Heel pain is soreness or tenderness behind the heel, at the bottom of the heel, or within the heel bone itself. If you develop heel pain, it is likely because of the effects of one of these common conditions: plantar fasciitis, Achilles tendinitis, sprains, strains, and fracture, Bursitis, and Ankylosing Spondylitis.
Heel pain is not uncommon because, as human beings, you rely on your feet to support your whole body. As a result, your feet bear your entire weight. Hence, your heel is the ‘shock-absorber” of all the activities that you do each day. No wonder how tired and worn out they can often feel.
You experience heel pain when you overuse or injure your heel. Heel pain can range from mild to disabling. You may need to have a podiatrist diagnose the cause of your heel pain if simple home remedies don’t ease it.
WHAT CAUSES HEEL PAIN?
If you are wondering about the most common causes of heel pain – it differs according to causes, treatment, and prevention. Knowing them might give you a clue about your heel pain, but it will still be best to see a podiatrist get a reliable diagnosis of heel pain type that you experience, for it will be hard to identify the cause of your heel pain just by yourself.
The plantar fascia is a thin ligament that runs from the bottom of the heel to the ball of the foot. When the plantar fascia becomes inflamed and painful, it is called plantar fasciitis.
The plantar fascia has excessive tension at the heel, resulting in a bony growth that causes pain and discomfort and is called a heel spur.
Plantar fasciitis is a common orthopedic symptom that can cause heel pain and make you feel extreme discomfort when walking. It can be a persistent stabbing kind of heel pain.
The heel pain from plantar fasciitis can make you feel worse in the morning when just getting out of bed, usually intensifies gradually, and is felt more just after stopping from any movement. As one of the most common causes of heel pain, plantar fasciitis is also one of the most frequent reasons for seeking a podiatrit’s help.
Plantar Fasciitis is more common in women than men. The reason for this can be pregnancy as ligaments can loosen and the feet can become flatter. Wearing high-heeled or too flat fashion shoes can also cause the plantar fascia to be inflamed.
Bad Shoe fit, style, or size
These may seem unimportant, but they matter a lot when taking care of the plantar fasciitis and when you have heel pain.
People who have issues with their arches, either because of flat feet or high arched feet, often experience heel pain.
Thus, flat footwear or wearing unsupportive footwear can irritate and cause a bursa to form at the back of the heel. A bursa is a sac of fluid protecting the Achilles tendon where it inserts into the heel. The typical symptom is intense heel pain in the back of the heel.
Flat feet force the soft tissues to extend beyond what it should and the arch compresses. When this occurs you start feeling intense heel pain sooner or later.
The best shoes to get in order to help reduce heel pain caused by plantar fasciitis are the following:
Comfort must be the first criteria for the best shoes, rather than the salesperson’s opinion.
According to experts, some brands consider comfort and health in designing their footwear and agree that uncomfortable footwear is a cause of heel pain. Comfortable footwear may be more expensive but if shoes are comfortable they may help prevent or reduce heel spur and plantar fasciitis.
- Arch and heel support
Arch and heel support is key to great comfort, according to Dr Mohammad Rimawi, DPM, AACFAS.
“It’s the arch and heel support, and not the cushioning provided by the footwear, that is crucial in the prevention of plantar fasciitis,” says Rimawi.
- Firm sole and cushion in the midfoot
Shoes with a firm sole and cushion in the midfoot will help protect the heel from any impact that may worsen plantar fasciitis.
“A shoe that has a thick midsole or rocker bottom is an ideal shoe for someone with this condition,” according to DR. NelvaLobkodova, DPM.
- Soft ground impact
If you have Plantar Fasciitis, choose footwear that has a soft ground impact. Make sure your feet do not have a significant effect when you hit the ground that does not only affect your entire foot but specifically the foot ankle.
- Firm and Thick Heel counter
A firm and thick heel counter help cradle the heel and arch so the ankle will not absorb too much shock from the activities of the foot or when walking or running on hard surfaces. This heel pad can help set the foot’s arch in an ideal position that may prevent you from experiencing real foot pain.
When inserted into the shoe, the heel counter that also acts as a heel pad will reinforce the heel cup and increase support. It is made of plastic, so it is lightweight and does not affect the weight of the shoes. Moreover, an ideal firm heel counter helps lock the foot into the shoe and sets it to the midsole.
