The foot and ankle account for 26 bones (tarsals), 33 joints, and more than 100 tendons, out of which the heel bone (calcaneus) is the largest. The heel is a padded cushion of fatty tissues that holds its shape despite the pressure from the body weight and movement.

Below are the conditions that can cause pain in the heels:

 

• Plantar fasciitis
• Achilles or flexor tendonitis/tendonosis
• Bone spurs
• Sever’s disease 
• Bursitis
• Stress fractures
• Inflamed tendons

It is necessary to have a medical evaluation to determine the exact cause of your heel pain so that the proper treatment regimen can begin. Heel pain makes it difficult to walk or take part in day-to-day activities. 

Where does heel pain develop?

 

One can experience pain, soreness, or tenderness anywhere in the heel. Typically the pain occurs:

• Behind the heel
• Beneath the heel
• Within the heel bone

People of all ages suffer from heel pain, but certain groups seem to be at increased risk:

 

• Middle-aged men and women
• Physically active people
• People who are overweight or obese
• People who tend to be on their feet for long hours every day
• Children aged between 8-13 years 
• Women during pregnancy

Symptoms of Heel Pain

 

Heel pain symptoms vary depending on the cause. In addition to pain, you may experience:

• The bony growth on the heel
• Discoloration (bruising or redness)
• Stiffness
• Swelling
• Tenderness
• After standing from a resting or sitting position, you may experience pain.

Causes of Heel Pain

 

The principal causes of heel pain are putting a lot of pressure and strain on your foot. Other factors that could add up to the pain are the way of walking (foot mechanics) and foot structure.

• Abnormal walking style 
• Obesity
• Ill-fitting shoes
• Standing, running, or jumping on hard surfaces
• Heel injuries
• Bursitis 
• Neuroma (nerve enlargement)
• Certain disorders, including diabetes and arthritis
• Foot and ankle arthritis
• Flat feet or high foot arches

 

• Achilles tendonitis:  - The Achilles tendon is a fibrous tissue that connects the calf muscle to the heel bone. It's the body's longest and strongest tendon, and its overuse causes inflammation. Runners and basketball players are generally more prone to this condition. It may cause swelling, pain, and stiffness in the back of the heel. 
• Bursitis:  - Bursitis occurs due to the swelling of fluid-filled sacs called bursae (plural of bursa). You may experience a tender, bruise-like area in the back of the heel after spending a lot of time on your feet.
• Haglund’s deformity:  - It is an enlarged bony bump in the back of the heel due to chronic inflammation and irritation. High heels shoes can cause worsening of this bump and pain.
• Sever’s disease (calcaneal apophysitis):  - Sever's disease occurs in children between 8 and 14. Kids participate in a lot of activities like running and jumping. The increased athletic activity in kids irritates the growth plate in the back of the heel, causing Sever’s disease. 
• Bone bruise or contusion:  - The fat padding underneath the heel gets bruised by stepping on a hard, sharp object. Discoloration might not be evident, but you will experience tenderness in the heel. Sever's disease may cause pain in the heel on the bottom, side, and back.
• Plantar fasciitis:  - The leading cause of heel pain is Plantar fasciitis. It occurs due to the stretching and tearing of fascia (the connective tissue that runs along the bottom (plantar surface) of the foot). When too much pressure is there on your feet, it damages the plantar fascia ligament, causing pain and stiffness. People who run and jump are more likely to develop this. Treadmills and hard surfaces are common irritants. Flat footwear stretches the plantar fascia, which may result in the area becoming swollen or inflamed.
• Heel spurs:  - A bony growth or heel spur may develop on the heel bone due to chronic plantar fasciitis in the heel. 
• Sprains and strains:  - Sprains and strains often result from physical activity. These are common and can range from mild to severe, depending on the incident. 
• Ankylosing spondylitis:  - It is a type of arthritis that primarily affects the spine and is characterized by severe inflammation of the vertebrae that might eventually lead to chronic pain and disability. 
• Osteochondroses:  - It affects the growth of bones in children and adolescents.  
• Reactive arthritis:  - The infection triggered in another part of the body may cause this type of arthritis. 

