Reasons, Treatment, and When to Contact a Healthcare Provider

Heel pain is an extremely common complaint and there are many potential causes, ranging from conditions that affect the heel bone, such as a hematoma or stress fracture, to conditions that affect nearby structures, such as plantar fasciitis or tendonitis. Achilles.

The pain can be stabbing and just plain annoying, stabbing and debilitating, or anything in between, depending on what's behind you and the severity of your case.

The heel bone, called the calcaneus, is at the back of the foot, below the ankle. Along with the surrounding tissue and another small bone called the talus, the heel bone provides balance and lateral movement to the back of the foot.

But because the anatomy of your foot is quite complex, your GP, podiatrist , or podiatrist will consider the problems associated with the bones, soft tissues, nerves, and skin that make up the entire foot and ankle when looking for the cause. of your discomfort. …

Illustration by Alexandra Gordon, Get Meds Info

Causes

Given the information above, it should come as no surprise that many potential causes of heel pain can be suspected. While it's best to leave the decision about what applies to you to your healthcare provider, knowing more about the reasons can help you prepare for this conversation.

general

The two most common causes of heel pain are plantar fasciitis and Achilles tendonitis.

Plantar fasciitis

Plantar fasciitis is an irritation and inflammation of the tight band of tissue that forms the arch of the foot and connects the heel bone with the base of the toes. Severe, stabbing, or shooting pain with plantar fasciitis is felt in the lower part of the heel and occurs when weight is transferred after rest, such as when taking your first steps in the morning or when getting up after sitting for a long time.

If plantar fasciitis persists for a long time, a heel spur, a bony bump, may form at the junction of the fascia with the calcaneus. In rare cases, a rupture (rupture) of the plantar fascia can occur.

Pain from a torn plantar fascia is severe, sharp, and sudden, and there may also be swelling and bruising.

Achilles tendonitis

Achilles tendonitis is an inflammation of the Achilles tendon, a large cord-like tendon that attaches to the back of the calcaneus.

The compressive or burning pain with Achilles tendonitis is located in the part of the tendon that is slightly above the heel bone. Slight swelling around the tendon and morning stiffness around the heel and lower leg are also common.

Achilles tendonitis is usually caused by overuse (for example, running too much and / or not warming up the calf muscles). Bone spurs from wearing ill-fitting shoes or arthritis can also cause Achilles tendonitis.

In rare cases, the Achilles tendon ruptures . This usually occurs as a result of vigorous physical activity in which the foot turns suddenly (such as in basketball or tennis). In addition to severe heel pain, some people report hearing a "snapping" or "snapping" sound when a tendon ruptures.

Used less frequently

You should also consider other less common causes of heel pain, even if you have experienced this discomfort and have previously received one of the above diagnoses.

Tarsal tunnel syndrome

Tarsal tunnel syndrome is a nerve disorder in which a large nerve in the back of the foot is pinched. Tarsal tunnel pain, described as aching or burning, can be felt in the heel, but is most common on the bottom of the foot and near the toes. As with carpal tunnel syndrome in the hand, there may be numbness and tingling, and the pain is often worse at night.

Stress fractures

Foot and heel stress fractures often occur in athletes or long-distance runners who increase their mileage in a short period of time. Repetitive stress on the calcaneus eventually results in a fracture.

Other factors that make you more likely to develop a stress fracture include:

A stress fracture causes severe pain that increases with physical activity and decreases with rest. In addition to pain, there may be swelling and tenderness in the area of the bone fracture.

Bruised heel

A bruised heel pad causes severe pain in the lower part of the heel. This can occur after an injury (for example, falling from a fall or stepping on a stone) or from overuse (for example, running long distances in shoes with poor shock absorption).

Fat pad atrophy

In older adults, the lining of the heel pad can atrophy or tear. Unlike plantar fasciitis, the pain from fat pad atrophy is absent in the morning but increases with physical activity during the day.

Heel pad syndrome occurs due to the thinning of this fat pad as a result of trauma, such as constant blows to the foot in marathon runners or pressure on the foot from obesity. This causes severe pain in the middle of the heel that is worse with exertion.

Haglund syndrome (with or without bursitis)

Haglund's syndrome , also called bump, occurs when a bony ridge on the back of the heel rubs against hard shoes.

It is not clear why some people develop this bulge, but experts suspect it could be due to a strain on the Achilles tendon, a high arch of the foot , the use of tight or ill-fitting shoes, and / or heredity.

Pain in Haglund syndrome is felt in the back of the heel and may be associated with lameness and signs of inflammation such as swelling, warmth, and redness. Bursitis can develop when the soft tissue surrounding the bump on the back of the heel is irritated.

