The most common cause of heel pain is plantar fasciitis [link], but other causes do exist including:

• Verrucae or plantar warts [link to content below]
• Achilles tendonitis [link]
• Stress overuse injury or fracture [link]
• Ankle impingement [link]
• Ankle or subtalar joint arthritis [link]
• Fat pad pain [no link]
• Nerve compression (foot, ankle or spine) [no link]
• Bony cyst or tumour [no link]

Heel blisters are a common problem. They’re usually caused by irritation or friction from footwear, very often new shoes. Shearing motion causes fluid to collect between the upper layers of skin (the epidermis) and deeper layers below (the dermis).

Applying cushioning foam or felt either to the inside of the shoe or strap or around the blister (donut effect) can alleviate irritation before a blister forms.

What to do if you have blisters on your heel

Treating your blister may involve nothing more than avoiding the offending shoe for a few days. You can also treat superficial skin blisters with medicated plasters and over-the-counter pads.

If needed, you can drain an intact blister (maintaining its ‘roof’ or the upper skin) as this results in the least discomfort and may make secondary infection less likely.

If your blister gets infected, you may need antibiotics and regular dressings, while ensuring nothing rubs against it. You may need to wear open footwear until the area heals.

How can Doctor Greene’s help you

Our specialist products can help you address heel blisters and local areas of irritation.

• Heel Grip
• Foot Cushions Multipack

Plantar fasciitis is the most common cause of heel pain and one of the most common foot complaints. 1 in every 10 people will suffer plantar fasciitis at some stage in their lives, while 30% of those will experience pain in both heels simultaneously.

This is a painful, debilitating condition that can be really frustrating, as you must limit walking and exercise to enable recovery. There are numerous factors thought to contribute to plantar fasciitis, including:

• flat feet
• excess body weight
• tight calf muscles
• any activity, work or sport that involves prolonged walking, running or standing
• poor footwear that does not shock-absorb well

What exactly is plantar fasciitis?

The plantar fascia is a connective tissue band, a cable that spans and supports the arch of the foot, from the heel bone to the ball of the foot. Plantar fasciitis is a microscopic tear(s) in the fine fibres that make up this cable.

If you develop plantar fasciitis, you usually feel pain in the inner aspect of the heel. It may be a dull ache or sharp penetrating pain. Symptoms are often worse in the mornings or when you stand up after a period of rest.  The pain can lessen after standing or walking for a little while, but generally gets progressively worse towards the end of a day of activity.  You may find the pain manageable initially, but gradually it can get worse over weeks and months.

About half of those who develop plantar fasciitis are also found to have a heel spur, if they have an x-ray. This spur does not directly cause any impingement and does not need to be removed, but sometimes the term ‘heel spur syndrome’ is used to describe plantar fasciitis pain.

Diagnosing plantar fasciitis

Diagnosis is usually based on your clinical history and identifying point tenderness over the inner aspect of the heel or sole where the fascia inserts into the heel bone. It is important to exclude other causes of pain, as listed at the top of this page. While x-rays are not especially useful here, an MRI may help facilitate an early accurate diagnosis.

How to treat plantar fasciitis

Treatment for plantar fasciitis attempts to accelerate the healing process within the microtear, gradually easing pain and enabling a return to normal activity.

Plantar fasciitis can be difficult to treat, but the good news is that 90% of cases get better without invasive treatment within 12 months. You may find recovery is slow and no one therapy works for everyone, which is why we see so many different types suggested.

Rest is really important, difficult as that may be, when most people need to stand and walk (on average 2000 steps) during a normal day.

Offload the foot, or rest  is advised as much as you can and wear a cushioned, stiff soled, shock absorbing shoe or sandal.

Avoid walking barefoot and remember low-impact exercise is best – go for aqua aerobics, swimming or cycling.

