Heel Pad Pain

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

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.

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 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

Heel Pain from Running


Heel pain from running can be due to a number of conditions, including plantar fasciitis, structural or muscular issues or imbalances in the lower leg and foot, or sometimes even your biomechanics (improper gait pattern). During your consultation, your sports podiatrist will carry out a comprehensive examination in order to determine the cause of your heel pain from running. This will include taking into account your previous and current running and other exercise history, checking your range of motion in the lower leg, gait assessment and if required, medical imaging, such as x-ray or ultrasound imaging.

heel pain from running

Many Australians enjoy going for a run. It is an inexpensive and convenient form of exercise, however it is common for some people to experience heel pain from running at some point during their lives. If you are suffering with heel pain, it is important that you see a suitably qualified sports podiatrist sooner rather than later. Pain is a sign that there is a problem occurring somewhere. Ignoring and pushing through the pain can lead to further strain, injury, or other complications associated with the condition.

Plantar Fasciitis

Plantar fasciitis is commonly a cause of heel pain from running. The plantar fascia is the thick, flat band of tissue (ligament) that runs along the base of your foot, connecting your heel bone to your toes. When plantar fasciitis occurs, the plantar fascia becomes inflamed and thickened due to irritation at the attachment point at the base of the heel. People who suffer with plantar fasciitis often feel pain directly under the ball of the heel. Sometimes they have associated arch pain too. The pain is most commonly felt first thing in the morning or immediately after resting, such as when you have been lying or sitting down and then stand to walk. The heel pain can be persistent or intermittent. Occasionally, if there is a sudden onset of pain, this can indicate micro-trauma, or tearing, of the plantar fascia.

Achilles Tendonitis

Achilles tendonitis is a condition that causes back of the ankle and heel pain from running. The Achilles tendon is a fibrous cord that attaches the back of your calf muscles to your heel bone. In people suffering with Achilles tendonitis, this tendon becomes irritated and inflamed, particularly in the area where it attaches at the back of the heel. Redness and swelling is sometimes visible with the naked eye in the sore area, and in some patients, a bump or lump can be felt in the tendon as well. There are a number of factors that contribute to the development of this painful condition: tight calf muscles that impede the range of motion at the ankle joint, overweight or obesity, and poor gait biomechanics are amongst the most common causes of heel pain from running.

Heel Spurs

A heel spur is an abnormal bony projection that develops around the heel bone. It is commonly misunderstood that these spurs cause heel pain from running. Most health practitioners now generally accept that heel spurs are not the cause of the pain, but rather that the pain experienced is because of the inflammation of the tissues around the location of the heel spur. Heel spurs are most commonly either at the back of the heel, when associated with Achilles tendonitis, or under the base of the heel if associated with plantar fasciitis. Heel spurs tend to form over many months, when there is constant strain or pressure on the foot muscles, ligaments and/or tendons.


Bursitis quite often causes heel pain from running, and the pain may be worse at night, while stiffness worse in the morning. The bursae are little fluid-filled sacs that sit between two neighboring muscles, tendons or bones. Their purpose is to reduce resistance, or friction, between these structures and to allow the tendons to move smoothly over bony surfaces without injury. Bursitis develops when these sacs become inflamed. Too much repetitive movement and strain to the bursae usually cause this painful condition, or injury to the tissue found inside the bursae. People that suffer from bursitis may experience sharp or shooting pains and there may be visible redness and swelling.


Your sports podiatrist will conduct a thorough examination and subsequently will be able to recommend the most appropriate ways to treat your heel pain from running. A few of the common treatments include:

Shock wave therapy

Shock wave therapy is used across many medical fields. It is non-invasive, and has the potential to relieve pain almost instantly. A special probe is used to direct bursts of high-energy sound waves into the painful area, where they make contact with the tissues. The brain is signaled to promote repair of the injured or inflamed tissues through this process.

Calf stretching

Your podiatrist will prescribe the most suitable stretches for you to practice as part of your treatment. Be mindful that some stretches may aggravate or irritate injured and inflamed tissues, so it is always best to check with your therapist prior to undertaking any aggressive stretching.

