Heel Pain – Perform Podiatry

Signs Your Heel Pain Is From A Heel Spur

Heel spurs are a hot topic in our clinic – particularly around whether they’re the underlying cause of a person’s ongoing or recurring heel pain. There’s a lot of confusion and misconceptions around heel spurs, especially in relation to plantar fasciitis heel pain. Here’s what you should know about heel spurs from the heel pain experts.

What Is A Heel Spur?

A heel spur is a bony growth that develops on the underside of the heel bone (calcaneus). It typically forms in response to repeated stress or pressure on the heel, which causes calcium deposits to accumulate and harden over time. Heel spurs can range in size and shape, and they may or may not cause pain or discomfort. They are often associated with plantar fasciitis, a condition that involves inflammation of the tissue that runs along the bottom of the foot from the heel to the toes. It should be noted that bony spurs can develop in areas all around the body where a tendon attaches to bone. This includes a spur at the back of the heel bone, at the Achilles tendon.

What Causes Heel Spurs?

Bony spurs develop when soft tissues repetitively apply stress to the bone that they are attached to. This may be the result of overdoing it during exercise, poor foot mechanics that overload the tendons, medical conditions like arthritis or gout, wearing unsupportive footwear that leads to excess strain on the tendons, and may even be linked to the ageing process, where our bones and tissues naturally grow weaker.

What Are The Symptoms Of Heel Spurs?

Interestingly, the majority of people we see with heel spurs do not experience any symptoms, painful or otherwise, and the spurs are often detected incidentally on X-rays or other imaging tests. However, when symptoms do occur, they can include:

Pain: this is felt on the bottom of the heel. The pain is often described as a sharp, stabbing sensation that worsens with standing, walking, or running.
Inflammation: the plantar fascia (the tissue that connects the heel bone to the toes and the one affected in the condition plantar fasciitis), can occur alongside heel spurs. This can cause swelling, redness, and warmth in the affected area.
Tenderness: the area around the heel spur may be tender to the touch.
Stiffness: there may be stiffness or reduced flexibility in the affected foot.
Difficulty walking: the pain and discomfort associated with heel spurs can make it difficult to walk normally, especially first thing in the morning or after periods of rest.

How Are Heel Spurs Diagnosed?

The only way to confidently diagnose a heel spur is via x-ray medical imaging. With this said, it’s important to note that the majority of heel pain we see is not caused by heel spurs. Other conditions, primarily plantar fasciitis, as well as Achilles tendonitis, can also cause similar symptoms. Hence, x-rays are not often used to investigate heel spurs specifically further.

What Is The Treatment For Heel Spurs?

The treatment for heel spurs is very similar to the treatment for plantar fasciitis heel pain, given the spur develops at the insertion of the fascia. This includes using custom foot orthotics, wearing good, supportive footwear, and starting a rehab program with stretching and strengthening exercises. Your podiatrist will discuss your management plan in full during your appointment, once we confirm what the cause of your heel pain truly is.

Can Heel Spurs Be Prevented?

While not all heel spurs can be prevented, there are several things you can do to reduce your risk of developing a spur. This includes wearing well-fitting, supportive footwear, stretching regularly before physical activity, maintaining good technique and form during exercise, not going too hard too fast during exercise and straining your tendons, and keeping conditions like rheumatoid arthritis well managed.

How Long Does It Take To Recover From Heel Spurs?

The recovery time for heel spurs can vary depending on the severity of the condition and the individual’s response to treatment. With proper treatment, you can expect a significant improvement in your symptoms within six to eight weeks. In more severe cases, recovery may take several months.

Can Heel Spurs Come Back After Treatment?

Yes, if the original cause of the heel spur is not properly addressed, then they can recur when the tissues are again repeatedly strained and overused.

Do I Need Surgery For Heel Spurs?

In most cases, no. Most cases of heel spurs can be effectively managed with non-surgical treatments, such as physical therapy, orthotics, and wearing supportive footwear. Surgery is typically reserved for severe cases of heel spurs that do not respond to conservative treatments. Struggling with heel spurs? Our podiatry team is here to help. We’re proud to offer exceptional podiatry and heel pain care in Remuera, Newmarket and the surrounding areas. Book your appointment with our podiatrists by calling us on 09 523 2333 or book online here.

Causes Of Foot Pain At Work

When you’re busy at work with a seemingly never-ending task list, foot pain slowing you down and holding you back is the last thing you need. Foot pain can have a wide range of causes that require very different care at home, and treatment to get fixed, which is why it’s important to know the cause of your pain. Here are some of the common causes of work-related foot pain that our podiatrists see and treat in our clinic, based on the location you’re experiencing the pain. If your foot pain is extending over multiple areas, remember that injuries are not always isolated and can involve many structures.

