More Heel Problems: Pain Series 4

 The most common types of heel pain arise from general overuse or repetitive heel pad strain. Fasciitis is often confused with heel spurs and heel pad strain. 

You go to You Tube and find out about most foot conditions. The USA is by far the most prolific film maker on ‘how to’ but remember there is often a sales pitch behind such films. The first myth you need to be mindful about is the heel spur.  Of course I have my own pitch on heel pain which may also provide useful first aid remedies. Surgery is not considered in this article, but my current recommendation is the website FootEducation.com for further information (click) representing impartial non nonsense advice produced by health professionals specialising in feet.

Children and adults present with heel pain for different reasons. In this article I hope we can make some sense of this? Severs apophysitis (children) and Haglund’s heel bump (children & adults). Fasciitis and heel pad strain for adults. Read bout the myth of the heel spur together with these common problems when you download my FREE self help sheet [Self-help Heel pain].


Other related articles to heel pain on ConsultingFootPain

Burning pain (tarsal nerve)
What’s the difference between fasciitis and plantar fibromatosis?


Sever’s diseases or calcaneal apophysitis

In a child (10-16) the growth plate can become irritated. It is not a disease and often thought of as growing pains. The problem arises where sections of bone determined by the growth plate meet to contribute to the lengthening of the bone and are put under strain from an over active achilles tendon.

Remedy: Apophysitis

The most important thing that any parent can do is to ensure there is no visible reason for heel pain. A blister, verruca, small hair from an animal. Get the magnifying glass and have a good look. Is the heel hot and swollen, painful to touch and does simple pain medicine make no difference. If pain cannot be relieved by medication seek professional help especially if the foot has been rested.

Apophysitis in adolescents actually is self limiting and all we are doing is waiting for the two sites making up the heel bone to mature i.e join together. The aim is to remove the tension-pull effect on the smaller part of the heel. To do this raise the heel with a 1/4 in foam or felt pad, or use a heel pad from a sports shop used for heel pain. Nothing more is required. Adjust the thickness, put two pieces together if necessary. Felt compresses and thins out so it needs replacing and this is why it is only good as a temporary measure. A more dense, firmer pad lasts longer so shop around.

You can rub ant-inflammatory gels over the heel to help as well, but rest and stopping high activity sports is important for a week to ten days, then reduce the frequency for up to six weeks allowing the heel to settle. Of our four children, it was only the male who developed this problem and indeed it self cured, perhaps with a little help from Dad!


 

Heel bump or Haglund’s deformity

A condition that affects children and adults.

The bump is not prominent, as shown in Haglund’s disease (deformity) below. As with the heel spur which lies under the heel bone,  traction pulls at the back of the heel from the big achilles tendon. This can arises during adolescence and later in life when increased activity triggers  pain and inflammation. The achilles tendon is often the site where the tendon produces harmless spurs. Heel pain for the young person can be quite distressing but more so after activity. X-rays are usually unremarkable and are not always required.

 

 The bump (below) is shown in side profile and consists of bone and overlying soft tissue. Gel sleeve (above right).The pad is contoured and made as a sleeve or half sock

 The bump arises most commonly in adults although can occur in adolescents. Known also as a retrocalcaneal exostosis and Haglund’s deformity names are often confusing. Symptoms are easier to spot because discomfort arises over the bump. Many shoes can irritate the location so selecting shoes around the heel. The tell tale sign is the bump illustrated. Apart from the obvious increase in size to the heel, the inner heel lining is worn at one point. Redness and tenderness can be due to simple friction or chilblains during autumn and winter seasons.

Remedy: Haglund’s deformity

  • If the skin is damaged this should be protected by a blister dressing or felt pad. Blister dressings are available from high street pharmacies often with their foot care products. Made from a gel this cushions and is water resistant.
  • Felt pads are often best fitted inside the shoe and should have a cavity created to take away pressure from the bump.
  • A soft sac or bursa can form over the skin and needs protecting from friction
  • A heel lift may be useful to change the position. ¼ inch (6mm) felt or foam insert works well
  • I have personally found a gel pad similar to the one illustrated above useful but replacement is required with heavy use. These are great in walking boots

 


Repetitive heel pad strain

Reading the literature it is easy to believe that heel = fasciitis. In truth sometimes this is possible and the two exist, at other times this is not the case, despite management often overlapping. I have had both conditions myself, fasciitis and heel pain, the latter being an overuse syndrome. Fasciitis came on midway through a family camping holiday when I was in my mid-thirties. Heel pain arose after I decided to keep fit and used a treadmill aggressively at 45 years of age. Location can offer a guide.

Remedy: general advice for heel pain

Long standing periods and work shifts (above 8 to 10 hours) will make heel pain worse. 

  • Pain killers work to reduce pain but will not resolve the problem. Stop excessive exercise for 2-3 weeks.
  • Use a foam heel pad such as silicone jelly.
  • Sports shops also sell thin heel pads without taking up too much room but pads of this type are short lived. Heel lift pads can be used for Sever’s disease.
  • If pain persists, or increases in intensity, then seek help no later than 4-6
  • gently daily about three times a day using a Thera band as shown or stretch the band against the ground as in tendo achilles stretches. The tendo achilles and fascia share a close relationship.
  • Tuli heel cup is well worth considering and works well for many heel pain sufferers. Sourced through the internet so freely available with prescription.
  • Check your footwear for any cause of the problem and try to re-negotiate shorter shifts at work, or change roles so some of the time you are sitting.
  • If within a month the pain is still present, then seek assistance or earlier if the pain escalates.

Illustrations show Thera band stretch (Above) and Tuli Heel cup (Below


Plantar Fasciitis

(See my other article on this website and what the internet says about fasciitis )

Fasciitis arises less frequently than heel pad pain. However, fasciitis can involve the heel pad and arch and can become disabling if not treated. Follow the same advice for  heel pad pain for the same time periods but remain as active as possible, but do not exert the foot, i.e run or undertake sports requiring squats or springing until the symptoms have calmed. High heeled shoes may actually be more beneficial.

Remedy: plantar fasciitis

  • Once pain starts if the area is tender to press, avoid an arch support initially.
  • Use localised non-steroidal gel or creams or locally applied warming creams**
  • Apply local strapping (see fan design) to remove tension
  • Increase heel height inside the shoe up to ¼ in 6mm
  • Once pain is easier, longer term help can be gained from an orthosis.
  • Stretching once the condition improves helps prevent reoccurrence as shown with Thera band.
  • Also use stretches for the tendo achilles
  • Use a small rolling pin, cylinder to provide some deep massage

** Warming creams contain salicylates such as methyl salicylate and they are heat making when rubbed onto skin. The idea is to bring fresh blood to the area and speed up healing on non-infected unbroken skin.

 

 

Thanks for reading ‘More heel problems’ written by David Tollafield. November 2019