Other recommended treatments include:

• Cushioning Heel cup or heel wedge
• Calf muscle stretching
• Plantar fascia local massage
• Shoe inserts or Orthotics
• Night splinting
• A cast or surgical boot
• Low-dye taping.
• Dry needling
• Ultrasound or laser treatment
• Shockwave therapy
• Injections of steroids, Platelet derivatives or botox

Surgery is considered an absolute last resort and is not seen as any more successful than other treatments.

How can Doctor Greene’s help you

Our specialist products can help address the pain associated with plantar fasciitis.

• Heel Roller
• Gel Heel Cushion
• Ball of Foot Cushion

Stress-overuse injuries, bone bruising or fractures all occur due to repetitive loading. They can involve any bone in the foot or ankle. They are an extremely common cause of foot pain, often under-appreciated, with delays in diagnosis and timely management. Therefore they are associated with prolonged recoveries.

Causes can include increased activity, a change in footwear or a change in the terrain on which you walk or run, but often there is no obvious cause.

If you notice a gradual onset of pain without any obvious injury and it gets worse when you walk or engage in other weightbearing activity, suspect that it may be a stress injury. Any bone (of the 30) in the foot or ankle can be affected.

Diagnosing the problem

X-rays may reveal obvious fractures, but don’t detect bone bruising, which is best visualised on MRI.

What to do if you have a stress fracture or overuse injury

Treatment essentially involves reducing your activity so your bone can heal. You may need to choose specific footwear to cushion and protect your foot, or to use a surgical boot or shoe. Physiotherapy can help to maintain flexibility and address muscle imbalance.

Contributory factors can include suboptimal bone density(osteopenia/osteoporosis), or deficiencies in calcium, vitamin D or vitamin C, so consult your doctor if you are concerned.

How can Doctor Greene’s help you

Our specialist products can help address the pain associated with stress injuries to your foot.

• Ball of Foot Cushion
• Gel Heel Cushion

This refers to pain in the middle of the heel cord or Achilles tendon, usually caused by overuse, which leads to microscopic tears in the tendon. It’s now more appropriately termed tendinosis, but still widely called tendinitis, though there is no true inflammation here.

Along with tendon tissue overload or overuse, where the body does not have adequate time to recover, other risk factors include:

• Increased body weight BMI
• Diabetes
• Increasing age
• Medications such as some antibiotics (quinolones) and corticosteroids.

Symptoms include pain, local swelling, tendon thickening and dysfunction. You may notice discomfort at the beginning and end of exercise sessions. It may be painful or difficult to stand on tip-toes. Tendinosis unfortunately can be extremely slow to heal. Pain can fluctuate as the body attempts to repair local injury.

Diagnosing Achilles tendinitis (or tendinosis)

X-rays are not especially helpful for this.  Ultrasound or MRI scans are more informative.

What to do if you have Achilles tendinitis or tendinosis

No one therapy works for everyone, which is why we see so many different types of treatment exist.

Treatment aims to correct the cause of the problem. To encourage healing, you must modify – reduce or stop your usual level of activity. You’ll also need to commit to a stretching and strengthening regime, as this is the cornerstone of Achilles tendonitis treatment. Anti-inflammatories can alleviate pain, but use them with caution, as they can mask pain and do not necessarily encourage healing.

Other treatments can include: night splints if your calf muscles are very tight; dry needling; acupuncture; shockwave therapy; injections ; hydro-dilatation, and surgery.

How can Doctor Greene’s help you

Our specialist products can help address the pain and irritation associated with Achilles tendinois.

• Heel Grip
• Gel Heel Cushion

Although it’s the strongest tendon in the body, the Achilles is also the one that ruptures most frequently.

Achilles rupture causes sudden pain and swelling at the rear of the ankle, sometimes with an audible pop or the feeling of being struck by something. You may find it hard to bear weight on your foot, or feel weakness when your foot pushes off the ground as you try to walk.

An Achilles rupture can be caused by an abrupt change in training or activity intensity or participation in a new activity. Other risk factors include increasing age, a previous Achilles injury, or having used steroids or some antibiotics (quinolones) recently.

