The heel is designed to take a lot of stress. It is padded with thick skin and fat so you can pound the pavement or do sports activities without pain. If you do these things to excess, however, you can develop various kinds of heel pain. Heel pain can occur from overuse of the heel or from wearing shoes that do not effectively cradle the heel as you walk or run.
Heel pain is very common. Fortunately, it can get better without treatment (including surgery) if you allow the heel to rest. On the other hand, some people ignore early heel pain and continue to walk or run on the heel until it becomes impossible to do so without pain. The pain can even be present when you are not on the foot, leading to chronic pain that affects many of your daily activities.
Symptoms and Diagnosis of Heel Pain
Heel pain can be located on the bottom of the heel or in the back of the heel. The doctor can ask you questions about where your pain is located and may be able to elicit tenderness in the affected area. The range of motion of heel and ankle will be assessed and areas of swelling noted.
Because there can be many causes of heel pain, you should seek the advice of a doctor or podiatrist who can help you identify the source of the pain. X-rays may be taken to see if there is any heel spur on the bottom of the heel that may be contributing to the pain. The doctor will also watch you walk and will ask you to stand on the heel to see how it sits on the ground.
Causes of Pain underneath the Heel
If you are experiencing pain beneath the heel, it may be due to any number of conditions that cause inflammation of the soft tissue at the bottom of the foot. These include the following:
- Bruising from stepping on something. You can step on something hard like a stone or rock, bruising the tissue that normally pads the heel. This may show up as a bruise on the bottom of the foot and minor swelling. Usually, you know you’ve stepped on something and can rest the foot, thereby relieving the pain and inflammation.
- Heel Spur. You can develop a heel spur on the bottom of your calcaneus, which is made from a calcium deposit. The heel spur is the insertion point of the plantar fascia that spreads along the arch of the foot to help form the arch. An x-ray can be done to show the calcium deposit. The best way to treat a heel spur is to rest the foot as much as possible. Your podiatrist or doctor will show you exercises you can do to relieve the pain or can make or recommend inserts for your shoe that are cut out to protect the heel spur. In rare cases, surgery needs to be done to remove the heel spur if conservative measures fail to heal the pain and inflammation.
- Plantar fasciitis. This is an inflammation of the connective tissue band that connects the calcaneus (the heel bone) to the base of the bones that make up the toes. It is caused by walking or running too much on the foot. The pain is usually in the base of the heel but it can spread down the foot to involve the entire arch of the foot. It is usually worse first thing in the morning or after an exercise program involving being on your feet. Your doctor or podiatrist can recommend exercises to ease the pain of plantar fasciitis, and heel pads can be placed in the shoe to protect the plantar fascia and ease the heel pain.
Causes of Pain behind the Heel
Pain behind the heel is usually related to the Achilles tendon; specifically to an inflammation of the area where the Achilles tendon connects to the calcaneus. This is called “retrocalcaneal bursitis”. This can be caused by excessive running or by having shoes that excessively rub the back part of the heel. This type of pain tends to build gradually over time. The skin over the heel can be thickened from excessive rubbing on it and there can be redness or swelling over the back of the heel.
Some people will get a bump on this part of the heel that is both warm and tender. It may be more painful first thing in the morning or when you get up after resting for a period of time. Wearing normal shoes can become too painful when this occurs. There may be a bone spur underneath the swelling and an x-ray can show this.
The best treatment for pain behind the heel is to do various kinds of stretching exercises, avoiding activities that worsen the pain and wearing shoes that have an open back. Heel inserts can be prescribed to put pressure on different parts of the heel and stretching exercises can be done to stretch out the Achilles tendon. Nonsteroidal anti-inflammatory medication can be used for the pain and ice can temporarily ease the inflammation.
“I love to play basketball but was prevented from doing so by my heel pain, so my osteopath Jenny Mullen suggested I see The Foot Practice. I was diagnosed with plantar fasciitis, then given fun exercises and advised that I needed to wear orthotics to alleviate the pain. He used a sleek 3D scanning machine to make a great fitting orthotic to use with my every day shoe. After wearing them for a month the pain was gone and I felt an improve strength in my feet especially during sports even though the pain has gone I continue to wear the soles. Thank you very much Tim.”