Heel Pain

Heel Spurs

Heel Spurs – A side effect of Plantar Fasciitis?

Do you have pain in the arch of your foot when you first put your foot down to walk in the morning?

You may well be suffering from a condition called plantar fasciitis (‘plantar fasciopathy’). The plantar fascia is designed to provide shock absorption for the arch of the foot and if overused, can become painful and interfere with daily and recreational activities.

A ‘heel spur’ is a bony growth that forms on the heel as a result from prolonged or excessive pulling of the plantar fascia from its attachment on the bone. Activities such as prolonged walking, running and dancing are the common causes.

Fasciitis

A heel spur may or may not be present with plantar fasciopathy, therefore, an X-ray is not needed when determining a diagnosis. In addition, a heel spur may even worsen on X-ray once symptoms have completely resolved.

The take home message… If you have been told you have a heel spur, or a heel spur is present on an X-ray, don’t stress, it may not mean anything! It’s best to go and get your condition properly assessed from a physio.

The Worst and Best Shoes

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We’ve all heard of the phrase ‘beauty is pain’, but could you shoes be destroying your feet?? The answer is Yes! Here are my 5 top shocking shoes……

  • The higher they are – the further you fall! Or roll….. Ankle sprains and nasty fractures often result from a lateral roll of the ankle when wearing heels. The heel height alone puts extra stress on the ball of the foot (see pic above) and shortens the achilles tendon. In fact, some women who have been wearing heels for a long period of time find it hard to get their heel to the ground when not wearing heels! Thats some serious foot fauxpas! The solution? Go low….. the lower the heel the more natural the foot position.
  • Beware the stiletto heel! Pinpoint heels a have a smaller the base of support and result in a greater chance of you wobbling around like a baby giraffe on stilts! What this means is that there is much more of a chance of tripping, rolling or slipping! The solution? Opt for a more chunky heel which will better distribute your weight.
  • The next type of dangerous shoe is the pointy toe heel! Not only do you have to deal with the effect of the heel – the triangle shape of it forces your forefoot into an unnatural position and can result in the development of unsightly bunions! (see pic above). The solution? Pick a heel with enough space for your forefoot – or at the very least one which goes triangle shaped after your toe line!
  • On the flip side of the stiletto you also need to watch out for the completely flat shoe. Those are the ones with zero arch support. This covers the ballet flats and the thongs (or flip flops for the British). The lack of support here makes your foot quite vulnerable to developing plantar fasciitis – a painful condition involving inflammation and sometimes tearing of the connective tissue underneath your arch. So if you opt for these type shoes – make sure you add some support (ie in the form of an orthotic or a thong with some built in arch support).
  • The final shoe I’ll ruin for you is the hard soled wedge! Although these offer a much nicer support base – the rigidity of the wedge can restrict normal movement of the foot. Try to choose a wedge with a little flexibility to counter this.

So when all is said and done…. most of the shoes that look amazing on the catwalk are not so amazing for your feet. As I said earlier… beauty is pain so choose your shoes wisely! Wearing these not very sensible but ever so sexy shoes will not do too much damage if worn in the short term. In saying that you need to be aware of long term use and day to day poor footwear choices! Your feet will thank you for it……

shoe fall

Achilles Tendinopathy

achilles-tendinitis-pain

Achilles Tendinopathy is a degenerative condition characterised by pain and stiffness in the Achilles tendon.  It is different from it cousin Achilles Tendinitis because in a tendinopathy there is an absence of an acute inflammatory response and therefore it is often poorly responsive to Non-Steroidal AntiInflammatory (NSAID) medications.

A misconception is that as a tendon degenerates it becomes thinner and more prone to tearing like a cartoon rope imagesbut this is an inaccurate image and one that can lead to chronic pain behaviours.  Degenerative tendons look more like old rope which has thickened.  Micro tears have occurred but the overall effect is that the tendon is thicker

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Thats often why the tendon feels thicker than on the non affected side and may contain focal nodules.

It’s important to realise that this does not mean that your Achilles is going to snap…far from it, in fact there is no evidence that shows that achilles tendinopathy progresses into tears.

So…thats all well and good….but what to do about it?

Well..lets look at it from a microscopic perspective…if we want the tissues to heal and recover we have to cease irritating it.  ACTIVITY modification is therefore an important step….In other words REST…take it easy.   Even the use of heel raises can offload the tension in the system, this can be especially useful in the more painful early stages.

Kinesiotape (stretchy elastic tape) can be used…and it looks so cool too!! (thats me being sarcastic!).  Use it if it creates at least a 50% reduction in symptoms, if it doesn’t don’t worry.fa5b3b1f18c3edffd54f1061ba772d47

Application of ice and ice cube massage has been shown to cause a local vasoconstrictive response which can reduce neovascularisation (or the creation of useless small blood vessels that impede the healing process).  It’s worth a try.

Current evidence supports the use of extracorporeal shockwave (ESWT) therapy (a machine that works like a mini jack hammer!) and eccentric exercise.  Although the link just posted shows the patient dropping from a normal step,  new research indicates there may be additional benefit from having a rolled towel placed underneath the toes to further increase the windlass effect of the foot.  There appears to be benefit in adding loading to the exercise, even if it induces some pain.

Dynamic calf stretching and foam rolling have also been shown to have some beneficial outcomes for some so they are worthwhile adding into  management program, but the mainstay of management still needs to be eccentric exercise.

Despite implementing these strategies some people may suffer from persistent or recalcitrant pain.  For these it may be worthwhile discussing with their doctor whether glycerin trinitrate (GTN) patches would be a worthwhile addition.  The jury is still out as to whether injections should play a role in management with a 2015 Cochrane Review reporting that there was little evidence to suggest injection therapy (including Cortisone and Plasma Rich Protein (PRP) injections) was worthwhile. It seems the key is

1. let it settle

2. address any biomechanical dysfunction

3. load it progressively over time.  But the most important thing?….

Be patient and be positive.

A final note from a Sports Physician John Orchard who has a special interest in tendons

The body – eventually – does a good job of curing the pain of Achilles tendinopathy itself in the vast majority of patients, probably with the help of the patient being advised or stumbling upon the formula of moderately loading the tendon just enough to strength it but not enough to overload it.