Heel pain can be a very painful and distressing condition. The underlying diagnosis is usually a heel spur or plantar fasciitis and, along with metatarsalgia (forefoot pain) and hallux valgus, it is one of the most common foot problems of all. The diagnosis can usually be made by the orthopaedic surgeon on the basis of the patient's medical history and a thorough examination. The onset of pain in the morning after getting up or after sitting for a long time are often the first sings. Sharp, initially localised pain under strain is the main symptom; pain at rest or at night, which wakes the sufferer up, is rare.

Behind heel spurs is chronic plantar fasciitis

Most often, this heel pain is due to chronic inflammation/irritation of the plantar fascia. The plantar fascia is a strong tendon plate that spans the sole of the foot and extends from the heel to the toes, it essentially forms the arch of the foot. With every step as well as when standing, the plantar fascia is stretched and is under high mechanical strain. A weak point of this system is usually the attachment to the heel bone, so that chronic inflammation can develop here, leading to heel pain, foot pain or even pain in the area of the Achilles tendon.

Source: Privatpraxis für Orthopädie und Osteopathie Dr. Borgmann; Freiburg 2021 https://www.orthopaedie-osteopathie-freiburg.de/fersensporn/

Inflammatory irritation of the plantar fascia of this kind can be triggered by overloading. Most of the time, however, no single triggering cause can be identified. In general, there is a chain of unfavourable factors behind it. It often starts with a pelvic torsion due to an ISG block or a block in the lumbar spine area, resulting in a so-called functional leg length discrepancy. Because of this functional leg length difference, one foot is overloaded with each step. This leads to recurrent micro-injuries in the fascia and thus represents a chronic inflammatory stimulus with shortening of the fascia. In most cases, analogous to Achillodynia (painful Achilles’ tendon), there is also a shortened calf musculature with active trigger points, which obviously also leads to increased strain on the plantar fascia.
For these reasons, after undergoing the osteopathic or manual therapy treatment of the pelvic-leg chain and the shock wave treatment, the compensation of an anatomical leg length difference or pelvic obliquity and self-exercises for stretching and fascia treatment of the calf and plantar fascia play a decisive role in eliminating the pain.

Source: Privatpraxis für Orthopädie und Osteopathie Dr. Borgmann; Freiburg 2021 https://www.orthopaedie-osteopathie-freiburg.de/fersensporn/

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