Causes Of Heel Pain

If you’re getting pain at the bottom of the heel that feels worst first thing in the morning when you take your first few steps, then eases, and may radiate through your arch, then you may have plantar fasciitis. If the entire pad around the bottom of your heel is sore, your fat pad may be damaged. If the pain is affecting the very back of your heel, your Achilles tendon may be injured. You may also have developed a ‘pump bump’ – otherwise known as a Haglund’s deformity – that can occur if you regularly wear tight work shoes that rub against the back of your heel. General heel pain from tired, used muscles can also develop as a result of long periods of standing on your feet – especially when you’re regularly walking over hard surfaces, in unsupportive footwear, or you have poor foot biomechanics – like flat feet.

Causes Of Pain At The Ball Of Your Feet

Pain at the balls of your feet can indicate that you’re putting more pressure on the joints in the area. Often we see this being a result of the footwear worn at work, particularly if they’re heeled or have a firm base without much cushioning. It can also be related to repetitive movements performed as part of your work duties, like standing on the balls of your feet to reach files or moving over uneven ground where your toes are gripping the shoe at the front of the foot to try to gain stability. Your foot biomechanics and the tendency to naturally place more pressure on the balls of your feet can also play a big role. Having pain at the ball of a foot can indicate that you’ve damaged, or at least irritated, a joint, muscle or tissue. This can look like a plantar plate injury, bursitis, or capsulitis. If the pain is felt more in the middle of the foot, along one of the long bones, it may be metatarsalgia. If squeezing the foot from the sides elicits pain, you may have a Morton’s neuroma – the inflammation of the lining around one of the nerves in your foot.

Causes Of Ankle Pain

Pain on either the inside or outside of the ankle that makes it difficult and painful to walk can indicate damage to one of the ankle ligaments. This is usually the result of an ankle sprain or suddenly twisting or rolling your ankle, which can occur when working on an uneven or slippery surface. If you haven’t noticeably suddenly twisted the ankle, you may have an impingement where a tendon or nerve is getting trapped in the space between bones in the ankle. It may also be a tendon injury, where the tendon runs down the leg and crosses over the ankle and causes pain in this area, or the pain may be arthritic in nature.

Causes Of Pain At The Toes

Pain at your toes may be the result of an ingrown toenail, a corn or callus from your work shoes, or often, the direct result of work shoes rubbing against the feet. If the pain is at the big toe and towards the ball of the foot, it may also be sesamoiditis – which we often see in runners or those very active on their feet. If you have arthritis or gout, the big toe joint is also a common place to be affected.

Generally Sore And Tired Feet

If you’re struggling to pinpoint a specific location for your feet, and are feeling like you just generally have sore feet and legs, it may just be general muscular overuse as a result of your foot type, your footwear or your work conditions. A classic example is flat feet, where various muscles of the feet and legs must work much harder to move the foot through every step compared to a regularly arched foot. Unsupportive work shoes can also add to the problem by not helping to stabilise your foot within the shoe, meaning that your feet and legs will have to work even harder to maintain good stability and adapt to the uneven ground throughout your workday, tiring your muscles more. Hard surfaces and higher arched feet can also contribute to foot fatigue, and we often see tradies and those working on concrete that have high arched feet come in with sore feet and legs as their foot type means they may not absorb shock efficiently and the hard surfaces increase the forces that their feet are exposed to.

Need Help With Sore Feet?

Wherever your foot pain is located, it’s important to get to the cause of your pain and address it before it worsens. As we are on our feet all day every day, putting force and pressure through the feet, issues and injuries are highly likely to worsen if left untreated. Our experienced podiatrists are here to help and will not only treat your current pain but get to the root of the problem to help prevent the problem from coming back. Book your appointment by calling 09 523 2333 or book online

Are Heel Pain & Back Pain Related?

The heels and our back seem miles apart, so could there be a relationship between the two? According to studies, there is, with up to 75% of people with ongoing heel pain being shown to have unmanaged low back pain or low back dysfunction. As podiatrists, this tells us that if our heel pain isn’t resolving, we should also look at the nerve pathway between the lower back, down the leg and to the feet. To help you better understand the connection between the two and what it means, today we’re talking about the back problems that can lead to heel pain at the bottom of your foot. If you have any questions, feel free to send them to us via our Facebook page – we are highly experienced in heel pain and love helping Remuera & Auckland residents get rid of their heel pain.

Is your heel pain from sciatica?

A well-documented cause of heel pain that starts in the back is from sciatica. Sciatica refers to the compression of the sciatic nerve which starts in your lower back. Damage or irritation can radiate symptoms all the way down to the feet, through the hips, buttocks and legs. If you have sciatica, you may also notice tingling, numbness, burning around your heel. The pain may be dull or achy, or may shoot up the leg depending on the way you stand. You may also notice slower reflexes or muscle spasms.

Is your heel pain from problems in the spine?