Diagnosing Achilles tendon rupture

Diagnosis is based on factors such as local pain and swelling, a ‘palpable gap’ where the tendon cord used to be, and being unable to stand on tiptoe. You may need an ultrasound or MRI to confirm the diagnosis.

How to treat a ruptured Achilles tendon

Treatment aims to restore tendon continuity, at the optimal tension, so you can recover the level of strength you had before and return to your usual levels of activity.

It’s important to get a suspected ruptured tendon seen quickly by a medical expert as the pain can dissipate quickly, creating a false sense of security. The underling issue actually gets worse as the tendon ends separate further.

Treatment can either involve functional rehabilitation (casting or bracing) or surgery followed by rehabilitation. The non-surgical option requires regular monitoring and physiotherapy, while you are recovering. The choice between surgery and functional rehabilitation will depend on your particular situation.

This refers to pain where the Achilles tendon connects to the heel bone. It’s often associated with an enlarged bony spur or prominence, termed a Haglund. Pain may emanate from the spur, the tendon tissue or an inflamed sac of fluid called the bursa, between the bone and tendon.

Symptoms include: local pain, generally aggravated by shoe contact; local swelling; and limitations in footwear and activities.

Diagnosing an Achilles bone spur or Haglund’s deformity

X- rays can reveal spurs or calcifications within the tendon. MRI or ultrasound can help assess the integrity of the tendon.

What to do if you have an Achilles bone spur or Haglund’s deformity

Choose your footwear carefully. Treatment involves cushioning or protecting the area. You can add liners that reduce friction. Local anti-inflammatory creams can reduce inflammation. Heel lifts or cups can offer relief by reducing tension in the tendon.

Surgery may be required where symptoms do not respond. This involves  shaving the bump and repairing the tendon. Recovery can take up to six months.

How can Doctor Greene’s help you

Our specialist products can help address the pain and irritation associated with Achilles bone spurs or Haglund’s deformity.

• Gel Heel Cushion
• Heel Grip

Ankle arthritis is relatively uncommon, as the ankle joint is naturally resilient. It affects about 1% of the population, making it nine times less common than knee arthritis. It’s often caused by one significant injury or a series of multiple minor ones.

Symptoms include pain, swelling, stiffness and limited function. Pain can build up gradually and change over time from a dull ache or discomfort to become sharp, stabbing or grinding. It is aggravated by weightbearing activity, relieved by rest. Stiffness also builds up gradually, while swelling can fluctuate.

Diagnosing ankle arthritis

Arthritis is an all-encompassing term, referring to any joint inflammation. The specialist treating you will seek to assess what type of arthritis you have. This could be osteoarthritis (caused by cartilage wear and tear), inflammatory or rheumatoid arthritis, or another type.

They will also have to figure out which specific joint is affected, as there are 33 individual joints in the foot and ankle region, and assess the severity of the arthritis, through an X-ray or other scan.

Treating and managing ankle arthritis

Managing any arthritis can involve multiple different approaches, some of which can be performed together. Make sure your shoes and runners offer comfort, protection and support, and get advice on the right footwear and orthotics for you. Although losing weight can be hard, it can really help if this is a contributing factor.

Changing your exercise habits can help. This could involve reducing heavy impact activity, alternating between impact and non-impact (swimming or biking) activities, running shorter distances or extending the rest and recovery periods between activity events. Ankle bracing or taping can reduce pain and swelling by limiting joint movement. Physiotherapy can also help by strengthening the muscles of the foot and ankle.

If you suffer persistent pain, you may benefit from injections of steroids, lubricants or concentrated platelet-plasma preparations. Surgery is generally a last resort. The surgical options will vary depending on the degree of damage.

How can Doctor Greene’s help you

Our specialist products can help address the pain associated with ankle arthritis.

• Gel Heel Cushion
• Ball of Foot Cushion

This condition is characterised by pain at the front or back of the ankle due to the trapping or catching of bone spurs, or soft tissue in the hinge of the ankle joint.