 

Diagnosis of heel pain

 

Your physician will examine the foot and determine the cause of the pain. Factors like the amount of walking and standing the person do, what type of footwear they use, and their medical history will be some of the questions the physician may ask. 

 

The doctor will examine all the muscles from the knee and look for any unusual shape or skin changes. The examination may help differentiate between growth, psoriasis, and other conditions. Squeezing the heel can help detect nerve problems, the presence of a cyst, or a stress fracture. An X-ray may check for arthritis, bone fractures, alignment, and joint damage. Sometimes you may need an MRI or ultrasound to detect problems that X-rays don’t reveal.

 

Complications of heel pain

 

Heel pain may interfere with your ability to work, walk around, exercise, and complete day-to-day activities. When movement becomes difficult, it will lead to a sedentary lifestyle. Weight gain is a principal effect of an inactive lifestyle. Other conditions like depression and obesity can also occur subsequently. Untreated Achilles tendonitis can cause the tendon to break down and rupture.

 

Treatment

Generally, heel pain gets better over time with nonsurgical treatments. Treatment focuses on easing pain and inflammation, improving foot flexibility, and minimizing stress and strain on the heel. These treatments include:

 

• Exercises: - Exercises that stretch out the calf muscles can help ease heel pain and assist with recovery.
• Avoid walking barefoot:  - Walking without shoes puts undue strain and stress on your plantar fascia.
• Ice Application: - An ice pack on the heel for around 20 minutes several times a day can reduce inflammation. It is beneficial to place a thin towel between the ice and your heel; do not apply ice directly to the skin.
• Limit activities:  - Cut down on physical activities that require running and jumping to give your heel a rest.
• Shoe modifications: - Supportive shoes with good arch support, heel lifts, and shoe inserts help reduce pain.
• Medications: - Oral nonsteroidal anti-inflammatory drugs (NSAIDs) help to reduce pain and inflammation. 
• Padding, taping, and strapping: - Inserting pads in the shoe softens the impact of walking. Taping and strapping support the foot by reducing strain on the fascia.
• Orthotic devices: - Custom orthotic devices can be designed that fit into your shoe to correct the underlying structural abnormalities.
• Injection therapy: - Your doctor may recommend corticosteroid injections to reduce inflammation and relieve pain.
• Night splint: - Wearing a night splint reduces the morning pain experienced by some patients.
• Physiotherapy: - Physical therapy, including massage and ultrasound therapy, may be effective in breaking soft tissue adhesions. These treatments reduce pain and inflammation. Additionally, regular foot massage and concentrating on the arch of the foot can also help.
• Your doctor may recommend posture and walking style to correct imbalances and gait abnormalities that may contribute to the pain.

When Is Surgery Needed?

 

Most patients with heel pain respond to nonsurgical treatment. But a small percentage of patients may require surgery. If you continue to have heel pain even after several months of nonsurgical treatment, your doctor may consider surgery an option. The surgeon will discuss the surgical options to determine which approach would be most beneficial for the patient.

When should you contact your doctor?

 

If you develop heel pain, try home remedies such as rest, icing, and stretching exercises to ease your symptoms. If it doesn't get better within two to three weeks, you should make an appointment with your doctor.

 

You should consult a physician immediately if you experience the following:

 

• There is swelling in your heel.
• You are unable to walk because of the pain in your heel.
• Pain, numbness, or tingling in the heel
• Pain in the heel combined with fever
• If you experience difficulty while walking
• If you find it difficult to bend the foot downward or stand on a tiptoe
• If the heel pain continues for more than a week
• If the heel pain persists when you are not standing or walking

Conclusion

 

Heel pain generally improves over time with nonsurgical treatments. Your healthcare provider can determine what's causing the pain and recommend stretching exercises, orthotics, and other methods. The problem is often worsened by disregarding heel pain and continuing to do activities. It's essential to give your body time to heal and recover. If you ignore the pain and continue with daily activities, you may develop chronic heel pain that may affect your life for an extended time.