Heel pain is a common foot condition that can occur in anyone. The heel bone is one of the largest bones in the foot and it’s responsible for weight bearing. There are several muscles and ligaments that attach to the heel bone and when these become inflamed or irritated, heel pain can develop. Heel pain can be caused by a number of factors such as wearing high heels, running, obesity, or even arthritis.
Causes of heel pain
Plantar fasciitis
Heel pain caused by plantar fasciitis is a common condition that results in pain and inflammation of the plantar fascia, a ligament that extends from the heel to the ball of the foot. The plantar fascia supports the arch of the foot and can be injured by overuse or abnormal loading of the foot.
Heel bursitis
Heel spurs, plantar fasciitis, and heel bursitis are just a few of the conditions that can result in heel discomfort. When the bursa, a little sac filled with fluid that cushions the joint between the heel bone and the Achilles tendon, gets inflamed, it is said to have heel bursitis. The heel may experience pain and swelling as a result.
Heel bumps
Heel bumps are a common cause of heel pain. They are caused by an accumulation of hard skin on the heel. This can cause pain when you walk and make it difficult to plant your foot firmly on the ground. Heel bumps can be treated with over-the-counter heel pads or by rubbing them with a pumice stone. If the bumps are severe, you may need to see a doctor for treatment.
Tarsal tunnel syndrome
Many different conditions, including tarsal tunnel syndrome, can result in heel pain. The posterior tibial nerve is compressed as it travels through the tarsal tunnel, causing tarsal tunnel syndrome. The foot and ankle may experience discomfort, numbness, and weakness as a result of this compression. Rest, ice, compression, and elevation of the foot are frequently used as tarsal tunnel syndrome treatments, along with NSAIDs to lessen inflammation.
Chronic inflammation of the heel pad
Chronic inflammation of the heel pad is often the result of repetitive stress on the feet, and is a common cause of heel pain. The inflammation can cause the heel pad to thicken and can also lead to the growth of bone spurs. Heel pain also caused by chronic inflammation.
Stress fracture
Heel pain caused by stress fracture is a condition in which the heel bone becomes cracked or broken. It often occurs due to repeated stress on the bone, such as from excessive running or jumping. Symptoms include pain and swelling in the heel, difficulty walking, and a popping sound when the foot is moved. Treatment typically involves rest, ice, and compression of the foot. In severe cases, surgery may be necessary.
Severs disease
Heel pain caused by Sever’s disease is a common condition that affects the heel bone. The heel bone is surrounded by a band of tissue called the Achilles tendon. The Achilles tendon attaches the calf muscles to the heel bone. The Achilles tendon, which is pulled by the calf muscles as they contract, pulls on the heel bone. This constant tension can cause the heel bone to become irritated and sore. Sever’s disease is more common in children who are 8 to 12 years old.
Achilles tendinosis
Heel pain caused by Achilles tendinosis is a common problem that can be treated with a combination of rest, ice, and physical therapy. The Achilles tendon is the largest and strongest tendon in the body and connects the calf muscles to the heel bone. Tendinosis is a condition in which the tendon becomes inflamed and thickened, and can cause pain and stiffness in the heel.
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Symptoms of heel pain
Heel pain can make it difficult to walk or stand, and can interfere with your daily activities. Some of the most common symptoms of heel pain include:
- Sharp or stabbing pain in the heel: This is a common symptom of plantar fasciitis, which involves inflammation of the plantar fascia, a thick band of tissue that connects the heel bone to the toes. The pain is usually worse in the morning when taking the first steps out of bed or after periods of rest.
- Aching or throbbing pain in the heel: This type of pain can be associated with various conditions, such as Achilles tendonitis or heel spurs. The pain may be more noticeable during or after physical activity.
- Swelling or tenderness in the heel area: Swelling, redness, or tenderness may indicate inflammation or injury, such as Achilles tendonitis or bursitis.
- Stiffness in the heel or surrounding area: Stiffness may be more pronounced in the morning or after periods of inactivity and can be a sign of inflammation or injury in the heel area.
- Pain that increases with activity: Heel pain that worsens during or after physical activity, such as walking, running, or standing for long periods, could be a sign of an overuse injury like plantar fasciitis or Achilles tendonitis.
- Difficulty walking or bearing weight on the affected foot: If heel pain is severe enough to affect your ability to walk or bear weight, it is essential to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.
If you are experiencing any of these symptoms, see a doctor as soon as possible. Heel pain can be treated with a variety of methods, including rest, ice packs, physical therapy, and surgery.
Treatments for heel pain
Evidence-based treatment options for heel pain include orthotics, stretches and exercises, ice therapy, and other interventions.