There are two types of calcaneal bursitis:

  • Retrocalcaneal bursitis : inflammation of the bursa (fluid-filled sac) located under the Achilles tendon at the site of attachment to the posterior part of the calcaneus.
  • Calcaneal bursitis : inflammation of the bursa located between the Achilles tendon and the skin.

Retrocalcaneal bursitis causes deep pain in the back of the heel, while calcaneal bursitis pain is felt above and to the side of the Achilles tendon.

Tarsal syndrome

The tarsal sinus, called the "ear of the foot," refers to the space on the outside of the foot between the ankle and the heel bone. This space, although small, contains various ligaments, as well as fatty tissue, tendons, nerves, and blood vessels.

Stretching the ankle often causes this syndrome , which can lead to pain on exertion, a feeling of loosening in the ankle, and difficulty walking on uneven surfaces such as grass or gravel.

Rare

The following heel diagnoses are rare, but worth keeping in mind.

Piezogenic papules

Piezogenic papules are painful, yellow, or flesh-like bumps on the heels that represent fat deep in the skin that pushes through the heel capsule (called a fatty hernia). Papules are benign and cause pain in less than 10% of cases.

The cause is unknown, although experts suspect that papules may appear as a result of a violent heel strike when walking. Interestingly, they are a characteristic finding on the skin of people with Ehlers-Danlos syndrome , a connective tissue disorder.

Heel bone infection

In rare cases, a heel bone infection (called osteomyelitis) can cause pain, although unlike most other sources of heel bone pain, the pain from a heel bone infection is usually constant. There may also be a fever.

Calcaneal tumor

A swelling in the heel bone can cause pain, usually deep, irritating, and worse at night.

When to call your healthcare provider

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

Here are some clear signs that you should be examined by a doctor:

  • Inability to walk comfortably on the affected side.
  • Heel pain that occurs at night or while resting.
  • Heel pain that does not go away for several days.
  • Swelling or discoloration of the back of the foot.
  • Signs of infection, including fever, redness, and warmth
  • Any other unusual symptoms

Diagnostics

Most heel conditions can only be diagnosed based on medical history and physical examination. However, in some cases, additional tests are needed, such as imaging tests and / or blood tests.

History of the disease

A detailed history is often key to diagnosing heel pain. At the same time, it is reasonable to go to the doctor's appointment and get answers to the following basic questions:

  • Where is your pain? (for example, just above the heel or above the heel)
  • How is your pain? (For example, tingling or burning pain indicates a nerve problem, while sharp or painful pain indicates a soft tissue or tendon problem)
  • Do you experience pain when exercising or at rest?
  • If your pain occurs during exertion, do you notice it first in the morning after rest (as with plantar fasciitis) or later the day after activity (as with heel pad syndrome)?
  • Is heel pain worse at night? (Night pain is more common with nerve sources of pain, as well as tumors.)
  • Do you have symptoms other than heel pain, such as fever, numbness, or swelling?
  • Do you remember changes in your usual activity and / or an injury or trauma that caused your heel pain?

Physical exam

During the physical exam, your healthcare professional will examine and press (feel) various areas of your foot, including the heel, as well as the ankle, calves, and lower leg. In this way, they can check for focal tenderness, swelling, bruising, rash, or deformity.

Your healthcare provider will also likely evaluate your gait and move your leg and ankle to see if it is causing you pain.

Bloody work

Although blood tests are generally not done to diagnose heel pain, your healthcare provider may order one or more lab tests if they suspect or want to rule out a specific condition. The C-reactive protein (CRP) test is the most commonly prescribed type of blood test to rule out infection.

Display

A heel x-ray may be done to diagnose certain conditions, such as heel stress fracture, Haglund's syndrome, heel spur, or bone inflammation.

Other imaging techniques are used less frequently. For example, magnetic resonance imaging (MRI) can be used to diagnose soft tissue damage or infection.

Differential diagnosis

While it is reasonable to think that heel pain must come from the heel, this is not always the case. Sometimes the pain is related to the heel, as in certain neurological conditions.

Neuralgia

Irritation of a nerve in the lower back (called radiculopathy) can cause pain in the calf muscle, which travels up the leg to the heel. Additionally, peripheral neuropathies associated with diabetes, alcohol abuse, or vitamin deficiencies can cause diffuse pain in the feet and heels. In addition to a neurological exam, nerve conduction studies or MRI may be ordered to diagnose nerve problems.

Skin problems

Skin problems such as an infection on the back of the foot or ankle ( cellulitis ), a plantar wart , diabetic ulcers, or a fungal infection of the foot (such as a chronic athletic foot) can cause heel or sole discomfort. of the foot. foot. A history and physical exam are usually sufficient to diagnose a skin problem on the heel, although blood tests or a biopsy of the affected area may be necessary.

