Heel Pain: Is it a Spur, Plantar Fasciitis or something else?

You put your foot to the floor as you turn out of bed and as soon as you stand and walk your first step and its grabs you. Ouch! Heel Pain! You hobble a few more steps just to try to get your foot moving.

We understand how much your pain can limit your ability to perform simple tasks around the home, work duties and enjoy your hobbies and interests.

We often find pain continues because the cause is not being addressed or worse… it has been misdiagnosed! So my question to you is… are you sure that your pain is a Heel Spur or Plantar Fasciitis?

Plantar Fasciitis is often misdiagnosed as Heel Spurs and likewise, other conditions affecting the heel can easily be diagnosed as Plantar Fasciitis.

Conditions such as Abductor Hallucis Tendinosis, Tarsal Tunnel Syndrome, Calcaneal Nerve Entrapment, Fat Pad Contusion, Calcaneal Stress Fracture, Sprain Spring Ligament just to name a few. So how do we distinguish what the true cause of your pain is?

  1. The History of your Symptoms
    • Do you recall a trauma to your foot? Jumping, Falling or stumbling?
    • How do you describe your pain, its intensity and duration
    • Have you purchase new shoes or started a new footwear/barefoot habit?
    • Increased training or started new activities?
  2. Aggravating and Relieving Activities
    • What aggravates your symptoms?
    • What relieves your symptoms?
    • What treatment have you already tried? Did it reduce or worsen your pain?
  3. Our Physical Assessment
    • We try to find the exact location of the pain
    • We assess the area for other signs of injury eg bruising, swelling, redness, warmth, foot/alignment
    • We ask you to describe the pain and if pain refers anywhere
    • We assess your range of motion, muscle function and ask you to perform mini functional tests to see how it compares when your body is weightbearing and moving
    • We then look at he rest of your joint movement and alignment, muscular activation pattern and neurological input in your hips, knees, ankles or feet to see if there are other factors which may have contributed to your symptoms occurring.

Heel Spurs

Heel Spurs are a calcified growth often seen in an x-ray. In general it is not usually the cause of pain in most individuals with Heel Pain and is often an incidental finding during xray. Many people without heel pain will also have a heel spur.

Heel Spurs occur when tension or injury has occurred to the tissues that attach to the heel bone eg Plantar Fascia and the trauma continues to occur for longer than 6-8 weeks. The body with deposit calcium to strengthen the insertion point to the bone.

Many people who are shown to have a heel spur, do not have pain or symptoms. For those with pain, it is likely that there is an underlying cause for their pain. This underlying cause is often Plantar Fasciitis

Plantar Fasciitis / Fasciosis

The Plantar Fascia is a broad band of tissue that attaches from the heel bone which runs through the arch and fans out to the toes. Micro injury occurs causing degeneration of the collagen in the tissue which is responsible for your pain and swelling.

It is common in people who have changed footwear or increased activity recently for example, started exercising or increase their intensity of training.

Overloading the tissues can also occur with repetitive load for example, running the same route for example on the road with a camber to one side which might increase the load on one foot.

Weak or tight muscles in the hips, thighs and legs can lead to a compensation pattern which may leave the Plantar Fascia vulnerable to overuse. There is also some evidence that compression may be a contributing factor in some cases.

So how can we tell that you might have Plantar Fasciitis?

Pain is often in the first steps of the morning often improving after the tissue has stretched. Pain on standing for quite some time as well as after sitting for a period of time often can give it away.

The location of the pain would be in a very specific spot on the heel. This pain is usually able to be reproduced if we press into the medial heel. Some people may also have pain if their big toe is bent upwards towards their shin.

Barefoot weightbearing can be very painful for some people.

Quite often an ultrasound will show some thickening of the plantar fascia.

Treatment of Plantar Fasciosis is best initiate as soon as possible while it is in the new acute phase. Your individualised management plan will will address your concerns incorporating a multi-modality approach. For example, Strapping, Individual Exercise programs, Footwear Guidance, Massage Therapy, Foot Mobilisation, Dry Needling and Orthotic Therapy.

How can we tell if it is not Plantar Fasciitis?

Firstly, your history of your symptoms and trauma gives us the best clue. Also, your aggravating activities may not be a usual presentation of symptoms for Plantar Fasciitis. A good example such as a nerve entrapment will cause a different sensation such as burning, tingling or pins and needles which might send a referring pain or symptom up or down the foot and leg. The symptoms will appear in a different region of the foot. Often a specific movement assessment will also show issues with the discomfort. Obtaining the correct scans to image your foot will also help to accurately diagnose your complaint.

Summary

Whilst Plantar Fasciitis is quite common, a thorough investigation through a Biomechanical Assessment is worth the investment to accurately assess and diagnose your pain to get you on the right track and back to your passions.

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