While the sciatic nerve is a commonly affected nerve, other nerves and problems may also result in heel pain. These include:

A herniated disc in your lumbar spine: when the contents of one of your intervertebral discs leak or bulge
Degenerative disc disease: when the effects of ageing cause your intervertebral discs to narrow or shrink
Spondylolisthesis: when a vertebra slips over the one below it
Spinal stenosis: when the small bony openings of the spinal nerves narrow
Ankylosing spondylitis – an inflammatory arthritis that affects the spine and sacroiliac joints of the lower back. Can cause back pain, as well as referred pain down the legs

Is your heel pain from problems with your pelvis?

Moving a little further down the spine, there are three problems around the hip region that may also lead to heel pain. These include bursitis (inflammation of a fluid-filled ‘bursa’ sac on the side of the hip which can compress the nerves and affect the muscles in this area), sacroiliac joint dysfunction (when this hip joint doesn’t move in the way it should), and piriformis syndrome (piriformis muscle spasms in the pelvis impinges the sciatic nerve).

Heel pain may also occur from the compression of other nerves below the back, in the legs

You have a range of nerves travelling down the legs, and when they’re compressed, the effects may also radiate down the leg and to the heels. This includes compression of the peroneal nerve, sural nerve and the tibial nerve (known as tarsal tunnel syndrome). We know – the names are difficult to remember or understand. The most important thing to know is that heel pain isn’t always straightforward – and it isn’t always related to a problem in the heel itself. If your heel pain isn’t getting better, even if you’ve sought professional help from others, we highly encourage you to come in for a second opinion with our experienced podiatrists here at Perform Podiatry. We’ll complete a comprehensive assessment of your lower limbs to understand exactly what’s happening with your heel pain, what’s causing it, and why it hasn’t been getting better. We’ll then create a treatment plan to get you back to walking and living comfortably. Book your appointment with our team online here or call us on 09 523 2333

Why Do My Feet Hurt In The Morning?

If you’ve been waking up with sore feet, heels or arches in the morning, this is for you. There’s a very specific kind of heel pain with the following three symptoms that you may relate to:

Pain at the bottom of the heel that radiates into the arch
Pain when standing up first thing in the morning, which tends to ease or go away as you take those first steps in the morning and stay walking
Pain in the heel or arch when you stand up after having a rest or sitting down during the day

The name of this heel pain is plantar fasciitis, and it’s the #1 most common cause of heel pain that we see here in Auckland. Today, our podiatrists have shared all about this heel pain, why it happens, and how you can get rid of it today.

Morning foot pain: Plantar fasciitis

We know – terms like plantar fasciitis can sound confusing, but this one isn’t. Simply put, you have a connective tissue at the bottom of your foot called a fascia. Because of its location, it’s called the plantar fascia, meaning the fascia at the sole of the foot. As there is some damage or inflammation to the tissue, it is called plantar fasciitis. What the plantar fascia actually is, is a thick band that runs from the bottom of your heel (where you’ll be feeling your pain) and spans out like a fan to connect into your toes. It supports your arch and works every time you take a step.

Why am I getting foot pain in the morning?

When this tissue is overloaded or strained, damage and pain occur. Specifically, the plantar fascia gets very small tears through its fibres. If the strain is high, it may even partially or completely tear. The reason behind the overloading and subsequent damage can vary greatly, and for our patients here in Auckland, tends to include:

Taking on more physical activity or training – like a fitness challenge or doing a very big day of physical activity like a hike
Foot biomechanics – the way the feet and legs function overloads the fascia when combined with other factors like a long day on the feet or poor footwear choices
Unsupportive footwear, especially ones that have a flat, firm base – this is often pronounced when you move from regularly wearing supportive shoes to wearing less supportive shoes
Hard surfaces – which affect many tradies at work
Specific activities that overuse the fascia like climbing stairs
Injury to the heel – like jumping down from a high surface, which injuries the fascia

I have been getting pain in the morning for a while. Will it last forever?

Absolutely not. Don’t worry – you will only continue to get pain while there is still damage to the fascia. Once we can help repair and heal the fascia, reducing the daily strain on it, the pain will also go and you can have your pain-free mornings back.

Will my morning foot pain go away on its own?

Not easily. The foot is a tricky area – unlike other parts of the body where you can immobilise it and just not use it for little while, you activate the fascia with every step you take, which may result in more damage occurring – or at least prevent it from getting better as it keeps getting irritated day after day. This is why plantar fasciitis should be professionally treated with the help of a podiatry team that have a strong focus on musculoskeletal injuries – like we do here.

How is plantar fasciitis heel pain treated?