Ice packs

Ice is a safe, easy and convenient way to relieve your heel pain from running. Icing helps to reduce the pain by decreasing inflammation in the affected tissues.


Being observant of some preventative measures is important while you continue with your podiatrist’s prescribed treatment plan, so that you can avoid worsening the underlying cause of your heel pain from running.

Stretch and warm up

Running puts a lot of pressure on the tissues of your feet. Taking a few moments to do some basic stretches before and after you run can really help to reduce your heel pain from running. Ask your sports podiatrist for their advice as to which exercises are most appropriate for you. Some of the types of warm up exercises they may suggest might include foot and ankle stretches and stretches for your calf muscles.

Work to improve your foot strike pattern

Your sports podiatrist may conduct a running gait assessment as part of their examination. A rear-foot strike pattern is common with most people, where the heel hits the ground first. It is thought that this contributes to the development of heel pain from running. Your podiatrist may request that you try to change to a mid-foot striking pattern and see if that helps with reduce your heel pain, however this is not always applicable for everyone.

Aim to maintain healthy weight

Being overweight puts extra and unnecessary pressure on your legs, and especially your knees, ankles and heels, when you run. Aiming to reduce your  excess body weight will help you be lighter on your feet and give you greater balance when you exercise, not to mention the other overall general health benefits! This will help you in maintaining a healthy gait/foot strike pattern as you run, and in turn will reduce your heel pain from running.

Support the structure of your feet

Investing in a pair of sports shoes specifically made for runners is key in preventing your heel pain from running. Ask your sports podiatrist for their recommendation on what types of runners are suitable for your foot. Everyone’s feet are different, so it is important that you buy shoes that support the structure of your feet. If it is beneficial, your podiatrist will also be able to recommend a strapping technique for you.

The information provided in the article above should not be taken as general advice and is for informational use only. If you are suffering with heel pain from running, you should consult with an appropriately qualified sports podiatrist to discuss your individual concerns. You can make an appointment online at www.sydneyheelpain.com.au or by calling 93883322.

Karl Lockett– sports podiatrist.

Written by Karl Lockett

Outer Heel Pain (Grace)

Upper Heel Pain

What is a Possible Cause of Upper Heel Pain?

One of the most common causes of upper heel pain is insertional Achilles tendinopathy. This condition is sometimes confused with Achilles tendinitis which affects the tendon more proximally above the heel bone. As opposed to feeling upper heel pain, patients with Achilles Tendonitis will normally describe lower calf pain or discomfort around the back of the ankle joint. Insertional Achilles tendinopathy is associated with a degeneration or a breakdown of the Achilles tendon at the insertion onto the back of the heel bone. Many patients suffering with insertional Achilles tendinopathy will describe the feeling of stiffness or extreme pain for the first few steps in the morning. These patients also report that the upper heel pain is prominent when lying in bed. The posterior aspect of the heel bone can feel uncomfortable as it rests and gently presses onto the bed sheets and mattress. Commonly, these patients describe an improvement in symptoms after they have began walking. The upper heel pain is normally noticeable first thing in the morning when the patient places their foot onto the ground and begins to walk. This discomfort begins to ease within the first 5 to 10 minutes as circulation increases and mobility improves. Upper heel pain caused by insertional Achilles tendinopathy can sometimes be seen in association with Haglunds deformity which appears as a large bony prominence on the posterior aspect of the heel bone. Haglunds deformity can be clearly seen on x-ray imaging and appears as a spiky piece of bone that grows in an upwards direction towards the Achilles tendon. The upper heel pain from this condition can be exacerbated from the pressure of shoes on the back of the heel bone. The degeneration associated with this Achilles tendon problem can be age related but can also be seen in conjunction with stiffness and tight calf muscles. Most patients presenting to the Sydney heel pain clinic complaining of upper heel pain are aged in their 50s and 60s. These patients are often slightly overweight and have developed tight calf muscles. Interestingly, most of these patients report an improvement in the upper heel pain when they wear shoes with an elevated heel and a slight drop towards the front of the foot. Elevating the heel reduces the pulling sensation of the Achilles tendon on the heel bone which reduces the upper heel pain quite significantly. However, long-term use of shoes with an elevated heel does in fact contribute to an overall shortening of the calf muscle and Achilles tendon. This would prolong the condition and results in extended periods of upper heel pain when wearing lower shoes.

