What Is Heel Pain?
Heel pain is any discomfort that occurs at the rear of the foot along the heel bone. Usually, it’s the result of gait abnormalities that cause too much stress on the heel and surrounding tissues. People may experience heel pain after suffering an injury, wearing footwear that doesn’t fit, being overweight, or walking a lot on hard surfaces. Along with pain, patients may experience swelling, redness, and a sensation of heat.
Causes and Symptoms of Heel Pain
Heel pain can have numerous causes, including plantar fasciitis, excessive pronation, stress fractures, nerve entrapments, and other general health conditions.
Plantar Fasciitis
Plantar fasciitis is a condition where the band of connective tissue on the bottom of the foot becomes inflamed, causing pain. It is a common condition in people who run or jump frequently as these activities put extra strain on the plantar fascia. This causes the tissue fibers to tear, weakening the area and creating inflammation. Over time, the patient may even develop a bone spur where the tissue attaches to the heel. Wearing inadequate footwear can also exacerbate plantar fasciitis by further agitating the area.
For many patients, pain related to plantar fasciitis can worsen after being off the feet for a while. For example, walking first thing in the morning after getting out of bed.
Excessive Pronation
Excessive pronation is when a person rolls the foot inward while walking. In normal pronation, the arch of the foot flattens, and the heel strikes the ground first, with weight shifting along the outside of the foot and then back in toward the big toe to help absorb shock.
When a person rolls their foot inward, this stretches and pulls on the tendons and ligaments along the bottom of the heel. Over time, this causes pain and may also contribute to injuries in the lower back, knee or hip.
Other Health Conditions
Some other health conditions that can contribute to heel pain include:
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- Bone bruises—these occur when the tissues that lay over the heel bone become inflamed. It occurs after the foot suffers an impact.
- Achilles tendinitis—this is inflammation of the Achilles tendon, which wraps around the back of the ankle and connects to the heel bone. It is a common injury in runners and those with tight calf muscles, and develops over time as the tendon fibers tear.
- Bursitis—Bursitis occurs when a small sack of inflamed tissue irritates the heel. Many describe the pain as similar to that of a heel spur.
- Haglund’s deformity (pump bump)—Haglund’s deformity is the condition where the bone at the back of the heel becomes enlarged where the Achilles tendon attaches. It can develop after wearing ill-fitting shoes that cause bursitis.
- Rheumatoid arthritis—Rheumatoid arthritis, known as RA for short, is a chronic inflammatory disease that affects the joints, but can also affect other parts of the body. Swelling and pain are common RA symptoms as it affects the lining of the joints. RA can also cause potential joint deformities and bone erosion.
Heel Pain Diagnosis and Treatment
Heel pain is a symptom that can have one of several causes. Being examined by a podiatrist is highly advisable. Patients may even require x-rays for a definitive diagnosis.
Once the condition is diagnosed, patients may be prescribed several treatments, including:
- Oral or injectable anti-inflammatory medication.
- Exercise regimen.
- Shoe recommendations.
- Taping or strapping of the foot.
- Orthotic devices or other shoe inserts.
- Physical therapy.
In some cases, surgery may be required. Such surgeries may involve releasing the plantar fascia or removing bone growths, neuromas, spurs or bursal tissue.