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Case Study March 2017: Heel Spur

A 41 year old lady presents to the Sydney Heel Pain Clinic, Miranda, complaining of pain from a heel spur. She reports to the podiatrist, Rami Ghorra, that she feels pain first thing in the morning when she gets out of bed. She has been feeling pain in the heel for approximately 6 months but prior to this has never complained of a heel spur. There is a noticeable pain following long periods of being seated and at the end of the day after being on her feet at work. This lady works in the retail space and has had a physical job for the past 12 years. She describes a sharp stabbing pain under the base of her heel which is typical in patients who have a heel spur. She also reports the feeling of a stone bruise or a pebble in the shoe. A colleague that she works with informed her that she may have a heel spur as she herself experienced the same condition recently. After being in pain for three months this patient went to see her local doctor who arranged a foot x-ray.  After careful examination of the X-ray Rami the podiatrist was unable to clearly see a heel spur. The patient was informed that the pain that she was experiencing was not coming from a heel spur, but likely from something else such as plantar fasciitis. This is a common misunderstanding amongst patients who suffer from pain in the base of the heel. For many years the heel Spur has been the focus and has been incorrectly assumed to be the cause of heel pain. More often than not, patients who complain of a heel Spur actually have plantar fasciitis. During the appointment, Rami carried out an assessment of the patient’s footwear only to find that she was wearing shoes that offer minimal support. This patient was using flat and flexible shoes that were very soft and comfortable but lacked support. Patients complaining of pain from a heel spur often lean towards soft shoes as they feel that they need more cushioning under the heel. However, this is counter to treatment as a softer shoes collapses under load allowing the foot to work harder. This patient also reported calf tightness and a feeling of cramping in the calf muscles towards the end of the day. She explained to the podiatrist that sometimes she wakes in the middle of the night with cramps in both of her lower legs. She has tried to use magnesium powder to counter this problem but has found only slight relief. This patient has been rolling her foot on a frozen water bottle on a daily basis and reports that she feels very little relief. She has also been to see her local massage therapists who has applied deep tissue massage to the sole of the foot under the base of the heel around the heel spur. Following six sessions with the massage therapist this patient decided to stop treatment as her condition was feeling a little worse. Feeling frustrated she decided to do some online research and found some foot stretches on YouTube. The foot stretches involved hanging her heel off the back of a step and she reported immediate but very temporary relief. Due to the temporary relief she continued to carry out these stretches several times a day. However, after 5 days of foot stretches her condition began to get much worse. It should be noted that patients who complain of a heel spur often aggravate the condition by carrying out home rehabilitation. Some of the common exercises do provide immediate pain relief that is very short lived but that aggravate the condition overall. Naturally, this patient stopped these exercises and decided to seek treatment from a qualified sports podiatrist. Prior to feeling pain from the heel spur, this lady enjoyed going for morning walks each day. Since the heel pain, she has stopped exercising and reports a slight increase in body weight.

Physical Assessment For Heel Spur

Firm pressure was applied to the base of the heel in the area where a heel Spur can develop. The patient reported pain as the podiatrist palpated the tender area. The area of concern correlated with the attachment of the plantar fascia onto the base of the heel. Pain was experienced centrally and also quite medially which is common in patients with plantar fasciitis. Rami reported to the patient that the pain she was experiencing was not from the heel spur, but that she was suffering from a very common condition known as plantar fasciitis. The type of pain that she felt as pressure was applied was identical to the pain that she experienced on a day to day basis. The patient was asked to stand and raise up onto her tiptoes which she did without reporting pain. She was then asked to perform the same exercise on a single leg. The patient reported mild pain during this exercise which was normal for a patient complaining of a heel spur. Once again the patient was informed that the pain she was experiencing during this exercise was coming from the plantar fascia and not the heel spur.