Other Causes of Upper Heel Pain

Another cause of upper heel pain which often goes undiagnosed is a retro calcaneal bursitis. This condition can quite clearly be diagnosed using ultrasound imaging or MRI. Anatomically, this bursar exists naturally in order to lubricate the posterior aspect of the ankle joint around the Achilles tendon. However, if there is an increase in the amount of pulling around the posterior aspect of the heel bone, the bursar becomes irritated and inflamed. This irritation leads to upper heel pain and significant stiffness through the ankle joint itself. Once again, the upper heel pain symptoms are prominent first thing in the morning but will ease as the patient becomes more and more mobile.

This upper heel pain can be mildly uncomfortable during the first few minutes of exercise but most patients will report to the sports podiatrist that once they are warmed up they are able to successfully complete their activity as the pain dissipates. To this end, participants become reluctant to avoid or reduce physical exercise. However, the irritation to the affected Achilles tendon or bursar persists throughout the activity and causes further irritation. Even though the upper heel pain can be minimal or non-existent during this activity, the stress and load on the soft tissue prolongs the condition.

The sports podiatrists at the Sydney heel pain clinic commonly differentiate between these two different types of upper heel pain and implement the most relevant treatments accordingly. The treatment for each of these two conditions will differ slightly and can sometimes involve ultrasound imaging.

If you are experiencing upper heel pain you may wish to consult with the podiatrists at the Sydney heel pain clinic. Appointments can be made by emailing help@sydneyheelpain.com.au or by calling the following phone number: 9388 3322.

PodiatristKarl Lockett

Upper Heel Pain

Written by Karl Lockett

Shoes for Plantar Fasciitis

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.

Shoes for Plantar Fasciitis

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


Plantar Fasciitis Management

What Does Plantar Fasciitis Management Involve

Currently there is insufficient evidence to allow scientific clarity surrounding the most effective form of plantar fasciitis management. There are many different types of treatment for plantar fasciitis and each patient should be treated individually. The recommended plantar fasciitis management for one person may not be suitable for another as there are multiple contributing factors to this frustrating heel pain condition. Many patients resort to self treatment and online research in an attempt to resolve their condition before seeking professional plantar fasciitis management from a suitably qualified healthcare practitioner. Treatment and management of plantar fasciitis should most definitely involve measures to unload the plantar fascia mechanically. This can be achieved via the use of a touch and hold orthotic, designed by prescription and worn for up to 6 weeks diligently. Plantar fasciitis management may involve a referral for ultrasound imaging or MRI. X-rays are of less benefit in these circumstances. Imaging usually forms part of a plantar fasciitis management plan if the practitioner suspects tears in the plantar fascia itself. The treatments that maybe useful are treatments such as shockwave therapy which has been proven to stimulate healing via an increase in blood capillaries and new collagen. In addition to touch and hold orthotics and shockwave therapy, the temporary application of rigid sports tape can be very beneficial and usually helps to reduce pain levels. However, due to skin irritation strapping should only be carried out short-term. Other common treatments are things such as acupuncture, dry needling, stretching techniques and footwear changes. In troublesome circumstances the plantar fasciitis management plans may involve injections of Cortisone to reduce stubborn inflammation.

How Long Should Plantar Fasciitis Management Plans Last?

The length of time that a patient is involved in a plantar fasciitis management plan will be determined by several factors, such as the severity of the condition and the length of time that they have been experiencing heel pain. Typically the patient may receive treatment and care for anywhere between three and six weeks. Chronic conditions and patients with severe obesity may receive care for longer due to the excessive load on the feet.

Plantar Fasciitis Symptoms

The typical symptoms of plantar fasciitis which will normally be described during the consultation are things such as pain at the base of the heel which is often more noticeable first thing in the morning when rising from bed. Patients who are undergoing plantar fasciitis management will often describe the feeling of a stone bruise under the heel or the sensation of a pebble inside the shoe. They describe what can be called “start up” pain whereby there is significant discomfort when walking, following long periods of being seated. In extreme cases the patient will also report throbbing or stabbing sensations under the heel or through the arch of the foot.

