Spire St Anthony’s Hospital now has a dedicated team offering focused individualised treatment of heel pain (plantar fasciitis and Achilles tendinopathy). We offer a multidisciplinary approach using modern techniques to evaluate and treat the condition, which often has a considerable impact on patients’ lives.
Led by Mr Paul Hamilton Consultant Orthopaedic Surgeon - with an interest in foot and ankle conditions, the clinic offers a complete assessment at your first visit, including a focused assessment by a senior physiotherapist. An individualised treatment plan can then be put in place, which may include physiotherapy, insoles, podiatric assessment, gait analysis, image-guided injections, extra-corporeal shockwave therapy and, occasionally, surgical procedures.
The aim of the clinic is to provide a personalised approach to treating these common conditions that can greatly affect quality of life. Whether you are an athlete or live a more sedentary lifestyle, we aim to return you to your previous level of activity as quickly as possible.
The clinic runs on a Monday evening and usually involves consultant and physiotherapy assessment, with X-ray and ultrasound if required.
Details about heel pain
What is heel pain?
There are two main conditions associated with heel pain:
1. Plantar fasciitis or policeman’s heel is pain under the foot near the heel. It originates from a strong band of fibrous tissue that runs from the heel to the toes known as the plantar fascia. Symptoms are often worse first thing in the morning or after sitting for periods, and improve after ‘stretching’ the plantar fascia. The pain often returns after standing for long periods.
2. Achilles tendinopathy is pain at the back of the heel, either where the Achilles inserts (insertional) or just above this area (non-insertional). The pain is often worse first thing in the morning and may be associated with a lump and swelling.
How does heel pain occur?
The exact reason why it occurs is unknown but the process probably relates to increased or abnormal loading of the tendon or fascia, leading to degeneration. If this fails to resolve quickly the condition can become chronic and can often last for many months. Heel pain is associated with a sudden increase in activity, being overweight, a flat or high-arched foot, or a tight calf muscle. It is also associated with some generalised conditions such as rheumatoid arthritis and occasionally medication.
How can heel pain be treated?
An assessment will allow an individualised treatment protocol. Initial treatment should always involve physiotherapy focusing on calf stretches and possibly insoles. In some individuals a formal gait analysis with custom insoles may be appropriate. This will be successful in the majority of patients. If there is failure to progress after two to three months we can offer several treatments including injections, extracorporeal shockwave therapy and surgical stretching of the calf. These can be used in combination if required.
Although stretching alone can help treat these conditions, we recommend assessment and treatment via a trained physiotherapist. They can guide you through appropriate exercises and rehabilitation, not only to treat the
condition but also to prevent recurrence. They may also be able to assist you in providing simple insoles and night splints, giving guidance on shoe wear and advice on activities you should be undertaking and avoiding.
For those in need of more custom-made insoles an assessment can be made by our podiatrist. The consultation usually includes formal biomechanical evaluation with gait analysis.
Extra-corporeal shockwave therapy
Shockwave therapy involves three sessions at one to two-weekly intervals lasting about 5–10 minutes. It is thought to act by creating an inflammation that promotes healing of the injured tissue. You may experience some bruising, numbness, swelling and redness after each session. Strenuous exercise should be avoided for 48 hours. It is recommended to continue physiotherapy for this time.
Injections can be used to treat both plantar fasciitis and Achilles tendinopathy. Although both use a small amount of steroid, they are thought to act in different ways. Strenuous activity should be avoided for six weeks if you have undergone an injection around your Achilles. It is recommended to continue physiotherapy for this time.
Surgical calf stretching
In cases where the calf muscle is very tight, shockwave therapy or injection therapy may not work alone. In these cases surgical calf stretching may be recommended. This involves a day-case procedure where a small incision is made behind the knee. You will be able to walk out of hospital and can continue physiotherapy at two weeks.