Orthotics
Orthotic devices are custom-made or off-the-shelf inserts that provide support and stability to the foot, helping to correct any abnormalities in foot structure. Research has shown that orthotics can be effective in treating heel pain, particularly in cases of plantar fasciitis (Rome, 2011). By redistributing pressure and improving foot alignment, orthotics can alleviate stress on the affected areas, providing pain relief and preventing further injury.
Stretches and exercises
A variety of stretches and exercises can target specific muscles and tendons in the foot and ankle, improving flexibility and reducing tension on the heel. One well-known exercise is the plantar fascia stretch, which involves pulling the toes towards the shin to stretch the plantar fascia at the bottom of the foot (Digiovanni et al., 2006). Another effective exercise is the calf stretch, which can alleviate tension in the Achilles tendon and gastrocnemius muscle. Research has demonstrated that regular stretching can improve pain and function in individuals with plantar fasciitis (DiGiovanni et al., 2003).
Ice therapy
Applying ice to the affected area can help reduce inflammation and provide temporary pain relief. A systematic review by van Leeuwen et al. (2014) found that ice therapy, particularly in combination with other treatments, can be effective for short-term pain relief in patients with plantar fasciitis. Ice therapy can be applied using an ice pack, ice massage, or even a frozen water bottle rolled under the foot.
Physical therapy
A physical therapist can provide personalized guidance on exercises, stretches, and other therapeutic techniques that target the underlying cause of heel pain (Martin et al., 2014).
Extracorporeal shockwave therapy (ESWT)
ESWT delivers high-energy shockwaves to the affected area, stimulating the body’s natural healing processes. Research has shown that ESWT can be an effective treatment for chronic plantar fasciitis that has not responded to conservative treatments (Gollwitzer et al., 2015).
Anti-inflammatory medications
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce inflammation and provide temporary pain relief. However, these medications should be used with caution, as long-term use can lead to adverse side effects (Rosenbaum et al., 2011).
It is essential to consult with a healthcare professional, such as a physiotherapist or podiatrist, to determine the most appropriate treatment plan for your specific case of heel pain.
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Prevention tips for heel pain
Preventing heel pain involves addressing the underlying causes and risk factors. Evidence-based prevention tips for heel pain include maintaining a healthy weight, wearing appropriate footwear, incorporating regular exercise and stretching, and avoiding excessive strain on the feet. Here are some prevention tips supported by research:
Maintain a healthy weight
Excess body weight can place additional stress on the feet, particularly the heel, increasing the risk of developing conditions such as plantar fasciitis. A study by Riddle et al. (2013) found that individuals with a higher body mass index (BMI) had a greater risk of developing plantar fasciitis. Maintaining a healthy weight through a balanced diet and regular exercise can help alleviate pressure on the feet and reduce the risk of heel pain.
Choose appropriate footwear
Wearing shoes with proper arch support, cushioning, and a slightly raised heel can help distribute pressure evenly across the foot and minimize strain on the plantar fascia and heel. A study by Irving et al. (2007) found that footwear with adequate arch support and cushioning significantly reduced plantar fascia strain. Replace worn-out shoes and consider using custom orthotics if recommended by a healthcare professional.
Incorporate regular stretching and exercise
Engaging in regular stretching and strengthening exercises for the calf muscles, Achilles tendon, and plantar fascia can help maintain flexibility and reduce the risk of injury. A study by DiGiovanni et al. (2003) demonstrated that tissue-specific plantar fascia stretching exercises could improve outcomes for patients with chronic heel pain. Incorporating these exercises into your daily routine may help prevent heel pain.
Gradually increase physical activity
Avoid sudden increases in physical activity, particularly high-impact exercises, which can place excessive stress on the feet and increase the risk of heel pain. Gradually increasing activity levels allows the body to adapt and reduces the likelihood of developing injuries such as plantar fasciitis (Taunton et al., 2002).
Warm-up before exercising
Warming up before engaging in physical activity can help reduce the risk of injury by increasing blood flow to the muscles and tendons, promoting flexibility. A proper warm-up should include dynamic stretches and low-intensity exercises targeting the lower extremities (Malliaras et al., 2014).
FAQ’s
How can plantar fasciitis lead to heel pain?
The plantar fascia, a ligament that runs from the heel to the ball of the foot, becomes inflamed and painful as a consequence of the common ailment known as plantar fasciitis. Injuries to the plantar fascia, which supports the arch of the foot, may result from overuse or improper foot loading and cause heel discomfort.
How does heel bursitis relate to heel discomfort, and what is it?
Heel bursitis is an inflammatory disorder that affects the bursa, a little sac filled with fluid that cushions the joint between the heel bone and the Achilles tendon. Heel pain may be exacerbated by this inflammation, which can also produce discomfort and swelling in the heel.