When you suffer from a heel spur or have been diagnosed with plantar fasciitis, it is better to talk with a podiatrist before shopping for footwear and refrain from excessive walking, running, jumping, or any other physical exercises that may intensify the pain.
- Being Overweight
The weight that your body puts on your feet can dramatically affect them and is the common cause of heel problems.
- It Comes With Age
The capacity of your bones deteriorates in time and with constant use. Hence, as you age, there is also a possibility to feel heel pains. The people who most frequently develop Plantar Fasciitis are older adults between the ages of 40-70.
- Very Active Lifestyle
Athletes, who have a very active lifestyle, or people who have jobs that require frequent movement and use of the feet and legs, are more prone to damaging their plantar fascia thus, developing plantar fasciitis.
Running excessively or standing for long periods may strain the foot ankle and the soft tissue under the middle or bottom of the foot or cause an injury that may trigger these conditions.
- It’s in Your Foot
Some people are born with foot problems such as flat feet, high arches, or tight Achilles tendons. They may develop plantar fasciitis.
Treatment of plantar fasciitis depends on the severity of the condition. However, most recover in several months with homecare treatments like resting, stretching, and using ice on the painful part of the heel.
- Taking pain relievers and anti-inflammatory medications
Generally, those who experience this condition are taking anti-inflammatory medications and pain relievers like Ibuprofen that may help ease the pain from plantar fasciitis.
- Physical therapy
Physical therapy is a discipline that uses non-invasive procedures that help in restoring maximum body movement. It can include using ultrasound, shockwave therapy, exercise programs, and educating the patient.
Your podiatrist might suggest wearing a splint at night that may help to stretch your calf and the arch of your foot while sleeping. This splint will keep the Achilles tendon and plantar fascia in a stretched position overnight to promote lengthening.
In addition, we may prescribe prescription arch support (orthotics) to help the even distribution of pressure to your feet.
Other Medical Procedures
We may recommend the following procedures if the previously mentioned treatments like taking pain relievers to reduce pain and anti-inflammatory medicines are not effective:
- Injecting a steroid into the tender area
Injecting a steroid into the painful part of the heel can give excellent relief from pain. The injection is performed under a nerve block so there is no discomfort. The bottom of the foot is numb for 12 to 24 hours. Most patients report a dramatic reduction in their heel pain within 7 days of receiving a steroid injection.
- Using Shockwave therapy
Soundwaves are applied at the part of the heel where the pain is to help in stimulating healing. Shock wave therapy applies high-energy sound waves to help the injured tissues recover.
In very few cases of plantar fasciitis or heel pain surgery is the best option. This is only performed if there is minimal improvement in heel pain over a 3 month period. The most common surgery we do for heel pain involves a minimally invasive (keyhole) technique. A small amount of the plantar fascia is released. A postoperative shoe is used for 7 to 10 days.
Most patients have elimination of all heel pain in the first 2 to 4 weeks. In a very small number of patients, there is nerve entrapment in the heel or arch which requires more complex surgery to relieve heel pain.
2. Achilles Tendinitis
Achilles tendinitis is an injury from overuse of the Achilles tendon that also causes heel pain. The Achilles tendon is the band of tissue connecting the calf muscles to the heel bone.
Achilles tendinitis causes pain that starts as a mild ache in the back of the leg or above the heel. Many feel these discomforts after running or doing sports activities. However, these episodes of more severe pain may happen after too much running, sprinting or climbing stairs.
Runners who increase the duration and the intensity of their runs are usually suffering from this condition. In addition, when activities like playing sports are done only on occasion, where the body is not used to the movement, Achilles tendonitis can surface.
There are simple solutions and at-home care remedies under a podiatrist’s advice for most cases of Achilles Tendinitis. More severe cases can lead to tendon ruptures that may require surgery.
The following are the causes of Achilles tendinitis, according to Cleveland Clinic:
- Pushing the body too fast and too soon
- A sudden increase in inactivity
- Sports that have quick starts and stops
- Poor-fitting shoes/inadequate footwear
- Injury to the Achilles tendon
- Running or exercising on uneven ground
- Running uphill
- Tight calf muscles
- Bone spur (extra bone growth in the heel that rubs the tendon and causes pain)
- Flat arches, feet that roll in (overpronation), and weak calf muscles
- Not warming up before exercising
The suggested treatments for Achilles tendinitis are the following:
Nonsurgical treatments such as pain relievers and anti-inflammatory medications are typical recommendations. However, when you are already experiencing the pain beyond six months, it may require surgery.
