What is it?
Pain around the heel can quickly become debilitating and affect your ability of do the activities you want to do. Broadly heel pain can be categorised as plantar fasciitis, achilles tendon pain in the middle of the tendon and achilles tendon pain where it joins the heel bone. This can be accompanied by a bony lump described as a “pump bump”
Why does it happen?
No one is quite sure why some people develop heel pain and others don’t however there are several factors that make it worse such as having tight muscles and being overweight. If left alone without treatment, heel pain can get better by itself but it can take up to 2 years! So its definitely worth doing what we can to try and get the problem under control.
How can I treat it?
Initially, Its important to be sure exactly what the diagnosis is. I can usually do this from a thorough physical examination but I frequently also get a scan to rule out any other conditions and then we can focus directly on the problem.
I like to use a “multi-modal” approach to heel pain. This means that rather than just trying one treatment at a time, I will usually several things at the same time to really get on top of the problem. These treatments include directed physiotherapy and stretching programmes, special insoles and in some cases night splints. If there is no improvement after a period of 8-12 weeks the next step is shockwave therapy which I can arrange through a specially trained physiotherapist.
What if conservative measures do not work?
Around 80% of patients will be much improved by the treatments above and not require anything further. I have recently won a grant of over £15,000 to trial a new type of orthobiologic known as PRP. PRP has been around for a few years but usually required multiple injections to give a good result. I am trialling a new preparation where a single injection may have long lasting effects in patients with heel pain who are still having pain following conservative treatments.
I usually do the injections as a day case and sometimes in conjunction with some minimally invasive surgery.
If this is an appropriate option for you we will discuss things in more detail in clinic.
What does surgery involve?
I do several procedures for heel pain depending on the cause. My main aim is to minimise risk to you and get you back on your feet as quickly as possible with a positive outcome. For severe plantar fasciitis, I do a partial release of the tight layer using keyhole surgery and a camera. For severe achilles pain from the middle of the achilles, I use the camera to move another tendon in the back of the ankle to help with the pain.
For severe pain at the insertion of the achilles onto the heel bone I can usually do keyhole surgery to remove the bone without damaging the Achilles tendon. For redo surgery or in severe disease I do a mini open operation to remove the excess bone and reattach the tendon using a special, extremely stable fixation method known as speed bridge.
If surgery is appropriate, I will explain your procedure in detail in the clinic.
Risks and complications
There are risks to all surgery and conservative measures should be tried when possible. If surgery is an option, we will discuss all of the pros and cons and the risks that are specific to you in detail. Specific risks of this procedure are- The main risks with heel pain is that in some patients a number of different treatments do not work and it can be very frustrating. I will do my best to counsel you through each step of your treatment and get your symptoms under control safely and quickly.