Definition and Overview

Heel pain is a common medical problem affecting over two million people in the United States alone. Typically caused by a number of conditions, including injuries and disorders of the bones, muscles, tendons and nerves of the foot, it is typically felt either underneath the heel or behind the heel. Although its symptoms are not life threatening, persistent heel pain can be debilitating, and if not adequately addressed, may interfere with exercise routines and even activities of daily living.

Causes of Condition

The common causes of heel pain are overuse, uneven distribution of weight, and persistent trauma caused by physical activities such as running and jogging. The heel absorbs majority of an individual’s weight and running places an even greater pressure on it. Because of these, athletes tend to be at a higher risk of developing this condition. This soreness, which is often attributed to repetitive stress and pressure, produces mild pain that gets better with rest.

One of the most common causes of heel pain in both athletes and non-athletic individuals is plantar fasciitis. The plantar fascia, which is a fibrous band located on the underside of the foot, is designed to support the bottom of the foot and the arch. Excessive jumping and running, over-pronation and obesity can cause the plantar fascia to be overstretched and damaged, resulting in inflammation and pain in the foot and heel. The pain brought by plantar fasciitis, which is usually felt beneath the heel, is typically related to running and commonly seen in women.

Another common cause of heel pain is Achilles Tendinitis. In comparison to plantar fasciitis, the pain of Achilles tendinitis is felt on the back of the heel, instead of underneath it. The Achilles tendon is the tissue that connects the heel to the calf muscles. The condition is chronic, resulting in degeneration and weakness of the Achilles tendon, producing heel pain. Athletes who suddenly increase the intensity of their activities commonly experience this condition.

Aside from these, the other common causes of heel pain are the following:

  • Bursitis of the heel, or inflammation of the fluid-filled sac of the heel typically caused by constant pressure due to improper footwear.
  • The development of heel spurs, or bony growths on the heel, which is caused by chronic inflammation in areas where the soft tissue is attached to the bone.
  • Ankle sprains and strains, which are injuries to the ligaments and muscles, respectively.
  • A calcaneal fracture, or a fracture of the heel bone. Calcaneal fractures are typically caused by high impact injuries to the foot, such as those experienced in vehicular accidents or falls.
  • Tarsal tunnel syndrome or the compression of the foot nerves, specifically, the tibial nerve, which carries the sensation from the heel.
  • Peripheral neuropathy, which is common in diabetics, causes numbness and pain in the feet and the heel.
  • Bone infection or osteomyelitis
  • Various kinds of arthritis
  • Fibromatosis
  • Atrophy of the fat pads
  • Severs disease, which is due to repetitive trauma to the calcaneal growth plates and is common in child athletes.

Key Symptoms

The common causes of heel pain typically produce unilateral pain, which can be felt either beneath or behind the heel, and can also involve the arch of the foot. This symptom is common with patients who report a history of weight gain or sudden increase in exercise or activities or those who have a history of trauma to the foot.

Heel pain is infrequently bilateral; bilateral heel pain may be due to a systemic condition, such as arthritis or neuropathy.

Plantar fasciitis, specifically, presents with pain upon waking up in the morning or after a period of rest. The pain eventually improves after stretching and walking, but prolonged weight bearing further worsens the pain.

Who to See and Types of Treatments Available

If you experience heel pain, the first thing to do is to minimize the pressure on your heel by staying off your feet and sitting down instead. In some cases, it may be necessary to keep your foot immobile for a few days. Cold compress application decreases the swelling. Using proper footwear with a sole cushion and arch support, especially when you run or when you jog, is crucial in order to relieve the symptoms and prevent recurrence.

However, if the pain is persistent and comes with swelling or fever, and you are unable to walk normally, it is best to consult a specialist. A foot and ankle surgeon, podiatrist, or an orthopedic surgeon, will be able to diagnose your condition and give you the proper treatment.

In order to diagnose the exact cause of heel pain, your diagnosing physician will conduct a comprehensive physical examination and will look into the specific characteristics of your heel pain, including the location, any triggers, and the relation of the occurrence of pain to your activities. Several examinations and imaging studies, such as an x-ray, may also be ordered.

Pain medications, specifically nonsteroidal anti-inflammatory drugs, can reduce the swelling and inflammation on the heel. If the pain is persistent, your physician may resort to steroid injections.

Physical therapy can also improve the symptoms and prevent the recurrence of heel pain. Your physical therapist will teach you stretching and strengthening exercises and advice you to decrease the workload on the foot. Special supports and braces, or orthotics, may also be used in distributing the heel pressure, resulting in decreased pain, especially in the mornings. For unrelenting heel pain, surgery may be an option.

References:

  • Heel Pain – American Orthopaedic Foot and Ankle Society. https://aofas.org/
  • Heel Pain – NSH Choices. https://nhs.uk/conditions/heel-pain/pages/introduction.aspx/
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