Heel Pain & Plantar Fasciitis

We currently run specialist plantar fasciitis and chronic heel pain clinics from Sheffield & Nottingham. For specialist heel pain appointments please call 0845 2242576 please state that you require a heel pain assessment. All three heel pain clinics are located in central locations only minutes away from train stations by taxi.

Since 1999 we have developed a wealth of experience in treating people from all over the country with persisting heel pain. We receive referrals nation wide from a wide range of health professionals including GPs, Physiotherapists, Orthopaedic Consultants, Rheumatologists, Sports Medicine Physicians and other Podiatrists and tennis and golf coaches.

We specialise in stubborn persisting cases of heel pain. The average patient we see with heel pain will typically have suffered symptoms over eighteen months. Patients will have often had other forms of treatment. Our treatments enjoy high success rates, with typically 85% of patients being symptom free or significantly improved* (*defined as, a decrease in frequency and severity of symptoms by an order of 60-70%)   within the first 6 weeks of treatment. This level of success is based on experience of treating thousands of patients and thorough assessment of your condition. Investigations can include x rays, MRI scanning and in-house ultrasound scanning and computerised gait analysis (an assessment of how you foot functions when walking).  

The most common cause of deep pain on the bottom surface of the heel is Plantar Fasciitis (inflammation of the plantar fascia).

The plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot, from the heel to the toes. It is just below the skin and subcutaneous fat.

It helps to secure the arch of the foot. Long standing inflammation causes the deposition of calcium at the point where the plantar facia inserts into the heel bone. This can result in the appearance of a bony heel spur on x-ray. The spur itself is not the source of the pain. Stubborn heel pain should be evaluated by a Podiatrist. Plantar fasciitis may also present as pain anywhere along the sole of the foot, particularly along the arch and just in front of the heel.

Symptoms

• Sharp pain often localised to the bottom and/or inside margin of the heel
• Pain often worse on arising in the morning and after rest
• Aggravated by prolonged weight bearing and ambulation
• May severely limit activities
• Most common in middle-aged and overweight adults

Causes

• Excessive flattening of the arch on weight bearing
• Tight plantar fascia
• Over-pronation of the foot (a complex motion including outward rotation of the heel and inward rotation of the ankle).
• Excessive load on the foot from increased body weight
• Arthritic change changes to the big toe which alter the function of the plantar fascia
• Having a very high rigid arch profile of the foot
• underlying medical conditions such certain types of arthritis or diabetes.

What you can do

• Application of ice to the heel area after prolonged activity
• Wear supportive shoes with a stiff heal counter (the part of the shoe which wraps around the heel) and a good arch. A well made running or walking shoe is a good example
• Sometimes a shoe with a moderately high heel will relieve pressure on the fascia (you should try this unless directed to by a Podiatrist)
• Use over the Counter anti-inflammatory medications containing ibuprofen or aspirin when tolerated (please consult a Pharmacist prior to use)
• Use a prefabricated pronation control orthotic such as the Heelform Pro™ orthotic

What the Podiatrist may do

• Teach specific stretching and strengthening exercises to stretch plantar fascia and strengthen the small intrinsic muscles which stabilize the arch
• Control faulty foot function with orthotics
• Inject powerful anti-inflammatory medication to calm inflammation around the painful area
• Apply tape / padding to relieve strain on the plantar fascia
• Administer physical therapy (ie ultrasound)
• Prescribe special splints to help stretch the fascia
• In some cases surgical release of the plantar fascia and excision of the heel spur (rarely required)
• Because there are many causes of heel pain the treatment will be designed specifically for you
• Offer Cryosurgery, the latest technique which offers a 80-9-% clearance rate. See the Cryosurgery for Plantar Fasciitis page for full details...

Other causes of heel pain

• Various types of arthritis
• Trauma to the heel
• Inflammation of the tendons around the heel
• Heel Neuroma (benign tumours of the nerves around the heel)
• Abnormality in the shape of the heel bone
• Foreign body in the heel (for example a splinter)
• Nerve entrapment
• Loss of normal thickness of the fat pad beneath the heel
• Malignancy of the heel bone or soft tissue structures
• Tuberculosis

Why choose to see a clinician that is registered with the Health professions Council and not other organisations that are unregistered but make impressive claims regarding heel pain in the media?

The answer is simply our qualifications and experience. Heel pain is often complex and multi-factorial, because there are many causes there is no one magic cure. A cure is dependent on correct diagnosis. Podiatrists specialise only in foot and lower limb conditions and are therefore most likely to be able to diagnose the cause of your pain and prescribe the most appropriate treatment . Podiatrists study at University for 3-4 years, and have often undertaken extensive accredited post graduate foot and lower limb qualifications. Our qualifications mean we have a detailed knowledge of all the causes of foot and heel pain. This is important as some causes of heel can be part of more serious medical conditions that require careful management by Rheumatologists or other Medical Doctors. Put simply unless the person treating you has a UK recognised protected title and specialist knowledge of foot anatomy and physiology you risk being mismanaged by someone that is not regulated or accountable. We are registered with the HPC which is the only UK regulatory body for many allied medical professions such as Podiatrists and Physiotherapists and Orthotists. Anyone seeking treatment or advice for heel pain should ensure that the person they intend to see is registered with either the HPC or is a medically qualified Doctor registered with the General Medical Council. People who treat heel pain that are not registered can make impressive claims about equipment or techniques that otherwise would not be allowed by the HPC. or the  General Medical Council. If you have medical insurance you  should also check that your clinician is registered because medical insurers will not honour treatment cost of the unregistered.

How long does a heel pain consultations last and how much do they cost?

A Full length biomechanical assessment lasts one hour and costs £95.00 However If you have only been experiencing heel pain for a matter of weeks or months you will probably only require a thirty minute biomechanical assessment at a standard appointment fee of £40.00 should you require orthotics for your heel pain you can enjoy piece of mind knowing that in the unlikely event the treatment is unsuccessful you will receive a full orthotic refund. We are registered with most health insurance schemes including BUPA Norwich Union Westfield Etc.

X-rays of heel spurs

Posterior heel spur

This is a side (lateral) view of the heel bone, and demonstrates a spur on the back (posterior) surface of the heel bone (calcaneus). This was asymptomatic (without pain or other symptoms). A tight Achilles tendon can cause this to form. It may be associated with pain at the point were the achilles tendon inserts into the calcaneus.

Below: Magnetic Resonance Image (MRI) of Plantar Fasciitis showing a calcaneal spur