Treatment: For Plantar Fasciitis Not Heel Spur

After assessing this patients biomechanics the podiatrist decided to treat this condition with some footwear changes, calf stretches, rigid sports tape, and shockwave therapy.  The patient was given a list of shoes that she could buy which suited her foot type and architecture. The biomechanics of her feet did not suit the footwear that she was currently using. Patients complaining of pain from a heel Spur benefit from more rigid and supportive shoes as opposed to soft comfortable and cushioning shoes. The more rigid and supportive shoes support the plantar fascia and this helps the conditions to normalise. The patient was treated with 2000 reps of Shockwave therapy at 5HZ and 1.4 bars of pressure. The treatment was well tolerated. Rigid sports tape was applied to the foot and the patient was asked to return to the clinic in 5 days so that this strapping could be replaced and further shockwave therapy treatment applied. The patient was advised not to worry about a heel spur but to be more mindful of the stress and strain on the plantar fascia which attaches to the base of the heel, and runs through the sole of the foot. She was assured that her condition would settle in approximately 6 weeks. If there was insufficient Improvement with this patients’ condition then other treatment options would be considered such as orthotic therapy, dry needling or the use of an immobilisation boot. She was also advised that patients complaining of a heel Spur recover quicker if they apply ice packs to the affected area on a daily basis for approximately 30 minutes.

6 Weeks Follow Up

Following patient education, this lady understood that the heel Spur was not her problem and hence she focused on the plantar fascia. The weekly sessions of shock wave therapy, strapping and the use of ice packs provided significant relief.  The patient reported that her pain has subsided sufficiently. She did report to the podiatrist that on occasions she would feel some pain and stiffness first thing in the morning, but this was short lived and rare. She was comfortable in her new shoes that Rami recommended. This lady was advised to return to the clinic if her pain returned or deteriorated. She understood that the heel spur was not a problem but rather the plantar fascia, and to this and she should continue to support the foot with appropriate shoes and remove stress from the plantar fascia with regular calf stretching. Please note: The information in this case study is specific to one individual and should not be taken as general advice. If you have a heel spur or plantar fasciitis you should seek medical advice.

 
Written by Karl Lockett

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Chronic Plantar Fasciitis

Chronic Plantar Fasciitis – Symptoms

Patients with Chronic Plantar Fasciitis will have been suffering with symptoms for more than 2-4 weeks. The symptoms become consistent and the patients are able to see the patterns. Usually, the pain arises every single morning without fail. It is sometimes described as groundhog day – patients know that as soon as their foot hits the ground in the morning they will feel heel pain, which eases after a few minutes of walking. These patients with Chronic Plantar Fasciitis also know that later in the day if they sit down for a long enough period of time they will be sore as soon as they stand up and start walking. Some patients with Chronic Plantar Fasciitis will also experience throbbing and shooting pains at rest – while driving or sitting down.

Chronic Plantar Fasciitis – causes

More often than not, patients with Chronic Plantar Fasciitis will have tight calf muscles. The tight calf muscles pull on the heel and this allows the acute plantar fasciitis to develop into Chronic Plantar Fasciitis. People who stand up at work or walk for long periods will develop Chronic Plantar Fasciitis as there is no rest for the heel. Flat and flexible shoes that are unsupportive can cause this condition too. They allow too much stress on the foot and the continued strain on the heel produces more and more inflammation. People who stand up at work or walk for long periods can prevent the condition from developing by wearing more supportive shoes. Shoes with a slight heel and a more rigid sole provide more support. If a patient is suffering with acute Plantar Fasciitis and they continue to wear the wrong shoes they are almost certainly going to develop Chronic Plantar Fasciitis.

Chronic Plantar Fasciitis – X-rays don’t help

X rays will show a heel spur and calcification of the Plantar Fascia or Achilles tendon. They rarely show inflammation of the Plantar Fascia. To this end, the X-ray does not help the Podiatrist to help the patient (Heel spurs rarely cause pain). Patients with Chronic Plantar Fasciitis are better off having an ultra sound scan rather than an X-ray. This will help to detect micro tears in the Plantar Fascia in addition to inflammation. The inflammation confirms Chronic Plantar Fasciitis, although a Podiatrist who is experienced in treating the condition will usually be able to diagnose the condition during the consultation.