Your treatment starts with a comprehensive assessment that looks at characteristics of your feet and legs, your gait, your injury and symptoms, evaluates the cause of the problem, and considers your lifestyle and goals. Here at Perform Podiatry, we don’t want you wasting time (and money) trying methods that aren’t effective. We focus on getting you the best clinical outcomes as fast as possible using evidence-based medicine, with superior long-term results. We start by alleviating your current painful symptoms and creating the right conditions for your fascia to heal. Next, we look at ways we can prevent your plantar fasciitis from returning in the future. Every treatment plan is different, but may include:

Custom foot orthotics – to support the arch and reduce tension off the plantar fascia so it can heal instead of continuing being strained with every step
Footwear check – to ensure your footwear isn’t contributing to your ongoing pain and inadvertently delaying your recovery
Strapping or bracing as needed
Strengthening weak muscles that may have contributed to the development of your heel pain
Stretching tight muscles – not only to help stretch the fascia to reduce pain (where appropriate) but to also stretch other muscle groups that may have contributed to your heel pain, which often happens with tight calf muscles
Dry needling – to release or activate trigger points to relieve pain or improve range of motion. This is usually done in the calf region

There are other causes of foot pain too

While plantar fasciitis is our #1 cause of morning foot pain, other conditions can create similar symptoms. This is why having a diagnosis is important – in our assessments we rule out other causes of heel pain like Abductor hallucis tendinopathy, fat pad syndrome and calcaneal stress fractures, to name a few. Once your diagnosis is confirmed, we will proceed with your care.

Proud to be trusted by thousands of people with foot pain every year

Our podiatry team here in Remuera is proud to be trusted by thousands with their foot and leg pain every year. If you’re waking up with foot pain, or it’s going all day, we’re here to help. Book your appointment online with us here or call us on 09 523 2333.

Why Won’t My Achilles Tendon Stop Hurting?

A one-off pain at the back of your heel at your Achilles tendon that starts but then shortly subsides for good is one thing. Ongoing Achilles pains and problems that keep reappearing – or even worse, never truly go away – takes the problem to a whole new level of discomfort, frustration and pain. Ongoing Achilles pain can leave you unable to participate in sports, move efficiently at work, and even take your dog to the park. As Achilles pain is a common problem here in New Zealand, and ACC research shows that tendon injuries are on the rise, we’re filling you in on what’s going on when you have ongoing Achilles pain at the back of the heel, what’s causing it, and what you can do to prevent it from continuing to give you grief for years to come.

Why do I have Achilles pain at the back of my heel?

Your Achilles tendon is the largest and strongest cord-like tendon in your body. It connects the muscles at the back of your leg, your calves, to the back of the heel bone. More than that, it helps you to efficiently take each step, point your toes to the ground and push off as you run. Problems with the Achilles tendon falls under multiple names which describe different features of the injury process:

Tendinitis – this refers to the inflammation of a tendon, usually in the initial stages of overuse or injury
Tendinosis – this refers to a non-inflammatory degeneration of a tendon, usually after the initial inflammation has settled and the damaged tissue remains
Tendinopathy – this refers to the disease process of the tendon, and in the case of the Achilles tendon, typically describes chronic degeneration of the tendon

When you have ongoing Achilles problems that have lasted 3+ months, you’ll most likely have Achilles tendinopathy.

What causes Achilles pain and injuries?

Achilles pain most often starts when the tendon is overloaded and stressed or strained past the point that it can safely handle. This results in micro-tears and damage in the tendon. In severe cases, partial tears may develop in the tendon, which may then progress to a rupture. Common causes of overloading include:

Excessive running and jumping
Increasing training intensity and duration without adequate warm-up and preparation
Tight calf muscles
Abnormal foot biomechanics and poor foot posture that exacerbates the pull on the calves and Achilles tendon
Inadequate warm-ups and recovery techniques

Why won’t my Achilles injury get better?

If your Achilles pain won’t go away or stay gone, it’s a big sign to us that one or more of the causes of the overuse and stress are still present. You may try resting more and taking it easy on your feet, but if every time you walk your tight calf muscles and poor foot posture are straining the tendon, it will continue to incur damage and never truly get better. The only way to get rid of the pain for good – and keep it gone – is to understand all the factors that are contributing to the pain, and address them accordingly. This is one of our areas of expertise here at Perform Podiatry. We start with a comprehensive biomechanical assessment, and then put the right measures in place so that the tendon can heal appropriately without incurring additional damage.

What can you do at home to help prevent your Achilles pain from coming back?

There are a few things we recommend to reduce your likelihood of injuring your Achilles tendon:

Have a good warm-up and cool-down routine, focusing on effectively stretching your calves and Achilles
Retrain your gait if you know you have some biomechanical or alignment issues with your feet or legs. If you’re unsure about the biomechanics of your feet and legs, have it assessed by your podiatrist. If your feet and legs regularly feel sore and achy, it’s a good indication that this will be worthwhile for you
Don’t jump between low-intensity to high-intensity activity too quickly. If you’re just making the transition from casual to more strenuous exercise, ease into it. If it’s been a year since you were truly physically active, take it slow and don’t rush
Check your footwear. Our footwear serves an important function to support and stabilise our feet. Having your foot supported and contained inside the shoe, when it’s a good, strong shoe, limits the side-to-side motion of your foot and works to better control the steps taken, easing the strain on muscles and tissues including the Achilles tendon
Prioritise stretching and strengthening daily. This helps to optimise your lower limb health and thereby reduce future injury. Eccentric loading is a great strategy that strengthens tissues while lengthening them, helping you to absorb shock and better controlling the motion at your heel
Don’t ignore niggles or minor pain. This is perhaps one of the most important things you can do to prevent major problems developing. Many people will ignore minor niggles and aches in the hope they will resolve on their own. While this may be the case for some, for others, the injury will simply continue to worsen and then tendon will continue to degenerate until you have a much larger problem with a much larger recovery time.

