Is your heel causing you pain?

One of the most common questions we get asked by patients is “why does my heel hurt?”. While there can be many reasons for heel pain, we as podiatrists categorise heel pain into these primary causes: plantar fasciitis, Achilles tendonitis, bursitis and nerve pain.

• A very common cause of heel pain is plantar fasciitis, which is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. When people suffer from the condition, the fascia becomes irritated and then inflamed (swollen and red), resulting in heel pain or pain in the arch of the foot. Pain in the plantar fascia is a telling sign that there is a biomechanical issue going on in the foot. Plantar fasciitis is typically treated with nonsurgical strategies, such as stretching and strengthening exercises, rest, shoe inserts (such as orthoses) and footwear modifications.
   
• Achilles tendonitis is the inflammation of the Achilles tendon, and can also be a cause of heel pain. This condition is typically associated with 'overuse' and we see it most frequently in athletic patients who play sports with a high impact on the knees and ankles (such as tennis, netball or ballet). A sudden increase in repetitive activities can put too much stress on the Achilles tendon too quickly, leading to micro-tears or injuries of the tendon. Generally, Achilles tendonitis responds well to conservative treatments and can be aided by exercises which gently strengthen the tendon. If your Achilles tendonitis is linked to a biomechanical issue, our podiatrists can also help by providing orthoses to allow the foot to function in a position which minimises the abnormal forces being applied to the tendon, allowing it to recover and prevent recurrence in the future.
   
• Bursitis is another cause of heel pain we commonly see - where the 'fat pad' of the heel displays redness and swelling from inflammation of the bursa (the fluid-filled sac inside the heel). The bursa protects the heel from friction and can become irritated and inflamed from footwear (such as tight boots), repetitive use or overuse or from blunt force impact (such as falls or sporting injuries).  Additionally, biomechanical and gait abnormalities might also place additional stress on the bursa. Bursitis may be able to be treated with my simple home treatments, such as wearing broad shoes which aren't too tight on the foot. Rest, ice and elevation may also help to alleviate discomfort. If this doesn't help, a podiatrist can perform a full biomechanical assessment of your feet and gait, and may even refer you for further imaging (x-ray or ultrasound).
   
• A less common cause of heel pain is related to the nerves in the foot. Nerve pain in the heel will feel like a burning or electrical pain/sensations radiating down the foot from the heel towards the toes. Podiatrists will generally try conservative treatments in the first instance, which may include: a short course of anti-inflammatory medication, padding and offloading of the nerve entrapment site or stretching and strengthening exercises.

Whatever your heel pain, we encourage you to see a podiatrist for a proper diagnosis. We are experts in the foot, ankle and lower limb, and our training helps us effectively get to the cause of the pain.

International Women's Day - Women's Foot Health

Happy International Women's Day! In honor of the occasion, we thought we'd share some foot health information relating particularly to women's feet. 

There is quite a marked difference between men and women's feet - women commonly have a narrower heel and broader forefoot, and are generally more flexible in the foot and ankle than men.

Women also suffer more from certain types of foot problems than men. This is can be caused by  footwear (for example, wearing and walking in narrow-fitting shoes that have inadequate room for the toes). Problems may also be caused from the prolonged use of high-heels which cramp the front of the foot, shorten the muscles and tendons in the lower leg and ankle, and increase pressure on the ball of the foot - generating a host of foot and ankle problems.

Women may also be more prone to the following foot and ankle problems:

Morton's Neuroma - a thickening of nerve tissue in the ball of the foot resulting from compression and irritation of the nerve. This could be caused from wearing shoes which have a tapered toe, or high-heeled shoes which do not allow enough room for the toes.

Bunions - generally begin with a ‘leaning’ of the big toe, gradually changing the angle of the bones over the years and slowly producing the trademark bunion bump. Bunions are generally caused by a combination of issues (such as an inherited particular structure of the foot which is exacerbated by the way a person walks). Both men and women can get bunions, however the footwear worn by women often makes the issue progressively worse.

Heel Pain and Plantar Fasciitis - heel pain is most often caused by plantar fasciitis. Although a biomechanical foot structure issue is the most common cause of plantar fasciitis, in women, it can be worsened by wearing nonsupportive shoes (such as thongs or ballet flats).

Ankle Spain - whilst anyone can sprain an ankle, women are particularly vulnerable to this injury when wearing high-heeled shoes (particularly on slippery ground), platform shoes or other improper footwear.

Our podiatrists can help not only with diagnosis of any injuries or pain in your feet, but will also work with your GP and other allied health professionals to establish an appropriate management program. We are also able to advise on appropriate footwear and/or shoe inserts which help in reducing pain. If your feet are causing you concern, please get in touch with our team of skilled podiatrists today.