Who Offers Plantar Fasciitis Management

Podiatrists are expert in foot health and should be able to offer concise plantar fasciitis management plans. If the podiatrist that you see has a special interest in sports podiatry and has more exposure to biomechanical analysis than other foot conditions such as skin and nail, then there is a good chance that they will have more experience in the treatment of this painful condition.

Sydney heel Pain clinic offers appointments from five clinic locations across Sydney and executes plantar fasciitis management plans on a daily basis. The podiatrist at Sydney heel Pain clinic have vast experience and unparalleled knowledge around plantar fasciitis.

If you are in need of a plantar fasciitis management plan due to chronic heel pain then you may want to consult with the podiatrists at Sydney Heel Pain Clinic. Sydney Heel Pain Clinic can be reached on 93883322 or help@sydneyheelpain.com.au.

You may also wish to book on line: https://sydneyheelpain.com.au/book-online/ – just select the location you require.

Plantar Fasciitis Management

Written by Karl Lockett

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.


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.

heel pain in kids - severs disease


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
02 93883322

Written by Karl Lockett

Achilles Tendon Rupture

What is Behind An Achilles Tendon Rupture

If you have experienced an Achilles tendon rupture then you will be all-too-familiar with that snapping sensation and that acute pain that stops you in your tracks. When the Achilles tendon tears, it often happens mid stride or during an explosive movement. The podiatrists at the Sydney heel pain clinic commonly treat runners, basketball players, soccer players and a variety of other athletic people that don’t fully understand the signs and symptoms that precede the Achilles tendon rupture. “Quite often this injury will occur during one particular step or movement as the athlete attempts to propel themselves and move forwards or upwards quickly”, says Karl Lockett, sports podiatrist at the Sydney Heel Pain Clinic”. What these keen gym junkies do not understand is that quite often some of these injuries could have been avoided with correct intervention of biomechanical anomalies. One of the most common precursors to Achilles tendon rupture is ankle joint dysfunction due to tight , short calf muscles. The tightness in the calf muscles causes an increased load and pulling sensation on the Achilles tendon which if left untreated will eventually lead to Achilles tendon rupture. There are varying degrees of rupture and ultrasound imaging will often reveal micro tears, partial tears or complete rupture of this important weight-bearing tendon.

Achilles Tendon Rupture

Who Else Suffers from Achilles Tendon Rupture

Keen athletes are not the only candidates who suffer from these Achilles tendon ruptures. The podiatrists at the Sydney heel pain clinic also treat more sedentary individuals who may only partake in recreational walking. These patients are usually surprised to hear that they have developed an Achilles tendon rupture as they confess to being way too sedentary. Some of these individuals are carrying a few extra kilos in body weight and this in turn creates more stress on the foot and ankle and Achilles tendon. The extent of damage in these individuals may not be as severe as can be seen in the athletic type, and ultrasound imaging or MRI may reveal micro tears or partial tears. A complete Achilles tendon rupture is unlikely and less common in such individuals.

What are the Causes of Achilles Tendon Rupture

One of the most common causes of an Achilles tendon rupture is calf muscle restriction and extreme tightness. These people are the kinds of athletes who fail to perform diligent stretching techniques pre-and post exercise. “This goes to show the importance of calf muscle stretching when maintaining good foot and ankle health, not just to avoid Achilles tendon rupture, but other soft tissue injuries to such as plantar fasciitis or Achilles tendinitis”, says sports podiatrist Rami Ghorra. “As sports podiatrists we also highly recommend hamstring, quads and glutes stretching pre and post exercise”.

Other causes of Achilles tendon rupture would be the use of non-functional walking shoes or running shoes, which may lead to the calf muscle dysfunction. It can be highly beneficial to have your biomechanics assessed in the podiatry clinic, using video gait analysis and treadmills. This allows the sports podiatrist to recommend specific models of walking shoes or running shoes. Being fitted with the correct brand and model of shoe may sound like a simple solution but this can pay dividends and help you avoid injuries such as Achilles tendon rupture

Achilles Tendon Rupture Treatment

 The treatment for an Achilles tendon rupture will involve immobilisation of the affected tendon, which can be achieved a variety of ways. The sports podiatrists at the Sydney heel pain clinic will select one or a combination of treatments based on the severity of the condition. In more recent times shockwave therapy has been used as a treatment to accelerate the healing of an Achilles tendon rupture or less severe, Achilles tendinitis.