Is pain holding you back?

If pain or injury is preventing you from enjoying your chosen activity, come in and see our podiatry team in Remuera – we’re here to help, and pain management and prevention is one of our specialities. Book your appointment online here or call us on 09 523 2333.

5 Things That Are Causing Your Heel Pain

Heel pain sucks – and we hear this expressed with much pain and frustration daily from our patients. When your ability to walk is affected, it impacts your whole day and freedom to not just do the things you enjoy, but generally complete simple everyday tasks. Treating and relieving heel pain effectively starts with identifying the cause, then working to allow the injured structure to heel (and speeding up the process). Because there are many potential causes of heel pain, we thought we’d list the top 5 conditions/injuries that cause heel pain for our patients here at Perform Podiatry. Here we go:

Plantar Fasciitis

Plantar fasciitis is the biggie. We treat hundreds of patients each year with plantar fasciitis, which unfortunately develops in a lot of people when they’re on their feet, running around or have decided to get fit and exercise more. It describes damage to a fan-like fibrous band that attaches from the bottom of your heel to your toes, called the plantar fascia. It’s more common in those with flat feet. You’ll experience:

Pain at the bottom of the heel
Radiating aches up into the arch
Pain that is the worst with your first few steps in the morning, which then tends to ease
Pain when standing after resting

Abductor Hallucis Tendinopathy

Abductor hallucis tendinopathy (AHT) is an injury to the abductor hallucis muscle, which runs from the bottom of your heel to the big toe. It follows a similar route to the plantar fascia (except that it doesn’t fan out), so is often misdiagnosed for plantar fasciitis. You’ll experience:

Aches or pain at the bottom or inside of your heel
Tenderness may radiate inside the arch
Pain that is the worst with your first few steps in the morning, which then tends to ease
Pain when standing after resting

Achilles Tendinopathy

Achilles tendinopathy is an injury to the Achilles tendon – a thick band that connects the calf muscles to the back of your heel bone. This tendon plays an important role in helping us walk. You’ll experience:

Pain, aches and tenderness at the back of the heel
Pain that can be worsened by physical activity, especially running
Tenderness that may radiate up the back of the leg
Stiffness at the back of the heel
Inflammation at the back of the heel

Sever’s Disease

Sever’s disease is a temporary condition that occurs when kids are growing quickly, especially between the ages of 8 and 15 years. It describes the irritation of a growth plate situated at the back of the heel. Growth plates are present in all growing bones and solidify once the bone has reached full maturity. When strain and forces from surrounding muscles and tissues pull on the area around the growth plate, damage to the growth plate occurs. Kids will experience:

Pain and tenderness at the back of the heel
Pain during and after physical activity
Both sharp pains and dull aches
Tightness in the muscles at the back of the legs
Potential swelling at the back of the heel

Heel Fractures

There are two types of fractures:

Stress fractures
Regular fractures

Regular fractures involve the break or crack of a bone. A stress fracture builds up from repetitive strain over time, resulting in tiny cracks through the bone, appearing like tree roots. Regardless of the cause, they both need good care to ensure proper healing. You’ll experience:

Sharp pain at the heel (regular fractures)
Dull, aching pain that can start very mildly (stress fracture)
Tenderness in the area of the heel
Difficulty putting the heel down and bearing weight (mild to severe)

Regardless of the diagnosis, the next step is to see your podiatrist so it can be thoroughly assessed and the best course of treatment can be started. The sooner you commence treatment, the sooner you’ll get back to feeling great on your feet again! If you’ve got heel pain and need it gone, you can give us a call on 09 523 2333 or book your appointment online here.

Work In Retail? Survive The Long Christmas Hours With These Five Tips!

It’s that time again! While it feels like the Christmas decorations have already been in full swing for months in our local Westfield centres, it’s finally December and Christmas is almost upon us! If you work in retail, this means your hours may be ramped up massively – and you’ll be left facing the painful consequences on your tired, achy feet and legs. So what can you start doing today to reduce the painful toll on your feet? Here are FIVE of our top tips!

1. Only wear shoes if they feel great!

Ladies, before we dive into the fashion vs. comfort talk, the good news is that these days you can find great-feeling, great-looking shoes that are absolutely work-appropriate. Yay! The people have spoken and the shoe manufacturers have listened and provided us with a number of options. We love the range from Frankie4 and Ziera. Better yet, they have built-in arch support too! There are plenty of other great brands around – just try them on, and if it feels like you’re walking on a cloud and your foot is supported, then you’re on to a winner. From a podiatry perspective, you want to check that the shoe has good cushioning, that there’s nothing that is tight or that rubs, that it doesn’t have a significant heel height and that the footwear supports your arch and ankle.