Chronic Plantar Fasciitis – forced changes to lifestyle

Frustration sets in as patients with Chronic Plantar Fasciitis have no choice but to give up their morning walks, stop running, avoid tennis or reduce their preferred form of activity. Even the pet dog starts to suffer as he misses out on his daily walks! All of the above situations are extremely common in patients who attend the clinic for Chronic Plantar Fasciitis treatment. This problem is compounded by the fact that inactivity leads to weight gain – and weight gain leads to tighter calf muscles and more stress on the feet. It’s a vicious circle and requires intervention.

Chronic Plantar Fasciitis – treatment

We have to unload the fascia – fact. Patients with Chronic Plantar Fasciitis MUST engage in treatment that is designed to take stress away from the plantar fascia. Strapping, orthotics, a change in shoes, or an immobilisation boot if the condition warrants it – one of these forms of intervention is almost always required for patients suffering with Chronic Plantar Fasciitis. Patients MUST stretch their calf muscles too (correct technique is crucial or else can be detrimental) if they are found to be tight. If you are suffering with Chronic Plantar Fasciitis and you would like to learn more you may wish to click on the following: Plantar Fasciitis Treatment  

 
Written by Karl Lockett

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Plantar Fasciitis or Heel Spur

This article has been written to clear up the confusion that surrounds two of the possible causes of pain underneath the heel. Patients and practitioners alike seem to be using 2 different terminologies (Plantar Fasciitis or Heel Spur) to describe the same condition when in fact a Heel Spurs and Plantar Fasciitis are very different ailments.

So what causes heel pain, the Heel Spur or Plantar Fasciitis?

There is a common misconception that pain in the heel is caused by a Heel Spur when in fact it isusually caused by inflammation of the plantar fascia – Plantar Fasciitis. Heel Spurs can be present on the foot without there being any pain at all.

An example of a common heel pain situation follows:

A patient arrives at the Podiatry clinic and hands over an X-ray of the Left foot and an X-ray of the Right foot. The X-ray clearly shows a Heel Spur on both feet. The Heel Spurs look like small spikes coming away from the bone, shaped like small rose thorns. Further into the consultation the patient reveals that they have heel pain in only one foot, not both. It is fair to say then, that in this situation, that the Heel Spurs are not causing the heel pain, but that something else is. Typically, that something else is Plantar Fasciitis. Surely, if the Heel Spurs were the cause of heel pain in this patient then he or she would be experiencing pain in both heels.

Why the confusion?

It has been extremely common place for quite some time, that a large percentage of patients suffering with heel pain will visit their local GP before visiting anyone else. For many years, the common approach to these types of foot problems by a GP is a referral for X-ray. Understandably, these spikey bits of bone on the heel, that stand out like a sore thumb on the X-ray were, and sometimes are, still focused on by the GP and the patient. Heel Spurs look so out of place that it’s easy for the patient to accept that this spikey piece of Heel Spur is causing their pain. However, with the above information in mind it is safe to say that the Heel Spur isn’t the cause of pain, as they can be seen on X-rays of a pain free foot!

So what does cause pain?

Plantar Fasciitis causes pain. Of this there is no doubt. Plantar Fasciitis usually causes inflammation at the site of the Heel Spur, hence the confusion for patients and some practitioners. When we poke around at the site of the Hel Spur, we are prodding and pushing against an area of inflamed plantar fascia. When a patient reports pain from a Heel Spur they are really describing Plantar Fasciitis.

Why is it necessary to differentiate between a Heel Spur and Plantar Fasciitis.

An accurate diagnosis and a better understanding of the problem at hand will lead to the most appropriate treatment plan. The treatment plan that one would use for a Heel Spur would not necessarily help relieve Plantar Fasciitis, and vice versa. Most patients who misunderstand this concept will usually try to use soft shoes and soft pads inside their footwear in an attempt to cushion the Heel Spur. However, soft materials and cushioning create instability, and instability leads to further strain on the plantar fascia, which aggravates the condition. Therefore, correct treatment of Plantar Fasciitis should be to relieve strain on the plantar fascia with more supportive shoes and stronger materials as opposed to tying to cushion the heel with softer ones.