Systemic diseases

Inflammatory conditions throughout the body, such as sarcoidosis , rheumatoid arthritis , or reactive arthritis , can cause heel pain. Often other symptoms such as fever, rash, joint pain, and inflammation are present in these systemic diseases. Laboratory and imaging tests are also used to diagnose systemic diseases.

Watch out

Treatment depends entirely on the underlying cause of the heel pain. If you are unsure of your diagnosis or the severity of your condition, be sure to seek medical attention before beginning any treatment plan.

Some common treatments are listed below, but keep in mind that not all are suitable for all conditions.

Rest

For more acute causes of heel pain, such as a bruised heel, you may simply not need to avoid provocative actions to feel better. For example, take a few days off to jog or stand / walk for a long time.

In other cases, resting can help ease the worst pain until you can see your doctor or podiatrist.

Ice formation

For most sources of heel pain, applying an ice pack to the heel at 20 minute intervals up to four times a day can reduce swelling and relieve pain. Make sure to place a thin towel between the ice pack and the skin of your heel.

Recording

Covering the foot with sports tape or hypoallergenic tape is helpful for certain heel diagnoses, such as plantar fasciitis, bruised heel pad, and heel pad syndrome.

For plantar fasciitis, your healthcare professional may recommend a bandage technique that involves four strips of tape that are applied to the foot and heel. The tape should not be applied too hard; it can stay in place for up to a week.

Foundry

Many acute Achilles tendon tears are treated with a foot cast on the equinus (toes pointing downward).

Physical exercise / physiotherapy

Exercises and stretches are designed to relax the tissues around the heel bone. Some simple exercises, performed in the morning and at night, often help patients feel better quickly.

For Achilles tendonitis, your healthcare provider may refer you to a physical therapist who uses a specialized exercise program called the Alfredson protocol, which focuses on eccentric stress on the Achilles tendon.

Shoe modification

Depending on the cause of your heel pain, your doctor may recommend different leg supports.

For example, for plantar fasciitis, your healthcare provider may recommend wearing a splint at night to keep your foot straight. Additionally, wearing sturdy, comfortable shoes (with good arch and heel support) and / or using special shoe linings (such as gel pads or heel cups) can also be helpful in relieving plantar fasciitis pain.

Also, heels or shoe inserts may be recommended to treat Achilles tendonitis. For Haglund syndrome, your healthcare provider may recommend that you change the height of the heel of your shoe.

Medicines

Nonsteroidal anti-inflammatory drugs ( NSAIDs ) are generally prescribed for heel pain caused by problems such as plantar fasciitis, Achilles tendinitis, bruised heel pad, Haglund's syndrome, calcaneal bursitis, heel pad syndrome, and tarsal sinus syndrome.

For more severe heel pain, such as a fractured heel, opioids may be prescribed for a short period of time.

Sometimes cortisone , a steroid that reduces inflammation, may be injected into the heel to temporarily relieve pain (usually for several weeks).

Operation

For most causes of heel pain, surgery is generally only recommended if non-surgical treatments have not worked for a period of six to 12 months.

For example, for plantar fasciitis, surgery to separate the plantar fascia from the calcaneus (called plantar fascia release) may be done if all other treatments have failed within a year.

Another surgery called gastrocnemius muscle resection, which lengthens the calf muscles (gastrocnemius), may also be done for persistent plantar fasciitis.

Prophylaxis

Preventing symptoms of heel pain can be an important component of long-term management of your condition. Prevention strategies may vary slightly depending on the exact source of the pain. But in general, there are several steps you can take to avoid recurring symptoms of heel pain.

Some of these include:

  • Increase your activity level gradually: Increasing your physical activity gradually and taking breaks can help prevent heel injuries.
  • Maintain the ideal body weight . Being overweight increases the load on the lower extremities, including the heel.
  • Wear the right shoes . Wearing the right, well -fitting shoes (shoes with adequate cushioning and support) is critical to preventing many types of heel pain.
  • Early detection of discomfort : Your body usually tells you when it is engaged in some activity that is causing the aggravation. Listening to the symptoms, especially in the early stages, can give you a chance to deal with the problem before it escalates. Continuing activities that make symptoms worse can lead to a more serious problem that is harder to solve.

Get the word of drug information

Some causes of heel pain are more serious than others. However, your healthcare provider can help you figure out what is causing your discomfort and develop a treatment plan that will help you in your specific situation. On the plus side, most of the solutions are pretty simple – rest, ice packs, and shoe modifications – that you can do at home without a hitch.

Try to follow your healthcare provider's plan to the best of your ability – your body, including your heel, deserves your attention and care so that it can heal properly and eliminate pain.

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