Heel Pain

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What is it?

The heel carries most of our body weight and is therefore vulnerable to damage, and ultimately pain.Heel pain is an extremely common foot complaint and there are several common causes. The sufferer usually feels pain either under the heel or just behind it, where the Achilles tendon connects to the heel bone.Even though heel pain can be severe and sometimes disabling, it is rarely a health threat. Heel pain is typically mild and usually disappears on its own. However, in some cases the pain may persist and become chronic.There are 26 bones in the human foot, of which the heel (calcaneus) is the largest.The human heel is designed to provide a rigid support for the weight of the body. It absorbs the impact of the foot when it hits the ground when we are walking or running and springs us forward into our next stride.  It is important to make an accurate diagnosis of the cause of your symptoms to determine appropriate treatment. 

What causes it?

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 include: 

Plantar fasciitis 
This is the most common condition that causes heel pain. Plantar fasciitis is due to irritation and inflammation of the tight tissue that forms the arch of the foot. Common symptoms of plantar fasciitis include heel pain with prolonged walking and standing. Other causes include: 

Heel Spur

This is commonly associated with plantar fasciitis. Heel spur is most commonly seen in patients who have long standing heel pain due to plantar fasciitis. 

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome causes a large nerve in the back of the foot to become entrapped, or pinched. Similar to carpal tunnel syndrome in the hand, tarsal tunnel syndrome can cause heel pain.  

Stress fractures

Stress fractures of the calcaneus are an uncommon cause of heel pain. Stress fractures should be considered especially in athletes such as long distance runners who have heel pain. 

Heel bursitis

Inflammation of the back of the heel, the bursa (a fibrous sac full of fluid). It can be caused by landing awkwardly or hard on the heels or by pressure from footwear. 

Heel bumps

This is common in teenagers. The heel bone is not yet fully mature and rubs excessively, resulting in the formation of too much bone. It is often caused by having a flat foot or when teenage girls start to wear high heels before the bone is fully mature. 

Achilles tendonitis

This is a chronic (long-term) condition associated with the progressive degeneration of the Achilles tendon.   

Posterior Heel Pain

Posterior heel pain causes symptoms behind the foot, rather than underneath. Posterior heel pain causes include Achilles tendonitis and retrocalcaneal bursitis.  Heel pain may also be caused by arthritis, infection, an autoimmune problem, trauma, a neurological problem, bone bruise, bone cyst, gout, or some other systemic condition (condition that affects the whole body). Wearing flat shoes, such as sandals and thongs, often triggers it. Flat footwear may stretch the plantar fascia to such an extent that the area becomes swollen or inflamed.  In most cases the pain is under the foot, towards the front of the heel.  

Common treatments

Treatment of heel pain depends entirely on the cause of the problem. It is vital to understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis,or the severity of your condition, you should seek medical advice before beginning any treatment plan. 

Some common treatments to control heel pain include:  

  • Rest

  • Applying ice packs

  • Exercises and stretches (to relax the tissues that surround the heel bone)

  • Anti-inflammatory medications

  • Shoe inserts  

If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention.  

You should see a doctor or podiatrist if: 

  • You experience severe pain accompanied by swelling (or fever)

  • You have numbness or tingling in the heel

  • You cannot walk comfortably on the affected side

  • You cannot bend your foot downwards

  • Heel pain occurs at night or while resting

  • Heel pain persists beyond a few days

  • There is swelling or discoloration of the back of the foot

  • There are any signs of an infection (including fever, redness, warmth)

  • There are any other unusual symptoms  

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About Pain does not provide medical advice, diagnosis or treatment