Summary

To conclude, it is important to understand that a Heel Spur does not cause pain, but rather the inflammation of the plantar fascia surrounding the Heel Spur. This really indicates that Plantar Fasciitis causes heel pain and not the Heel Spur itself. Therefore, we must treat the Plantar Fasciitis and focus less on the Heel Spur. Learn about the treatment here: Plantar Fasciitis Treatment

NB: This article refers to plantar heel spurs underneath the heel and not posterior heel spurs at the back.

 

Written by Karl Lockett

What causes Plantar Fasciitis?

What causes Plantar Fasciitis? Its no coincidence. The majority of patients presenting with heel pain have gone from zero to hero overnight!

The amount of times that the heel pain patient reports that they made the decision to “get fit” is uncanny.

They usually join a bootcamp,  hire a personal trainer or join the gym. Often, there are exercise routines that involve explosive movements, hill running, jumping or squatting. This creates tight calf muscles which pull on the heel and also puts a lot of stress on the foot. The plantar fascia is put under a lot of strain and then becomes inflamed very suddenly : hence plantar fasciitis.

Regardless of the heel pain, there is a desire to keep training and to lose weight and so the routine continues, which adds further to the pain caused by the plantar fasciitis. Most patients find that they can get through a training session because the heel pain eases after warming up. However, a few hours later, and the morning after can be excruciating!

So what should happen? Well, there needs to be a much slower return to exercise, with ample rest days in between and regular stretching afterwards. Calf muscle stretching is crucial as this prevents the pulling on the heel.

Once heel pain has taken a hold then its important to seek treatment as soon as possible. Plantar fasciitis can persist for many months if left untreated.

With the correct heel pain treatments in place it is sometimes possible for patients with plantar fasciitis to keep training. However, this is not always possible and a few weeks rest can be required while the treatments take effect.

  • Call 93883322 to speak with our experienced practice manager.
  • Click here to request an appointment:
  • Text “help” to this number 0415977624 if you would like a pre consultation chat before committing to an appointment

You may also read about Plantar Fasciitis Treatment for more info.

 

Written by Karl Lockett

Plantar Fasciitis Treatment Shoes (Sydney Heel Pain Clinic)

We are seeing too many flexible shoes in the clinic!

Plantar fasciitis will settle much quicker with stable shoes. Remember, comfort is one thing, support is another!

You would not climb Mount Everest in your slippers would you? Even though they are comfortable.

Read more about: Plantar Fasciitis Treatment

If you are still struggling with plantar fasciitis after engaging in treatment then please consider your footwear.

  • Call 93883322 to speak with our experienced practice manager.
  • Click here: Contact Sydney Heel Pain to request an appointment:
  • Text “help” to this number 0415977624 if you would like a pre consultation chat before committing to an appointment

 

Written by Karl Lockett

The following article relates to Plantar Fasciitis Treatment.

Try to think of Plantar Fasciitis as a strained or a torn ligament in the sole of your foot. The ligament is pulling away from the heel bone, causing heel pain and arch pain.

Plantar Fasciitis Treatment

Therefore, the most reliable way to cure Plantar Fasciitis is to use orthotics for a few months, while the fascia heals. However, standard orthotics / arch supports will not help as they are designed to push upwards against the sole of the foot, which means they push against the plantar fascia. Your Plantar Fasciitis Treatment should not involve anything that puts pressure against the fascia or the sole of your foot. This includes rolling your foot on a hard object.

At Sydney Heel Pain clinic, as part of your Plantar Fasciitis Treatment , you will be fitted with an alternative orthotic which will relieve strain from the fascia and prevent it from pulling on the heel bone. Your Plantar Fasciitis will settle in a matter of weeks. (These orthotics WILL NOT push against your arch or your Plantar Fascia)

If you would like to read more articles relating to Plantar Fasciitis Treatment please visit our blog page Plantar Fasciitis and Heel Pain Blog

To book in for your Plantar Fasciitis Treatment at Sydney Heel Pain you can call us on : 02 94397811

 
Written by Karl Lockett