Podiatry and Ageing Feet

Podiatrists form an integral part of the health care team for ageing Australians. Podiatrists play a key role in assisting ageing Australians with general foot care, which would otherwise be left unattended and could lead to more serious problems, including infection, hospitalisation and, in worst-case scenario, even amputation.

Mobility in an ageing population is paramount to maintaining independence and quality of life. Podiatrists play a role in musculoskeletal assessment of the feet and legs of an ageing population and can assist in identifying and treating potential and active foot pathology that can reduce mobility.

It has been predicated that Australia, like most developed counties, will continue to experience a general ageing of the population. The proportion of Australians aged over 65 years grew from 8% in 1970-1971 to 13% in 2001-2. This is expected to reach and stabilise at about 25% over the next 30 years (1).

Below are listed some specific foot health problems that affect an ageing population:

1. Skin changes: As the skin ages, it looses some of its former qualities of elasticity, moisture balance and fatty padding. The skin becomes vulnerable to tears and, therefore, ongoing slower wound healing and infection. The foot is an area particularly vulnerable to skin break-down complications; being at the most distal part of a limb it has susceptibility to peripheral neurological and circulatory loss. A podiatrist is often the first health professional to thoroughly examine the foot and can be the first to detect skin changes, such as skin cancers, which are more prevalent in the aged foot.
    
2. Pressure areas: With the average person aiming for 10,000 steps per day, an 80-year-old foot could have tread over 290 million steps in a lifetime. It should therefore come as no surprise to learn that the fatty padding in the foot, either under the heel or the ball of the foot, can be considerably reduced in the ageing patient. The combination of pressure and reduced protection produces pressure-related problems unique to the foot; callouses and corns over boney prominences and metatarsal heads, heel pain from standing and walking, inter-digital neuromas and bursas or capsulitis.
    
3. Nail changes: Difficulties with bending down, eyesight or focal length and hand grip strength often are the initiating factors for a person to directly contact a podiatrist for assistance with foot care. Podiatrists regularly treat nails in the aged population, and offer professional care of nail pathology such as ingrown nails, fungal nail infections, and wounds related to excessively long or thickened nails.
    
4. Changing capability: As well as physical changes, there are often cognitive impairments related to chronic disease and complex medical presentations in the aged. Impairment in memory, loss of concentration, impairment in focus and judgment can affect personal care (2). These mental capacity deficits produce a higher risk profile for the aged foot, which often requires professional input of a podiatrist as a regular provider of foot care.
    
5. Orthopaedic changes: The foot shape and appearance can change with ageing due to changes in boney structure and weakness or loss of elasticity in the connective tissues, such as ligaments and tendons. Muscle strains and tendon pathology are common consequences of an active older person who is demanding a lot from an ageing body. Podiatrists are trained to assess and diagnose boney and soft tissue pathology of the foot. At times, orthoses can be prescribed to help support the tiring foot structure and these, along with footwear advice, can help maintain mobility in the aged population. Bunions and clawing toes are common presentations in the ageing foot. Other underlying chronic diseases such as arthritis and diabetes often exacerbate foot orthopedic problems. Complex feet of this nature require the professional care of a podiatrist as part of the health team for sustained mobility and quality of life. Changes in bone density with osteoporosis may affect the many bones in the foot. The combination of weakened boney structure and the forces the foot must endure in gait leave the foot vulnerable to stress fractures.
    
6. Gait changes: Falls in the elderly are a concern to people who have experienced falls, their families and the health system at a community level. It has been shown that people at higher risk of falls have a more variable pattern of minimum foot clearance, which could lead to trips and falls (3). Podiatrists have a role in footwear advice and maintaining the foot to be as pain-free and functional as possible.
    
7. Foot pain: Foot pain affects up to 24% of people over 65 years of age (4). Pain is associated with altered activities of daily living, balance and gait. Some of the risk factors for pain are gender (with women reporting more foot pain), obesity and chronic health problems.

Information sourced from the Australian Podiatry Association.

1. Australian Treasury. http://demographics.treasury.gov.au/content /_download/australias_demographic_challenges/html/adc-04.asp. Sighted August 28, 2014.

2. McIntosh IB. The ageing foot - a challenge for the Chiropodist and Podiatrist. Podiatry Review. 2014 May-June.

3. Barrett RS, Mills PM, Begg RK. A systematic review of the effect of ageing and falls history on minimum foot clearance characteristics during level walking. Gait & posture. 2010;32(4):429-35.

4. Menz HB, Gill TK, Taylor AW, Hill CL. Predictors of podiatry utilisation in Australia: the North West Adelaide Health Study. Journal of foot and ankle research. 2008;1(1):8. PubMed PMID: 18822163. Pubmed Central PMCID: 2553780.