2. Cushion hard floor surfaces

Retail store floors can be made from all sorts of materials these days. We’ve been noticing quite a few bare concrete floors in more boutique-style retail stores as they go for the minimalist and high-end feel. The upside? Trendy. The much more significant downside? Concrete is a tough surface for your feet, especially during long shifts. If this is you, we’d invest in a cushioned mat for behind the counter, or wherever you find yourself working often and is out of sight. If it decreases your soreness and increases your happiness (and hence service or productivity), your manager may be very much on board.

3. Take a moment to stretch

We know – pretty simple, right? Stretching is one of those things that everyone knows they should do, but few people actually do throughout the day – unless they’re exercising. Physiologically speaking, stretching gets the blood flowing, helps get the oxygen to your tissues, and gets the muscles working. When done regularly, you’ll be feeling better throughout the day, your muscles will be less stiff, sore and tired, and your future self will thank you!

4. Put your feet up

Now is the time where putting your feet up on the couch and breathing a deep sigh of relief is actually recommended! Elevating the feet helps reduce swelling, and when combined with a gentle massage, feels like pure bliss while you stretch out those muscles. If your feet are swollen, you can also try immersing them in cold water for 15 minutes. This will help to repair any damage from the day faster – and trust us, you’ll need it after being on your feet for so long.

5. Treat any pains immediately

Finally, and by no means the least important, if any pain develops, don’t hesitate to see your Podiatrist. Pain does not happen for no reason. It’s a sign that something is wrong and that damage is occurring. If you’re continuing to do these long shifts, we can almost guarantee that the pain will only get worse. The faster you treat a pain, the quicker your recovery and the better your overall outcome! Here at Perform Podiatry, we’re not just about treating aches and pains but understanding why they occurred so we know how to stop them from coming back in the future. We see plenty of shift workers and retail workers suffering from these pains and it’s such a rewarding feeling to help them feel fantastic on their feet, not only over Christmas but all throughout the year! We hope you have a very Merry Christmas with your families and stay safe and pain-free this summer! For any questions or to book an appointment, give us a call on 09 523 2333 or book online here.

What is causing your heel pain?

Heel pain is frustrating – and that’s the mildest description of it that we hear from our patients on a regular basis. Heel pain, and foot pain generally, is one of those painful problems where you suddenly realise how much you’ve taken walking around pain-free for granted for your entire life. And it’s true – it’s a debilitating injury that impacts your whole day and ability to not just perform at your best, but also complete your everyday tasks and chores. It comes with no surprise that one of the first things that comes to mind when pain develops and you realise it’s not going away is: let’s consult Dr. Google. Despite Google’s numerous degrees, years of clinical experience and uncanny ability to assess and analyse your exact symptoms without even seeing or speaking to you, we thought we’d save you the ‘terminal’ diagnosis you’d otherwise stumble across and give you the most common causes of heel pain that we see here at Perform Podiatry daily.

1. Plantar Fasciitis

What is it? Plantar fasciitis is probably the most common cause of heel pain we see. It describes damage to, and inflammation of, the plantar fascia, a soft tissue band that runs from the bottom of your heel and fans out along the bottom of your foot to attach to your toes. You’re more likely to develop plantar fasciitis if you have a flatter foot type. What does it feel like? Plantar fasciitis is characterised by pain at the bottom (and for some toward the inside) of the heel which may radiate into the arch. Pain tends to be worse first thing in the morning and when standing after rest, though may ease after the first few minutes of walking. Some swelling may or may not be present.

2. Abductor Hallucis Tendinopathy

What is it? Abductor hallucis tendinopathy describes damage to the abductor hallucis muscle, which runs from the heel to the inside of the big toe. This cause of heel pain is often misdiagnosed as plantar fasciitis because it shares similar attachment points as the plantar fascia. Your abductor hallucis works in the movement of the big toe and helping to stabilise your foot as you walk. What does it feel like? The symptoms are similar to plantar fasciitis – everything from pain and tenderness at the bottom and inside of the heel to first step pain in the mornings and after rest. You may feel the pay through the arch and the border of the foot more with abductor hallucis tendinopathy compared to plantar fasciitis.

3. Achilles Tendinopathy

What is it? Achilles tendinopathy describes damage to the achilles tendon, the thick band that connects the muscles at the back of your leg to the back of your heel bone. The achilles tendon plays an important role in helping us walk and run, so this damage can make it more difficult to perform daily tasks. What does it feel like? Pain is generally present at the back of the heel, and can radiate up the back of the leg. Running (particularly uphill) and other physical activities will worsen the pain, and stiffness may be experienced at the back of the leg. Initially, there may be some swelling, but the pain can continue even when the swelling has subsided.