Symptoms can develop gradually or suddenly, and include pain, clicking or locking. Between episodes, the ankle is often pain-free. Pain is typically generated when the ankle joint is placed in a position of extreme flexion, either lunging(at the front) or tiptoeing(at the back). The diagnosis can be aided by an X-ray or MRI.

Treating and managing ankle impingement

You may be advised to wear supportive footwear; braces or boots as these grasp and stabilise the ankle and limit painful motion. Orthotics both cushion and support the heel, and a heel raise can alleviate pinching pain at the front of the ankle. Physiotherapy may also help to optimise motion and muscle balance.

For resistant pain, you may consider a steroid injection or surgery.

How can Doctor Greene’s help you

Our specialist products can help address the pain associated with ankle arthritis.

• Ball of Foot Cushion
• Gel Heel Cushion

An ankle sprain is a tear of the ligament(s);  the supporting structures about the ankle joint, invariably caused by rolling or twisting the ankle. Pain, swelling, bruising, heat and difficulty bearing weight are the hallmarks of a sprained ankle.

What to do if you have a sprained ankle

Initially, follow the RICE approach: Rest, Ice, Compression, and Elevation. You may need to immobilise your ankle in a support or surgical boot for a few days to help the inflammation to settle. Once the acute inflammation has resolved, see a physiotherapist to ensure you follow the best path of functional rehabilitation to enable your ankle tissues to heal optimally.

When to get medical help for an ankle sprain

If your ankle is not improving, seek a medical opinion as you may have some bone bruising, or a fracture / break. These may need specialist intervention.

Should you wear an ankle brace if you sprain your ankle?

The role of ankle bracing is slightly controversial. Bracing alone will not substitute for the benefits of building up the leg muscles that stabilize the ankle. Braces and ankle supports however compliment good muscle rehabilitation. It is important to get expert advice from a physiotherapist or other specialist.

Verrucae are plantar warts, which are usually found on the soles of the feet. They’re caused by infection with a human papilloma virus (HPV). Up to a third of primary school children get verrucae, of which two thirds resolve within two years. They are often confused with calluses.

Verrucae develop at sites of increased pressure, such as the heel or the ball of the foot, where the skin is damaged and acts as an entry point for the virus. The virus can then penetrate the skin cells, replicate and shed more viral particles.

Verrucae appear as single areas or clusters of thickened skin. There may have be no symptoms or they can cause pain. Sometimes, they create the sensation of walking on a pebble.

A key feature of verrucae is the presence of small black dots, which you can see after the hard skin is removed. These are small veins and distinguish verrucae from true calluses or corns.

Verrucae can be very hard to eradicate, as the thick skin on the sole of the foot allows deep penetration and can prevent topical medications reaching the virus.

What to do if you have a verruca

There are numerous treatment options, but they all require patience, persistence and the understanding that verrucae often recur. There is no single guaranteed solution

If you have no symptoms from your verruca, you can adopt a ‘wait and see’ approach as most resolve within two years.

The two most common treatments are

• topical salicylic acid (burning the wart)
• cryotherapy with liquid nitrogen (freezing the wart).

Those with diabetes or poor circulation should be careful when trying these.

More serious cases may require surgical removal, chemical cautery, phototherapy, laser treatment, immunotherapy or antiviral medications.

This is a benign, painless, fluid-filled lump or swelling that can occur under the skin in any part of the foot or ankle, usually in connection with a named tendon or joint.

Ganglions may fluctuate, increasing or decreasing in size, but sometimes disappear completely. They can become uncomfortable, if they grow large enough or can be irritated by footwear.

Not all lumps are ganglions. All lumps, no matter what their size, shape or location, whether they or painless or otherwise, should be taken seriously. If you find a lump, make sure you discuss it with your GP or specialist.

Treating a ganglion

Ultrasound or MRI scanning can help confirm the diagnosis. If the lump is large, painful, or causing irritation then the ganglion can be drained or removed. Ganglions can unfortunately recur after both drainage or surgery.