Managing Heel Pain: Understanding Plantar Fasciitis, Bone Marrow Oedema, Bursitis, and Tarsal Tunnel Syndrome
Heel pain can significantly impact daily activities, causing discomfort and limiting mobility. Various conditions can lead to heel pain, including plantar fasciitis, bone marrow oedema, bursitis, and tarsal tunnel syndrome. Each of these conditions requires a tailored approach for effective management and relief. In this article, we will explore these common causes of heel pain and discuss the best practices for managing them. Please note that it is important to consult with a podiatrist about the options below and it is important to get an accurate diagnosis prior to treatment.
Plantar Fasciitis
Overview:
Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes.
Symptoms:
- Sharp, stabbing pain in the heel, particularly with the first steps in the morning.
- Pain after long periods of standing or getting up from sitting.
Management:
1. Rest and Ice:
- Resting the affected foot and applying ice packs can reduce inflammation and pain.
2. Stretching Exercises:
- Regular stretching of the calf muscles and the plantar fascia can improve flexibility and reduce pain.
3. Supportive Footwear and Custom Orthotics:
- Supportive footwear to cushion the foot and offload the strain on the plantar fascia
- Custom orthotic inserts provide arch support and distribute pressure more evenly across the foot.
4. Physical Therapy:
- Physical therapy can include exercises, massage, and other treatments to alleviate pain and improve function.
5. Medications:
- Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. Please consult with your endorsed podiatrist or doctor prior to taking to see if it is suitable for you.
6. Shockwave Therapy:
- Shockwave therapy stimulates healing in the plantar fascia tissue, providing pain relief.
Bone Marrow Oedema
Overview:
Bone marrow oedema refers to the accumulation of excess fluid in the bone marrow, often due to injury or stress to the bone. This can often be confused or accompany plantar fasciitis due to the nature of the heel pain. This is a rarer condition and is often a diagnosis of exclusion.
Symptoms:
- Deep, aching pain in the heel that worsens with activity and improves with rest.
- Swelling and tenderness over the affected area.
Management:
1. Rest and Activity Modification:
- Reducing weight-bearing activities and allowing time for the bone to heal is crucial.
2. Footwear and Immobilization:
- Supportive footwear may be sufficient in mild to moderate cases
- Using a walking boot or cast to immobilize the foot and reduce stress on the bone in serious cases.
3. Medications:
- NSAIDs can help manage pain and inflammation. Please discuss with your endorsed podiatrist or doctor.
4. Physical Therapy:
- Gradual reintroduction of weight-bearing activities and strengthening exercises.
5. Nutritional Support:
- Ensuring adequate intake of calcium and vitamin D to support bone health.
Bursitis
Overview:
Bursitis is the inflammation of the bursa, a small fluid-filled sac that acts as a cushion between bones and soft tissues. In the heel, bursitis commonly affects the retrocalcaneal bursa, located between the Achilles tendon and the heel bone.
Symptoms:
- Pain and tenderness at the back of the heel.
- Swelling and warmth over the affected area.
Management:
1. Rest and Ice:
- Resting the affected foot and applying ice packs to reduce inflammation.
2. Footwear Modifications:
- Wearing shoes with proper heel support and cushioning to reduce pressure on the bursa.
3. Orthotics:
- Custom orthotic inserts to improve foot mechanics and reduce strain on the heel.
4. Medications:
- NSAIDs to manage pain and inflammation. Please discuss with your endorsed podiatrist or doctor prior to commencing medication.
5. Physical Therapy:
- Stretching and strengthening exercises to improve flexibility and reduce tension on the Achilles tendon.
6. Cortisone Injections:
- Cortisone injections may be recommended to reduce severe inflammation and pain.
Tarsal Tunnel Syndrome
Overview:
Tarsal tunnel syndrome occurs when the tibial nerve, which runs along the inside of the ankle, is compressed. This condition can cause heel pain and discomfort.
Symptoms:
- Tingling, burning, or numbness in the heel and arch of the foot.
- Pain that worsens with prolonged standing or walking.
Management:
1. Rest and Ice:
- Resting the foot and applying ice packs to reduce inflammation and pain.
2. Footwear and Orthotics:
- Supportive footwear to reduce strain on the tibial nerve
- Custom orthotic inserts to support the arch and relieve pressure on the tibial nerve.
3. Medications:
- NSAIDs to manage pain and inflammation. Please discuss with your endorsed podiatrist or general practitioner prior to commencing medication.
- A cortisone or dextrose injection can relieve the tension of the nerve within the tarsal tunnel.
4. Physical Therapy:
- Exercises to strengthen the foot muscles and improve flexibility.
5. Nerve Gliding Exercises:
- Specific exercises to help the tibial nerve move more freely within the tarsal tunnel.
6. Surgery:
- In severe cases, surgical decompression of the tarsal tunnel may be necessary to relieve pressure on the tibial nerve.
Conclusion
Heel pain can significantly impact quality of life, but understanding the underlying cause is the first step towards effective management. Whether it’s plantar fasciitis, bone marrow oedema, bursitis, or tarsal tunnel syndrome, there are numerous treatment options available to alleviate pain and improve function. At Bondi Podiatry, our experienced team is dedicated to providing comprehensive care tailored to your specific needs. If you’re experiencing heel pain, don’t hesitate to contact us for a thorough evaluation and personalized treatment plan. Your foot health is our priority.