4. Sever’s Disease

What is it? Don’t worry, despite the name, sever’s disease is not really a disease, but a temporary condition present during stages of growth in kids. It describes the irritation of the growth plate located at the back of the heel. Growth plates are present in all growing bones and solidify once the bone has reached full maturity. Irritation and discomfort occur when strain and forces from surrounding muscles and tissues pull on the area around the growth plate. This is most common in active, growing kids between the ages of 8 and 15 years old. What does it feel like? Pain, tenderness and aches are felt at the bottom of the heel, usually during (and after) physical activity, particularly in running sports. The pain can range from sharp to dull and some swelling at the back of the heel may be present. The muscles at the back of the leg and heel may also feel tight.

5. Heel Fractures (Regular & Stress Fractures)

What are they? There are two types of fractures of note: regular fractures and stress fractures. Regular fractures are your standard fractures that you think of when a traumatic injury is sustained, like a tackle or jumping down from a high surface. It involves a break or crack(s) in the heel bone. A stress fracture, however, doesn’t usually involve an incident but builds up from repetitive activity and stress over time. This results in tiny cracks through the bone. What do they feel like? Regular fractures can cause sharp pain and aching at the heel. Stress fractures can range from mild, dull aches to sharp pain in the heel. In both cases, the heel can be very tender, may swell, and you may have trouble bearing weight/walking.

Other Causes

Of course, there are multiple other causes of heel pain. This can include skin conditions such as warts, corns, cracked heels and more. You may experience problems with the fat pad, which otherwise serves to protect the heel bone, but it can atrophy or become displaced. Nerve issues can also cause pain, alongside other neural problems such as numbness, tingling and pins and needles. This is where your Podiatrist will differentiate exactly what’s going on, the exact cause of your heel pain.

Treating Your Heel Pain

The trouble with heel pain is that you use your feet and heels to take every step, so it makes relieving pressure away from your feet so that the injury can heal significantly harder. This is why it’s important to see your Podiatrist so you can start recovering effectively. The sooner you start, the sooner you’ll get back to performing at your best and feeling great! Our team of foot health experts here at Perform Podiatry specialise in heel pain and help hundreds of people every year with these conditions alone. For more information or to make an appointment, you can give us a call on 09 523 2333 or book online here.

Is your child’s foot pain from a tarsal coalition?

From talking to patients about tarsal coalition, we’ve come to realise that this is a term that is not very well known by the general public, unless you or a family member has been affected by heel pain from it. Despite this, tarsal coalition does affect a number of people seeking podiatric help for heel pain, and it’s estimated prevalence around the world seems to range from less than 1% up to 2%, which in the bigger picture definitely does have a clinical significance. This being said, we thought we’d illustrate the typical presentation of a patient with a tarsal coalition and their symptoms, so you know what to look out for in the future.

Tarsal coalition: The background

For your reference, a tarsal coalition describes an abnormal connection or fusion between two or more tarsal bones of the foot. These fusions may be bony, cartilaginous or with fibrous tissue. These tarsal bones are located from the heel bone and toward the middle of the foot. The bones and joints most often affected are the calcaneus and the navicular (calcaneonavicular joint) and the talus and the calcaneus (talocalcaneal joint). One or both feet can be affected. A tarsal coalition typically occurs in the womb, leading to improper bone formation, and so is present a birth. This being said, the symptoms don’t usually start until the ages of 8+ as this is the time that bones start to mature and harden. Not all tarsal coalitions will have painful symptoms.

A young patient presents

Tarsal coalition is typically diagnosed between the ages of 8 and 16 years old, and in our experience we see kids around 10-12 years old come in with their parents in the clinic. The level of activity that these kids partake in varies, though it’s often on the higher end. The pain experienced can present both as a dull ache or a sharp pain (or both) and is in the area of the affected joint, which will often be around the ankle. The pain can come and go over time, and is usually associated with physical activity. Often the pain has been left for some time (weeks ormonths) to resolve on its own, and we see the patient after it has failed to resolve for some time. Though this is our experience, we do highly recommend bringing kids in as soon as possible! The pain can stop kids from doing the things they love and participating in sports matches, as well as general daily activities as the symptoms progress. Pain can radiate to the knees and other joints, and the joints can feel stiffer, particularly around the ankle.

Our assessment

On our end, we conduct a comprehensive biomechanical assessment in which we:

Palpate around the heels and painful structures
Check the range of motion at all the joints of the foot, ankle, knee and hip
Conduct a gait (walking) assessment with shoes and without, on the ground and the treadmill
Conduct a foot posture assessment
Conduct a footwear assessment
Check muscle strength

The findings can vary significantly, but often we find a very flat foot profile with potential damage or weakening of the surrounding muscles or tissues, such as the posterior tibial tendon on the inside of the ankle. There tends to be a limitation in the range of motion across some joints, to varying degrees, depending on the stage of the coalition and how much fusion has occurred. A tarsal coalition is confirmed radiographically, and this is usually necessary to also rule out the possibility of a stress fracture or any arthritic changes in the bones and joints of the feet.