 In summary, if you feel a tightness in your calf muscles and you want to avoid an Achilles tendon rupture it is crucial that you address the problem sooner rather than later. Prevention is always better than cure. Achilles tendinitis is always one of the warning signs that should also be addressed and not ignored. If you are suffering with Achilles tendinitis this may be a precursor to an Achilles tendon rupture, and good physical assessments and biomechanical analysis would be a great way to avoid this crippling injury.


Karl Lockett and Rami Ghorra.

Sydney Heel Pain Clinic


Written by Karl Lockett

Evaluation of Plantar Fasciitis Treatments

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 Treatments

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

The Problem With Evidence-Based Treatment for Plantar Fasciitis

Is There Sufficient Evidence-Based Treatment for Plantar Fasciitis

People suffering with plantar heel pain will often carry out online research in order to find evidence-based treatment for plantar fasciitis. Plantar Fasciitis is an extremely common condition and is thought to affect one in three people throughout their life. It is a condition that can stop you in your tracks and can be debilitating at times. Patients with plantar fasciitis will modify their lifestyle, stop exercising and become idol due to the severe pain. The common symptoms of plantar fasciitis are pain under the base of the heel and sometimes through the arch of the foot. The severity of the pain is often most crippling first thing in the morning when patients arise from bed. Evidence-based treatment for plantar fasciitis has tried to find the most reliable solutions in order to reduce or completely remove some of these symptoms. Many patients suffering with plantar fasciitis will jump on board the medical merry go round and will attempt to treat themselves with a whole variety of solutions. Most patients will visit more than one medical practitioner on their journey to become pain-free. Due to the fact that there is more than one contributing factor, treatment often fails. Many practitioners approach the condition from one angle and will miss important causes that allow the problem to persist. For this reason the condition can become chronic as practitioners have approached the problem from only one angle and failed. This will leave the patient frustrated and those proactive people will carry out extensive research online, searching for evidence-based treatment for plantar fasciitis.

The Short Falls of Evidence-Based Treatment for Plantar Fasciitis

The research papers that have attempted to find evidence-based treatment for plantar fasciitis often do not include all of the contributing factors. For example, one research paper studied the effectiveness of prescription orthotics against prefabricated orthotics. This paper was published in an Australian tabloid newspaper and did not address any other contributing factors whatsoever. It did not take into account things such as footwear, calf muscle stretching, body weight, level of activity, number of steps taken each day or other medical conditions affecting the patient. Many podiatrists have agreed that this particular research paper does not constitute evidence-based research for plantar fasciitis.

How to Carry Out Evidence-Based Research for Plantar Fasciitis

In order to effectively carry out evidence-based research for plantar fasciitis it is crucial that all of the contributing factors be considered. Specialist podiatrists who have extensive exposure to patients with plantar fasciitis are fully aware of all of the contributing factors. Therefore, if research were to be carried out these specialist podiatrists should be consulted. As mentioned earlier the contributing factors include but are not limited to ankle joint range of motion due to restriction in calf muscle range, footwear selection, body weight, other medical conditions that affect health and healing, the use of anti-inflammatory medication or ice packs, and shockwave therapy.

Plantar fasciitis patients searching for reliable treatments should be educated and mindful of the above information when selecting treatment.

In summary, there is insufficient evidence based research for plantar fasciitis and more work needs to be done before solid conclusions can be made. Only then can patients find reliable treatments from podiatrist, physios, allied health practitioners and doctors alike. It is understandable how frustrated and disappointed patient’s with heel pain become after entrusting their time and money in a variety of practitioners who struggle to get it right due to lack of evidence or experience. This is not to say that without the evidence based research, some practitioners can not get it right, as the podiatrists at Sydney Heel Pain Clinic have been treating plantar fasciitis and other causes of heel pain for many years.

Find the cause(s) , remove the cause(s), support the fascia > healing takes place.

Written by Karl Lockett