Heel & Achilles Pain Management in Canberra
How can a podiatrist treat heel pain?
Unfortunately, there is no ‘one size fits all’ approach to treating many musculoskeletal injuries. Treatments for the same condition can be different which is why what worked for your friend and family member might not have the same outcome for you. Your treatment depends on what we find in your assessment, and your lifestyle, goals, and level of activity. Furthermore, sometimes we send people off for diagnostic imaging and other times we use don’t because our assessments and clinical expertise have provided a conclusive diagnosis.
We like to break treatment for musculoskeletal injuries down into 3 phases:
- Our goal is to reduce severe, all day pain.
- Achieved through offloading the site of pain through taping, padding, orthotics, footwear changes, activity modification and/or braces.
- We may provide hands on treatments such as mobilisation, dry needling, cupping, massage and gentle home exercises.
- Pain in the morning or pain when walking after resting is allowed to proceed to next phase.
- Not all patients will require this phase of treatment if their pain is already considered stabilised.
- Our goal is to reduce pain in the morning and when walking after resting.
- In addition to the hands-on treatments mentioned in phase 1, shockwave therapy and gradual loading exercises may be recommended.
- Our goal is to return function to the previous state and/or the same function of the asymptomatic side.
- Achieved through personalised exercise prescription, return to full activity and pain neuroscience education.
Causes of pain in the back of the heel
The Achilles tendon is the largest tendon in the body and connects your calf muscles to the back of the heel. Achilles tendinopathy is described as inflammation or pathology of the tendon. Common symptoms of Achilles tendinopathy include stiffness in the morning that warms up after a few steps and pain that increases with higher like jumping, hopping, or running.
The paratendon is a thin sheath that surrounds the Achilles tendon. Paratenonitis is inflammation of this structure and occurs mainly due to friction from repetitive loading. The area can become red, swollen, and hot to touch. The symptoms normally get worse with more exercise, which is different from tendinopathy which typically decreases as it warms up.
Bursitis is inflammation of a bursa, which is a fluid-filled sac that helps to reduce friction between bone and tendons or muscles. Irritation to these bursas can occur with repetitive friction.
The sural nerve sits along the calf and travels just outside of the Achilles tendon. Impingement of the nerve can feel like pins and needles, burning, or numbness on the side of the Achilles tendon.
The plantaris is a smaller and often overlooked calf muscle. It travels just next to the Achilles tendon. Plantaris tendinopathy is normally in a location that is a bit higher than a midportion Achilles tendinopathy.
Pain can be vague in location and always replicated with plantarflexion (pointing down) of the ankle. Pain caused by impingement generally doesn’t increase when load is increased.
Causes of pain in the base of the heel
Injuries include tears, fasciitis, fasciopathy, fasciocis. The plantar fascia is a thick fibrous band on the bottom of the foot. It is attached to the heel bone (calcaneus) and fans toward the toes. It supports the medial arch and several muscles inside the foot.
There are several peripheral nerves that can get injured from/stuck in other structures like muscles, tendons and heel spurs causing pain. This can be accompanied by other neurological symptoms including numbness, burning and pins and needles.
We all have fibrofatty padding under our heels to cushion our heel bone and soft tissue from the impacts of movement. This padding can thin, be bruised and feel loose.
Overuse of small intrinsic foot muscles that run from the heel including the quadratus plantae, abductor hallucis, abductor digiti minimi, flexor digitorum brevis muscles.
The heel bone is called the calcaneus. It can also sustain stress fractures and fractures from too much loading and force.
The heel bone is called the calcaneus. It is a rather bumpy bone that can form spurs in many different spots. Plantar heel spurs are the ones that form underneath, on the bottom of the bone.
Some people with pain under their heel are told it is because they have heel spurs. This isn’t exactly true. Heel spurs are not the cause of the pain in many cases of heel pain. The pain is often a result of a soft tissue condition. We don’t fault people for thinking a heel spur is the cause of their heel pain. The pain is awful and can feel very deep, bony and bruised.
It is very unlikely that you will need surgery to remove the heel spur. We like to treat you and not your x-ray, and in most cases removing a heel spur may not address your pain. In most cases, a throughout musculoskeletal assessment and treatment plan to address the pain and biomechanical abnormalities will prevent the need for surgery. There are many non-invasive treatment options for heel pain available at New Step Podiatry.
Your podiatrist will do a thorough biomechanical and musculoskeletal assessment, where we will gather information about you.
What to expect in an Achilles injury assessment by a Podiatrist
Your podiatrist will do a thorough biomechanical and musculoskeletal assessment, where we will gather information about you. This can include:
Medical history (including any issues affecting your hips, knees, legs, ankles, and feet)
Your activity levels
Desired outcomes you wish to reach from seeing us
Overall joint movement & muscle strength specific to your injury
Achilles tendon specific testing
Foot and ankle posture and behaviour with different movements
Shoe assessment
Gait analysis (in the hallway, using a treadmill or with PodoSmart insoles)