In our daily clinic, we see a good number of people who come in with heel pain. This is a prevalent condition in Singapore. Treatment for this condition involves a wide variety of choices; it can be quite confusing as to which healthcare professional a patient should see.
While the most common cause of heel pain in Singapore is repetitive musculoskeletal injury, there exists uncommon serious conditions which can mimick the pain. It is advisable to see a Doctor or Podiatrist for an accurate diagnosis.
Regarding the common heel pain, you may often hear 2 different names for it: plantar fasciitis, and heel spur syndrome. For the most part, they are 2 different names for the same condition. But there are some differences which can impact the treatment plan.
This describes a recent-onset bout of inflammation at the plantar fascia, which is a thick connective tissue band stretching across the bottom of the foot. The plantar fascia spreads out under the ball of the foot on one end, and inserts under the heel bone on the other end.
Recent-onset heel pain describes pain duration of less than 6-8 weeks. It is easier to cure, because the treatment goal focuses on resolving the inflammatory process.
In Singapore, many people don’t actually have “plantar fasciitis” by the time they get around to visiting a foot specialist for consultation. The plantar fascia injury has already become chronic, and the initial inflammatory phase is already over. Many treatments which focus on treating acute inflammation, become ineffective for chronic heel pain.
As mentioned previously, many instances of “plantar fasciitis” actually don’t involve any inflammatory process. Instead, the plantar fascia is weakening under chronic collagen degeneration and tissue death. On foot X-rays, those with chronic heel pain may have a calcaneal spur (heel spur). Hence the name “heel spur syndrome”.
However, calcaneal spurs do not cause heel pain – people without heel pain may also have spurs on X-rays. The “bone spur” is simply the reactive calcification of a plantar fascia undergoing chronic stress. The pathology and pain still stems from the plantar fascia.
The existence of the heel spur clues the clinician in to the fact that the “plantar fasciitis” has been going on for a long time. It is not necessary to surgically remove the heel spur, to cure the chronic heel pain.
We’ve seen patients who have lived with severe heel pain for years. They changed the way they walk in order to accommodate the pain: Tip-toeing in the morning until the pain wears off, or simply preferring to stay at home as much as possible and choosing not to go places. This isn’t a way to live for something which is curable with the right diagnosis and treatment. Untreated heel pain impairs your walking, your work, and your personal life tremendously.
In some cases, time and self-treatment are adequate for the heel pain to calm to tolerable levels. However, the root cause of the pain has not been medically addressed. Many patients describe having off-and-on heel pain for years, gradually getting worse each episode. The heel pain can always return, and each time it will become more difficult to treat or heal.
Our podiatry clinic focuses on healing without surgery. Accommodating for the lifestyle in Singapore, the treatment strategy is individually calibrated with the right footwear, therapies, and orthotic insoles which are customised specifically to your feet and to your heel pain condition.
See a Podiatrist for proper diagnosis of the type of heel pain and proper treatment.
Conservative treatment options can include the use of foot orthotics (shoe insoles), shockwave, ultrasound therapy, sports taping, and focused stretching exercises. With well-calibrated treatment and patient adherence, most patients see significant improvement.
Surgery may be advised if the condition is severe and resistant to conservative treatments. Our Podiatrists work closely with expert Orthopaedic surgeons specialised in foot & ankle procedures. Podiatrists often handle the post-operative rehabilitation for lower limb surgeries with wound care, foot orthotics, and orthopaedic footwear.
Author: Principal Podiatrist Michael LAI, DPM