The following are some of the recommended nonsurgical treatment methods:
- You probably have not heard of this but stomping your heels is not a good practice. Walking barefoot or walking in shoes without lifting the heels is terrible.
- It would be best to be sensitive to how your tendon feels to stop the activities that are causing stress to them. Rest if you need to.
- Please avoid walking up ramps, climbing stairs and ladders.
- When you need to reduce swelling, lie down and raise your foot to a level above your heart. You may also opt to stretch your Achilles tendon by leaning forward against a wall with your foot flat on the floor and elevate your heel with the insert. Your podiatrist may want you to use a ⅜” or ½” heel lift..
- A cold compress or ice for 15 minutes after exercising is a good idea. Place the ice on the back of the heel to reduce inflammation. You may also use an athletic wrap or surgical tape.
- It could also help if you stretch your ankles and the muscles on your calf.
- If you are eager to reduce the swelling, a recommendation is to take an anti-inflammatory medication like Ibuprofen. It is good to use non-steroidal anti-inflammatory medications for pain and swelling.
- An X-ray may be recommended to see if you also have a bone spur.
3.SPRAINS, STRAINS AND, STRESS FRACTURE
Sprains and strains are the injuries that our feet may experience from physical activities. These injuries may be minor or severe depending on the extent of the impact on the foot.
A Fracture is a medical emergency that may require immediate attention. For example, a broken bone must be looked into as soon as possible to prevent more significant consequences.
Sprains and strains may include having bruises, swelling, difficulty in moving and pain around the affected heel.
A stress fracture is a broken bone that may just be a thin crack or a complete break. It causes foot pain that affects the outside of the foot. Whatever it is, you must seek medical attention right away.
A stress fracture is a sprain cuboid syndrome that results when a small bone in the foot becomes dislocated or when there is a repeated tension that irritates the tendon tarsal.
The common symptoms are:
- You will feel a snap or crushing sound when the injury occurs.
- There is inflammation, redness, and bruising in the injured area.
- You will see evident damage in the injured area.
- You are having difficulty standing with your injured heel.
Your very active lifestyle makes you prone to experience impacts on your heel, thus often experiencing heel pain. Most of you may experience an occasional strain or strain without even noticing. However, certain situations make you more prone to this:
- Athletic activities or exercise like jogging, running, or breast walking.
- You hardly notice that sometimes how you sit or stand is not appropriate to your body and thus puts too much pressure on your feet. It would be best if you consider that your body weight is distributed well on both feet.
- Falling or slipping may also cause you to have sprains, strains, and fractures.
- A fracture happens when your heel receives an impact that is too hard for it to handle. This condition usually occurs during traumatic incidents like falling, a force directly striking your heel, car accidents or gunshot wounds, and injuries from sports activities.
- Sprains and strains are treated with a cold compress or ice on the affected area, compression of surgical tape, elevating the affected area above your heart level, and most importantly, taking enough rest to allow the sprained or strained heel joint to recuperate.
- The severe sprains and strains may require surgery to repair damaged ligaments, tendons, or muscles. You must see a doctor as soon as you discover that all the other treatments don’t work.
- Treating a fracture is more challenging than it is with sprains and strains.
- It will depend on the extent of the fracture.
- Usually, we at Adelaide Foot and Ankle will try to put the pieces of broken bones back into their proper places and help them heal. Thus, there must be a restriction in your movement until the fracture heals. This healing is possible by using a cast to let your broken bones produce new bone around the edges of the broken pieces. Just like a puzzle, if aligned properly, they will eventually connect.
- Severe cases may require you to put pins or screws above and below the fracture site of your bone. These pins or screws will connect to a metal stabilising bar located outside of your skin, and it will stay that way until your bone is back in place and healing.
- I may also prescribe medication to relieve the pain, fight infection or control other complications.
