The heel bone also known as the calcaneum in Latin is the largest bone in the foot, designed to shock absorb and redirect forces required in bipedal (two legged) motion, spring boarding us forwards and cushioning the next step we take.
Not only is our heel bone required to take the full weight of our body, in actual fact it supports one and a quarter times this amount, increasing to two and three quarter times our body weight when we run.
As chiropodists | podiatrists it is important that we distinguish between a patient presenting with a vascular, autoimmune, infectious or neoplastic heel pain origin. However, once these often rarer presentations have been ruled out, we can then safely move into the traumatic, neurologic, mechanical and musculoskeletal presentations.
The heel bone’s length is longer than its height and width, like a rectangle with rounded edges. It has many soft tissue attachments, a rich nerve and blood supply with strategic bursae, which are fluid filled pouches positioned at strategic areas where increased forces are found. In certain presentations these bursae can become inflamed and exacerbate a heel pain presentation.
A tendon known as the posterior tibial tendon is a very important muscle and tendon, which attaches extensively into the underside of the foot. Here we usually observe a flattening of the arch due to a dysfunctional tendon that has fatigued due to biomechanical factors, often mistaken for simple heel pain.
Located at the underside of the heel is a fatty padding made up of dense pockets of fat surrounded and interwoven with stretchy muscle fibers found under the heel bone to protect and cushion. However, as we age this fatty padding can shrink to half its original size, whereby its elasticity is reduced and the ability to cushion is effectively reduced. This presentation is also known as fat pad atrophy and is another cause of heel pain.
One of the most common things we hear from patients is: ‘I have been told I have plantar fasciitis’ or the precise term plantar fasciopathy. This is because the plantar fascia is considered the key stone of the foot and comprises of numerous slips of fascia that actually attach all the way up into the underside of the toes. If this structure is compromised it can become very disabling, taking months to repair and recover.
Overuse, such as long periods of standing, micro trauma such as repeating and heavy loading, or the presence of heel spurs can sometimes complicate and lengthen symptomatic periods, especially if nerves (tarsal tunnel syndrome and / or a medial calcaneal neuritis) are impinged within the plantar fascia, suggesting what is known as a recalcitrant heel pain a.k.a. very stubborn!
In cases of extreme sports, excessive jumping or excessive force although fortunately rare, we do at times observe fractured heel bones, which will need total immobilisation and zero weight bearing for a period of time.
Check your footwear – a supportive shoe or trainer with a deep heel cup is ideal, where possible try to avoid standing on your feet for long periods of time, avoid walking bare foot if you can. Good nutrition cannot be emphasized enough, reducing or quitting smoking and a little weight loss for your heel pain goes a long way.
If you are experiencing ongoing and stubborn heel pain why not call the clinic so that we can offer a consultation and treatment protocol designed and tailored specifically for you.
Paola Ash osteos MSK | podiatrists MChS & associates