Heel pain is a very common foot problem. The patient usually feels pain either under the heel (planter fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone.
In the majority of cases heel pain has a mechanical cause. It may also be caused by arthritis, infection, an autoimmune problem, trauma, a neurological problem, or some other systemic condition (condition that affects the whole body).
What are the signs and symptoms of heel pain?
Pain typically comes on gradually, with no injury to the affected area. It is frequently triggered by wearing a flat shoe, such as flip-flop or sandals. Flat footwear may stretch the plantar fascia to such an extent that the area becomes swollen (inflamed).
In most cases the pain is under the foot, towards the front of the heel.
Pain after rest – symptoms tend to be worse just after getting out of bed in the morning, and after a period of rest during the day.
After a bit of activity symptoms often improve a bit. However, they may worsen again towards the end of the day.
What are the causes of heel pain?
Heel pain is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel.
The most common causes of heel pain are:
- Plantar fasciitis – inflammation of the plantar fascia.
- Heel bursitis – inflammation of the back of the heel, the bursa (a fibrous sac full of fluid).
- Heel bumps (pump bumps) – common in teenagers. The heel bone is not yet fully mature and rubs excessively, resulting in the formation of too much bone.
- Tarsal tunnel syndrome – a large nerve in the back of the foot becomes pinched, or entrapped (compressed).
- Chronic inflammation of the heel pad – caused either by the heel pad becoming too thin, or heavy footsteps.
- Stress fracture – this is a fracture caused by repetitive stress, commonly caused by strenuous exercise, sports, or heavy manual work. Runners are particularly prone to stress fracture in the metatarsal bones of the foot.
- Severs disease (calcaneal apophysitis) – the most common cause of heel pain in child/teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the calcaneus (heel bone). Children aged from 7-15 are most commonly affected.
- Achilles tendonosis (degenerative tendinopathy) – also referred to as tendonitis, tendinosis, and tendinopathy. A chronic (long-term) condition associated with the progressive degeneration of the Achilles tendon.
Diagnosing heel pain
A podiatrist will carry out a physical examination, and ask pertinent questions about the pain. The ppodiatrist will also ask the patient how much walking and standing the patient does, what type of footwear is worn, and details of the his/her medical history. Often this is enough to make a diagnosis.
Sometimes Xrays, CT scans, ultrasounds or MRI’s are required to confirm the diagnosis.
What are the treatment options for heel pain?
Treatment for plantar fasciitis – the vast majority of patients recover with conservative treatments:
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Physical therapy : exercises which stretch the plantar fascia and Achilles tendon, as well as strengthening the lower leg muscles, resulting in better stabilization of the ankle and heel.
- Night splints – the splint is fitted to the calf and foot; the patient keeps it on during sleep. Overnight the plantar fascia and Achilles tendon are held in a lengthened position; this stretches them.
- Orthotics – insoles and orthotics can be useful to correct foot faults, as well as cushioning and cradling the arch during the healing process.
- Footwear – the podiatrist will discuss what footwear is best suited to reduce the pain and prevent re-occurrences
- Initial Home care
- Rest – avoid running or standing for long periods, or walking on hard surfaces. Avoid activities which may stress the heels.
- Ice – place an ice-pack on the affected area for about 15 minutes. Do not place bare ice directly onto skin.
- Footwear – proper-fitting shoes that provide good support are crucial.