The fluid-filled sacs surrounding your joints are called Bursa. Bursa acts as a protective cushion and lubricant between muscles and tendons sliding over the bone. Bursitis is the inflammation of this fluid-filled sac behind the heel bone or the stress fracture, which can be the result of repetitive stress, excessive physical activity, athletics, heavy manual work and sudden impact of the feet on hard surfaces.
When you have Bursitis, it is excruciating when moving and using your feet. The pain will increase when walking on tip-toe. You will also have stiff joints and pain on joint movement or when touching a joint and swelling or redness.
The following are some causes of Bursitis:
Excessive use of the ankle can irritate and inflame the Bursa that resulted from too much walking, running, or jumping.
Bursitis is generally linked to Achilles Tendinitis and sometimes mistaken to be it. This condition may be because of the following:
- A workout schedule that the bones could not handle
- Changes in activity level that the bones could not take, or because the body is not conditioned for the activity; or
- You have a history of arthritis that may be causing the inflammation.
- Generally, Bursitis heals on its own, but sometimes it does not. As a result, you may choose at-home remedies such as rest ice compress and take a pain reliever treatment to lessen or relieve the pain.
- I may prescribe an antibiotic for the infection and to heal the inflammation.
- I may also recommend Physical therapy or a set of exercises that may help strengthen the muscles in the affected area to lessen pain or total treatment of the syndrome.
- An assistive device like a walking cane or other suitable devices will ease pressure on the injured area.
- In rare cases, a steroid injection in the Bursa can help ease pain and inflammation and totally stop the syndrome.
- In rare cases also, the solution is to drain the inflamed Bursa of the affected part and stop the possible nerve enlargement due to complications of this syndrome.
- After these treatments are done, I will recommend physical therapy to help you regain the regular use of your bone.
Ankylosing spondylitis is an inflammatory disease that can make some of the tiny bones in your vertebrae fuse. The fusing of the bones may cause a hunched forward posture. The condition that the body experiences may also be the common cause of back pains.
It is a known fact that as you get older, the more you are prone to back pains. Back pain is a top health complaint. The back pains may be due to lack of exercise, inappropriate posture, overactivity, and many more. This back pain may go down your leg and contribute to heel pain, just like the one caused by Ankylosing spondylitis.
Some signs and symptoms at the onset of Ankylosing spondylitis are the following:
- lower back pain
- neck pain
- stiffness in your lower back and hips
- As time passes by, these symptoms could get worse, may improve or possibly stop.
The cause of ankylosing spondylitis is still unknown up to this day. However, As a result, it may seem that genetics has something to do with it. Some studies have found that people who have a gene called HLA-B27 are at a significantly increased risk of developing ankylosing spondylitis. Still, only some people with the gene develop the condition.
Ankylosing spondylitis still has no cure; only available treatments are done to lessen symptoms and help slow the development of the disease. Heel pain may be due to many causes and when properly diagnosed its effects may lessen or stop.
A Short Anatomy of the Heel
It will be tough for you to delve into the world of the anatomy of the human heel, but knowing a little bit might save you from worrying so much about your heel pain.
The bones of the foot support the soft tissues and help the foot carry the body’s weight.
These bones divide into three groups which are the Tarsals, Metatarsals, and Phalanges.
- Tarsals – these are the seven irregularly shaped bones in the ankle area.
- Metatarsals– these are the five bones that connect the phalanges to the tarsals.
- Phalanges – these are the bones of the toes.
The Tarsal bones divide into three rows: proximal, intermediate, and distal. The heel bone is in the proximal tarsal bones.
The talus and calcaneus are the proximal tarsal bones. These bones comprise the hindfoot that forms the framework around the proximal ankle and the heel.
The most superior of the tarsal bones is the talus. It transfers the weight of the entire body to the feet. Its main goal is to distribute the forces to the heel bone, which is the Calcaneus.
The largest of the tarsal bones is the Calcaneus underneath the talus, making up the heel. The Calcaneus is protected by a bursal sac, fat pad, and thickened skin. It takes much of the weight when standing. The Achilles tendon is a strong band of fibrous tissue that connects the calf muscles to the heel bone (Calcaneus). It is also called the calcaneal tendon.
Unresolved Heel Pain? Contact Adelaide Foot and Ankle
After trying all the home remedies and nothing seems to work out, contact us at Adelaide Foot and Ankle to get professional help. That way, you can perform day-to-day activities without heel pain and prevent the issue from getting worse.