While the most common cause of heel pain in Singapore is repetitive musculoskeletal injury, there exist uncommon serious conditions which can mimic the pain. It is advisable to see a podiatrist for an accurate diagnosis.
Two terms are commonly used to describe heel pain – plantar fasciitis and heel spur syndrome. For the most part, they are two different names for the same condition, but there are some differences that 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 or discomfort lasting fewer 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 are ineffective for chronic heel pain.
As mentioned previously, many instances of “plantar fasciitis” do not actually involve an inflammatory process. Instead, the plantar fascia is weakening due to 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 stem from the plantar fascia.
The existence of the heel spur clues the clinician into 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. Non-surgical treatment can also be an effective solution.
We have seen patients who have lived with severe heel pain for years. Often, they have altered the way they walk in order to accommodate the pain – Tip-toeing in the morning until the pain wears off, simply preferring to stay at home as much as possible or choosing a more sedentary lifestyle. This is not 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. The treatment strategy includes shockwave therapy and orthotic insoles which are customised specifically to your feet and your plantar fasciitis (heel pain) condition.
See a podiatrist for a 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 will 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 and ankle procedures, often handling the post-operative rehabilitation for lower limb surgeries with wound care, foot orthotics, and orthopaedic footwear.
Heel Pain is a feeling of discomfort or pain in or around the back of the foot. There are many possible causes for heel pain, but some of the most common are plantar fasciitis, stress fractures, and tendonitis.
Heel pain is caused by injuries to that area of the foot. These injuries are typically divided into three main categories – Acute, Overuse, and Chronic. Acute injuries are those that are caused by a single traumatic event such as sprains, falls or fractures. Overuse injuries share some similarities with chronic injuries and are caused by repeated actions that affect a particular group of soft tissues such as muscles and joints. Left untreated, overuse injuries frequently become chronic injuries as they rarely heal completely on their own. Chronic injuries are injuries that have persisted for over three months (or longer depending on definition).
As there are numerous conditions responsible for heel pain, the symptoms also vary widely. Some of the symptoms include swelling or stiffness around the back of the heel, discolouration (typically red) or warm skin on the back of the heel, limited or painful movement, or discomfort when pressure is applied.
One of the most common causes for heel pain, plantar fasciitis is caused by an injury to the plantar fascia. The plantar fascia is the band of tissue that connects the front of your foot to the heel. It is responsible for supporting the arch of your foot and helps to support much of the weight of your body when you are on your feet. The plantar fascia also absorbs much of the shock caused by movement, which also frequently leads to injuries over time. Plantar fasciitis may also be caused by factors such as having a flat or high arched foot, excessive exercise and being overweight.
While heel pain may go away on its own after a period of rest, the underlying factors responsible for it typically persist until treated. This means that once the aggravating factors such as exercise or being on your feet for long periods of time will trigger the injury once more. Moreover, if left untreated, these injuries can result in permanent damage to the plantar fascia such as a rupture which can only be resolved through surgery.
There are two main stages for the treatment of heel pain. The first is to address the pain by reducing and relieving it to the greatest extent possible and the second is to address the underlying causes of it. Reduction of pain can be performed in a number of ways – analgesics and rest, shockwave therapy, physical therapy and other therapeutic modalities are all possible. However, for maximum effect, patients should complete the course of treatment in its entirety. The second part of treatment is to address the underlying causes for the pain. Depending on the nature and severity of the problem, this can range from customised orthotic devices to surgical correction. The likelihood of surgery increases the longer the condition is neglected, so it is critical to seek treatment at an early juncture.