Treatment

The best course of action is decided by the podiatrist after the comprehensive assessment and evaluation of the feet and legs. We have tended to see patients in the earlier stages where the patients are relatively young and their pain is not severe. In these cases, an initial conservative approach is first indicated before considering the surgical route. Again, this is on a case-by-case basis. We can use things like custom-prescribed orthotics, footwear changes and activity modifications to improve stability, reduce pressure on the affected tarsal bones and limit their movement – as it is the pressure and movement on a bone that is not completely fused yet that tends to elicit the painful symptoms. These devices, especially the custom-designed orthotics, will help keep the foot in the best possible alignment while the bones continue to fuse (this process is irreversible). This will provide the most comfort and best long-term outcomes for the patient. Where appropriate and where the symptoms require, anti-inflammatories and physical therapies may also be used. We then monitor the patient regularly to ensure good alignment and that we are satisfied with the way the bones are fusing, so we can control and minimise any factors and changes that may impact the quality of life for our patient in the long-term. This is also where we may choose to involve an orthopaedic surgeon, though the need for this is again on a case-by-case basis.

The outcome

We are very pleased with the overall outcome of the patients we treat and their quality of life after the completion of the fusion. We work to minimise any resulting issues and restrictions and generally, they can function fairly normally apart from some restrictions in movement at the ankles/feet. We hope that this has given you a good insight into tarsal coalition and helping you identify the signs and symptoms if they arise. If you’re concerned or your kids are experiencing any problems or pains with their feet and legs, bring them in to see our kids foot experts here at Perform Podiatry. We’re located within the One Health Building on Remuera Road, close to Newmarket. You can give us a call on 09 523 2333 or book online.

Haglund’s Deformity: The Bump at the Back of Your Heel

If you’ve noticed a bump at the back of your heel, then you may have a bony enlargement called a Haglund’s Deformity. As we’ve been seeing quite a few patients with these ‘bumps’ who have recently started developing painful symptoms at the back of their heels, we thought we’d fill you in on what’s going on the what’s, how’s and why’s of this condition. As patients come that come in with heel pain often assume it’s related to their Achilles Tendon, this is a condition that is NOT directly associated with the achilles, though can produce achilles pain as a result.

So, what is a Haglund’s deformity?

As we mentioned earlier, a Haglund’s deformity describes a bony enlargement of the calcaneus (heel bone). You may hear it being referred to as a pump bump because of the firm backs of pump-style shoes that will often rub against it at the back of the heel.

What are the signs and symptoms?

Generally, you’ll notice a palpable lump at the back of your heel that has been irritated. This irritation can cause pain and tenderness in the area, along with redness and swelling. The swelling can there irritate the surrounding structures and lead to things like bursitis, or even pain at the achilles tendon.

What causes the painful symptoms?

While many people with an enlargement at the back of the heel can go through their lives without developing pain, symptoms can develop from irritation and rubbing of tissues against the bump, for which there may be various causes. Note: it isn’t actually the presence of the bump itself, but the resulting friction with other tissues. Causes of the irritation can include:

Injury to the heel
Footwear that is tight or has a firm heel counter
Tight calf muscles or achilles tendon
Structural foot abnormalities such as a high arched foot
Abnormal foot biomechanics such as rolling inward or outward excessively
Gait abnormalities, such as walking on the outside of the heels

What should you do if you suspect you have a Haglund’s deformity?

If you haven’t experienced any pain or symptoms and just have the bump present at the back of your heel, then you may not require any treatment as the presence of the bony enlargement alone does not mean that anything is ‘wrong’ or that you’re definitely going to develop painful symptoms. It can, however, make you more like to develop symptoms. In this case, it’s all about making small changes to minimise your risk of this occurring. This can include:

Avoiding tight footwear
Avoiding footwear that has a firm heel counter over the area of your ‘bump’
Regularly stretching the calves and achilles tendon to reduce the likelihood of rubbing
Managing abnormal gait and foot abnormalities through devices such as orthotics

Where painful symptoms have manifested, treatment looks to reduce the painful symptoms and then alleviate the tension from the back of the heel. Your podiatrist will create the best treatment plan for you based on your symptoms and presentation. This may include:

Resting and icing the heel
Using anti-inflammatories to reduce painful symptoms
Heel lifts to reduce the strain at the back of the heel
Avoiding footwear that is tight and rubs against the back of the heel
Using orthotics to reduce tension from the back of the heel
Physical therapy to stretch tight muscles such as the calves and the achilles tendon

It’s important to have your feet and legs assessed to gain an understanding all of the biomechanical and structural factors that are contributing to your painful symptoms and therefore create the most effective treatment plan for you. Our team here at Perform Podiatry are experts in sports medicine and the biomechanics of the feet and legs, and have the pleasure of helping thousands of Aucklanders each year. For more information or to make an appointment, give us a call on 09 523 2333 or book online.