Heel pain


Heel pain is a general term used to describe pain and discomfort experienced anywhere in or around the rear foot. There are many different signs and symptoms of heel pain with many different causes, the most common are detailed below.

Plantar Fasciitis

What is it?

The plantar fascia is a band of tissue that stretches along the sole of the foot from the middle of the heel to its insertion at the ball of the foot and the toes. Sometimes this band of tissue is forced to stretch excessively and the insertion point of the tissue into the heel area becomes aggravated and inflamed. This is known as plantar fasciitis.

Signs & Symptoms

  • Pain experienced in the centre of the sole of the heel
  • Pain is worse in the morning and eases off as activity progresses
  • Can affect both feet or only one foot at a time
  • May be present with a heel spur (see below)
  • The pain may 'come and go' for weeks at a time
  • Plantar fasciitis can, and quite often does, resolve itself

Causes

  • Flat feet, also referred to as fallen arches or excessively pronating feet (see Flat feet)
  • Weight gain
  • Standing or walking for long periods of time in poor footwear, particularly high heels (see Footwear guide)
  • Heel spurs that form from the heel bone (calcaneum) can aggravate the plantar fascia and are often thought to be the cause of the pain

Treatment

A podiatrist can diagnose, discuss treatment options, and provide a treatment plan for you. Treatment options include -
  • Stretching and strengthening exercises to reduce tension in the plantar fascia and restore strength and flexibility in the calf muscles
  • Assessment of bone and tissue alignment in the foot and provision of insoles to support the arch and correct misalignment(see Biomechanics & orthotics)
  • Padding and strapping
  • Advise on footwear
  • Referral to GP for corticosteroid injection
Simple advise for you to follow at home includes -
  • Rest as much as possible and avoid standing for long periods of time
  • Modify exercise regimes to allow time for recovery
  • Wear good quality shoes with a supportive arch and a lace or other fastening to prevent your feet from slipping around inside the shoe
  • Apply 'Ice therapies' to reduce the inflammation and pain - a bag of frozen peas or a cold drinks can rolled under your foot can bring instant relief!

 

Heel spur

What is it?

A heel spur is a small growth of bone that protrudes from the heel around the site of the insertion of the plantar fascia (see above). The new bone growth occurs when the plantar fascia is put under strain and becomes inflamed and so unsurprisingly, often occurs with plantar fasciitis and can be resolved with the same treatment and advice.

Signs & Symptoms

See plantar fasciitis above.

Treatment

See plantar fasciitis above. It is not necessary to remove a heel spur as symptoms usually resolve when a conservative treatment plan is followed.

 

Heel bursitis

What is it?

A bursa is a fluid filled sack that can develop just underneath the skin. It develops as a result of increased friction over that body part in a similar way to how blisters develop. Bursae develop most commonly on the rear of the heel and on the underneath of the heel. Sometimes a bursa can develop and become inflamed and painful and this is known as bursitis.

Signs & Symptoms

  • Swelling and tenderness around the rear of the heel. Bursitis in this area tends to develop as a result of overuse of the Achilles tendon (the thick band of tendon that attaches the calf muscles to the back of the heel). The swelling can usually be felt on one side of the Achilles tendon.
  • Swelling and tenderness felt deep underneath of the heel, also known as Policeman's heel. This type of bursitis is quite rare.

Treatment

  • A podiatrist can diagnose the heel pain and help to pinpoint the cause. Treatments vary according to the type of bursitis you may have but is likely to involve footwear assessment and advice as well as assessment of bone and tissue alignment in the foot (see Biomechanics & orthotics)

 

Heel bumps

What are they?

Small protrusions that develop at the rear of the heel as a result of rubbing footwear

Signs and Symptoms

Heel bumps are visible and can be obviously attributed to poor fitting footwear as they will increase in size and or pain when incorrect footwear is worn

Treatment

A change in footwear is usually sufficient to improve the symptoms, though in extreme cases surgery may be necessary