwear selection, calf stretching, assessment of biomechanics, elevating the heel and applying ice packs to the affected area are all treatments that should be considered in these children. Sometimes the use of prescription orthotics is beneficial for children who present with an inherent foot weakness. Not all kids with heel pain will require orthotics and some will benefit from simple heel wedges ranging from 7 to 10 mm. The application of cold packs will help to reduce pain and inflammatory change within the heel bone. Usually, footwear with an elevated heel and a small forefoot drop will allow the child to feel more comfortable. These shoes should also be relatively firm and robust and less flexible through the midsole. Heel Pain in kids is usually more manageable if the child is compliant with the above and in particular if they commit to regularly stretching the calf muscles. It is not usually necessary to refer for MRI or ultrasound. Sports podiatrists seem to have a good handle on Severs and physiotherapy is not usually necessary. Because children are young and healthy they seem to respond to treatment very quickly and very effectively. Severs can occur in 1 foot but is often seen in both feet. Parents can rest assured that the onset of the heel pain in kids is nothing to do with neglect on their part. The inherent foot weakness can sometimes be due to ligament laxity and while this is a genetic factor parents are not to blame.

OTHER CAUSES OF HEEL PAIN IN KIDS

It is important to consider other causes of heel pain in kids such as stress fracture
and bone bruising. While plantar fasciitis and Achilles tendinitis are more readily seen in adults, this is not to say that they cannot affect children too. Ultrasound imaging is often sufficient in order to diagnose plantar fasciitis or Achilles tendinitis. A bone scan would be useful in determining stress fracture or bone bruising. Once again, severs is the most likely cause of heel pain in kids who are active and aged between 7 and 14 years, but parents should know that regardless of the treatment options, children will always grow out of this condition once the heel bone has fused.

If you have a child with heel pain or if you would like to know more about heel pain in kids, please contact a suitably qualified sports podiatrist or reach out to the team at Sydney heel pain clinic.

Karl Lockett, sports podiatrist
help@sydneyheelpain.com.au
www.sydneyheelpain.com.au
02 93883322

 
Written by Karl Lockett

Evaluation of Plantar Fasciitis

An evaluation of plantar fasciitis and the treatment options that are available, is important in order to gain an understanding of the efficacy off all different management options. At the Sydney heel pain clinic, the main conditions that are treated are plantar fasciitis, Achilles tendonitis and bursitis. An evaluation of plantar fasciitis is important as it is the most common of all these conditions that the podiatrists treat. Some of the common treatments available are orthotics, shockwave therapy, immobilisation boot, footwear changes, dry needling and strapping.

Plantar fasciitis is a painful condition that can be debilitating and causes severe pain under the base of the heel. The condition can be excruciating and patients are are often required to modify their lifestyle in order to accommodate it. Commonly, patients will report significant pain after periods of rest. This can be referred to as start up pain and is often noted first thing in the morning when the patient takes their first few steps, or after long periods of being seated. Evaluation of plantar fasciitis patients also commonly reveals the feeling of a stone bruise under the heel or a pebble in the shoe. Furthermore, these patients find that there are often long periods of the day where they are free of any symptoms and are able to walk without any problems. These brief moments of relief are then masked and undermined by the return of the sharp stabbing pain through the base of the heel or the arch of the foot.

Evaluation of Plantar Fasciitis Including Orthotics

An evaluation of plantar fasciitis sufferers who were treated with prescription orthotics was carried out at the Sydney heel pain clinic. It was found that those patients using firm inserts that provided control instead of cushioning responded to treatment within 4 to 6 weeks. It was concluded that soft orthotics allow the foot to compress the material and therefore creates hypermobility around the heel, which causes irritation and prolongs the condition. The evaluation of these plantar fasciitis suffers revealed a significant reduction in start up pain first thing in the morning and after long periods of being seated. The pain in the heel subsided immediately with the orthotics in place, although this did not mean that the condition had healed. The plantar fasciitis symptoms were deemed to have subsided when there was minimal or no pain when walking or when firm finger pressure was applied to the base of the heel, at the attachment of the plantar fascia. The evaluation of the plantar fasciitis first thing in the morning when rising from bed was also used as a “measuring stick”.

 

Evaluation of Plantar Fasciitis with Shockwave Therapy

Shockwave therapy was applied to patients with plantar heal pain and evaluation of plantar fasciitis symptoms were noted over an 8 week period. Shockwave therapy provides an instant analgesic effect and this was consistent throughout all patients. Commonly there are approximately 5 days of pain relief following the application of the shockwave therapy machine. Please note, that the analgesic effect is merely a positive side effect and is not the main reason for using it. Shockwave therapy is used to stimulate healing by increasing blood flow and the turnover of new collagen cells. Over the period of 4 to 6 weeks, the healing takes place albeit slowly. However it can be proposed that healing is quicker with shockwave therapy than without. Shock wave therapy as a “stand alone” treatment, when no other supportive intervention was applied, proved to be less reliable. This eludes to the fact that the single most important point in the healing of plantar fasciitis still remains to be the support for the plantar fascia itself.

More information on shock wave therapy here: https://sydneyheelpain.com.au/shock-wave-therapy/

Evaluation of Plantar Fasciitis that Includes Calf Muscle Stretching

When an evaluation of plantar fasciitis was made of the variety of treatments for the condition it was found that the heel pain problem improved quicker when calf stretching was included. It can be proposed that the restricted range of ankle joint motion due to tight calf muscles creates a stressful pulling on the heel and that this prolongs the condition. The evaluation of plantar fasciitis and Achilles tendonitis revealed the same beneficial findings that highlights the benefits of these stretching techniques. It should be noted that stretching alone does not provide the same benefits or a faster rate of healing without supportive intervention from the podiatrist. Supportive intervention can be provided via prescription orthotics, strapping techniques and footwear recommendations. Please note: calf stretching can over load the plantar fascia and prolong the condition if not done under instruction of an experienced podiatrist.

Please see the style of orthotics that work the best for plantar fasciitis here on our sister company website: https://www.heelclinic.com.au/

Please note that the above information should not be taken as medical advice and if you need an evaluation of plantar fasciitis or any other of your foot problems then you should consult with a qualified sports podiatrist.

 

Written by: Karl Lockett, Sports Podiatrist