Heel pain is very common, especially among adults over the age of 40 and children between the ages of 8 and 13. It is usually the result of daily weight-bearing activities and exercise. The calcaneus, or heel bone, is the largest bone in the foot. It is also the first bone to make contact with the ground when walking or jogging, which makes the heel prone to stress and pain. In 30 percent of cases, heel pain affects both feet. The left heel is typically the first to be affected.
Heel Pain Symptoms
Heel pain is usually a symptom of an underlying condition, and it varies in severity. Most people tend to ignore heel pain, especially if they often spend long days standing or walking. Most people who suffer from heel pain describe it as worse after resting for long periods. Many people are surprised when the pain disappears once they resume their daily activities. But as a rule, inactive muscles tighten, increasing strain on the plantar fascia. Heel pain symptoms may include:
- Pain, especially after resting
- Swelling or inflammation
Heel Pain Causes
There are certain factors that may increase your risk of developing heel pain. If you are obese, stand for long periods, or wear shoes that do not fit properly, you could be more susceptible to heel pain. The most common cause of heel pain is swelling (inflammation) of the fibrous connective tissue on the sole of your feet (a condition called plantar fasciitis). Plantar fasciitis can cause more severe pain following periods of rest, such as when you are sleeping. This condition is referred to as post-static dyskinesia. Later on, small, micro-tears may occur in the fascia, leading to heel pain. This is known as plantar fasciosis.
Finally, heel pain sometimes arises because the foot does not absorb shock as it should. Less frequently, the patient’s heel pain is a result of a nerve entrapment, tendon dysfunction, or other plantar structural changes of the foot.
Other common causes for heel pain include:
- Achilles tendonitis
- Bone bruises
- Bone spurs (enthesis)
- Haglund’s deformity
- Sever’s disease (seen in children)
- Stress fractures
- Tarsal tunnel syndrome
- Severe tear of the plantar fascia
- Bursitis (plantar and retrocalcaneal)
- Seronegative or seropositive arthridities
- Tibialis Posterior Dysfunction
- Bony or soft tissue mass
When to See Your Podiatrist
The sooner heel pain treatment is initiated, the better the outcome. There are many remedies that can help relieve heel pain in the short term and keep the pain from returning. Your podiatrist is specifically trained to make a proper diagnosis and to treat your condition. Not all patients are alike, and treatment plans may vary accordingly.
If your heel pain continues when you are resting, or if the pain lasts longer than a month (especially after trying home remedies such as icing), you should contact your podiatrist for evaluation and testing. If the pain is severe, or if you have the following symptoms, call your podiatrist immediately:
- Inability to bend your foot downward
- Inability to rise on your toes
- Inability to walk
- Swelling in the heel region
- Pain coupled with fever, or numbness or tingling in heel
Diagnosing Heel Pain
The reason it is important to have your heel pain diagnosed by a professional is that you may have a fractured heel bone or tarsal tunnel syndrome. Your podiatrist will diagnose you by looking at your medical history and by giving you a physical exam, using imaging tests such as x-rays or ultrasound to detect problems like stress fractures. He or she will look for signs of swelling and tenderness, and you may be asked to walk or stand on one foot.
Heel Pain Treatment Options
Heel pain does not always subside immediately after treatment. Unfortunately, it may take several months for the pain to completely disappear, although most cases of heel pain can be treated at home under a podiatrist’s supervision. Avoiding activities that may worsen the condition, such as running or standing for long periods, is one way to reduce the pain. You can also try applying cold compresses or ice packs to your heel to reduce the pain and swelling. Your podiatrist may recommend that you change your footwear. Plantar fasciitis exercises and wearing closed-back shoes with a stiff heel-counter can help relieve the pain. Relapse of heel pain most often occurs because of noncompliance with treatment programs. Many patients feel that once the pain is resolved that they can go back to their bad habits rather than following their podiatrist’s recommendations.
Some patients may initially try over-the-counter items for their heel pain. Some patients may need a heel lift if they have posterior heel pain or Achilles tendonitis. Patients may also try heel seats, heel pads, cushioned heel cups, and over-the-counter arch supports. Typically these items help in the short term, but some patients need prescription orthotics prescribed by a podiatrist. Unlike items that you may buy over-the-counter, orthotics are custom-molded to your foot. Put simply, orthotics are devices used to modify the force with which the foot hits the ground. Orthotics will help to relieve the acute condition and they will keep the heel pain from returning. Anti-inflammatory medications can be prescribed, or you can purchase over-the-counter medications such as ibuprofen to help reduce pain and swelling.
If none of the above options work, your podiatrist may recommend physical therapy or additional treatment options not listed here, such as casting, night splints, or cortisone injections to help relieve the pain.
Surgery is an option if you are suffering from problems such as heel spurs, or if your heel pain does not respond to long-term conservative care. Heel spur surgery requires the podiatric surgeon to make a small incision on the side of the heel and detach the plantar fascial ligament from the heel bone. Newer, similar procedures such as an Endoscopic Plantar Fascia Release are also being used to help treat heel pain. Newer procedures tend to be less expensive and require less recovery time. Your podiatric surgeon will notify you if surgery is an option.
Heel Pain Complications
If you suffer from chronic or persistent heel pain, there are several complications that may arise. Common complications include:
- Arthritic changes in the heel that may place extra stress on the joints at the knee, hip, and spine
- Pain that does not go away with rest
- Difficulty walking or standing
Preventing Heel Pain
The American Podiatric Medical Association offers several tips for preventing heel pain:
- Begin exercises slowly.
- Consult your podiatric physician before beginning a new exercise program
- Stretch properly before and after exercising.
- Purchase shoes that fit correctly and have inserts.
- Wear shoes that are appropriate to any planned activity. For example, do not wear sandals if you plan to participate in sporting events such as running or cycling.
- Wear athletic shoes with good shock support in the heels, a stiff heel counter, good flexibility in the forefoot of the shoe, and good support to control side-to-side motion. The heels of your everyday shoes should be no higher than 1.5 inches.
- Avoid going barefoot on all surfaces.
- Avoid uneven walking surfaces when possible.
- If you use a treadmill, vary the incline.
- Avoid activities that may put constant strain on the foot.
- Switch activities—for example, swim one day and cycle the next.
Questions to Ask Your Podiatrist
Here are some questions you may want to ask your podiatrist about heel pain:
- What exercises and stretches will benefit me most? How often should I perform these exercises?
- Should I elevate or wrap (ACE bandage) my feet at night to relieve pain?
- Can changes in my diet decrease the pain during my normal activities?
- What additional symptoms should I watch for that may indicate an underlying problem?
- If additional symptoms begin to show, how long should I wait before seeing you again?
- If I have to come back because my heel pain continues, what diagnostic tests should I expect?