How do I take care of heel bumps?
To lessen the buildup of hard skin on the heel, heel bumps may be addressed with over-the-counter heel pads or by massaging them with a pumice stone. You may need to contact a doctor for treatment if the bumps are serious.
In what ways can tarsal tunnel syndrome lead to heel pain?
The posterior tibial nerve is compressed as it travels through the tarsal tunnel, causing tarsal tunnel syndrome. Heel discomfort may result from this compression, which can also cause pain, numbness, and weakness in the foot and ankle.
What role do orthotics play in treating heel pain?
Orthotics are inserts that are placed inside of shoes to stabilize and support the foot. They may assist in resolving any structural issues with your feet, which will ease heel discomfort.
What are some heel pain prevention strategies?
To prevent heel discomfort, wear supportive, well-fitting footwear, stretch your calves and feet often to maintain the flexibility of the muscles and tendons around the heel, and avoid standing or walking for extended periods of time. Take frequent rests to allow your feet to rest if you must stand or walk for an extended period of time.
When should I go to the doctor if I have heel pain?
It’s critical to consult a doctor as soon as possible if you have severe symptoms, chronic heel pain, or if your discomfort interferes with your everyday activities. Depending on the underlying reason, heel pain may be addressed using a range of techniques, such as rest, ice packs, physical therapy, and surgery.
Sources
- Ibrahim, T., Beiri, A., Azzabi, M., Best, A.J., Taylor, G.J. and Menon, D.K., 2007. Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. The Journal of foot and ankle surgery, 46(2), pp.65-74. https://www.sciencedirect.com/science/article/pii/S1067251606006259
- Roche, A.J. and Calder, J.D.F., 2013. Achilles tendinopathy: a review of the current concepts of treatment. The bone & joint journal, 95(10), pp.1299-1307. https://online.boneandjoint.org.uk/doi/pdf/10.1302/0301-620x.95b10.31881
- Sullivan, J., Burns, J., Adams, R., Pappas, E. and Crosbie, J., 2015. Musculoskeletal and activity-related factors associated with plantar heel pain. Foot & ankle international, 36(1), pp.37-45. https://journals.sagepub.com/doi/pdf/10.1177/1071100714551021
- Thomas, J.L., Christensen, J.C., Kravitz, S.R., Mendicino, R.W., Schuberth, J.M., Vanore, J.V., Weil Sr, L.S., Zlotoff, H.J., Bouché, R. and Baker, J., 2010. The diagnosis and treatment of heel pain: a clinical practice guideline–revision 2010. The Journal of Foot and Ankle Surgery, 49(3), pp.S1-S19. https://www.sciencedirect.com/science/article/pii/S1067251610000025
- DiGiovanni, B.F., Nawoczenski, D.A., Lintal, M.E., Moore, E.A., Murray, J.C., Wilding, G.E. and Baumhauer, J.F., 2003. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain: a prospective, randomized study. JBJS, 85(7), pp.1270-1277. https://journals.lww.com/jbjsjournal/Fulltext/2003/07000/Tissue_Specific_Plantar_Fascia_Stretching_Exercise.13.aspx
- Digiovanni, B.F., Nawoczenski, D.A., Malay, D.P., Graci, P.A., Williams, T.T., Wilding, G.E. and Baumhauer, J.F., 2006. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis: a prospective clinical trial with two-year follow-up. JBJS, 88(8), pp.1775-1781.Irving, D. B., Cook, J. L., & Menz, H. B. (2007). Factors associated with chronic plantar heel pain: a systematic review. Journal of Science and Medicine in Sport, 10(1), 11-22. https://journals.lww.com/jbjsjournal/Fulltext/2006/08000/Plantar_Fascia_Specific_Stretching_Exercise.13.aspx?__hstc=215929672.82af9c9a98fa600b1bb630f9cde2cb5f.1535155200301.1535155200302.1535155200303.1&__hssc=215929672.1.1535155200304&__hsfp=2025384311
- Malliaras, P., Barton, C.J., Reeves, N.D. and Langberg, H., 2013. Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports medicine, 43, pp.267-286. https://link.springer.com/article/10.1007/s40279-013-0019-z
Assistant professor, Dhaka College of Physiotherapy
Chief Consultant(Ex): Popular Medical college Hospital, Dhanmondi- 2.
Chairman and Chief Consultant: ASPC Manipulation Therapy Centre, Nurjahan Road, Mohammadpur.
Founder and conceptual inventor: Structural Diagnosis and Management (SDM) concept.
Secretary: Centre for the Rehabilitation of Autism and Person with Disabilities (CARD).
Secretary-General: Bangladesh Physiotherapy Association (BPA).
Phone +88 01712-867364
Email aspc.dhaka@gmail.com
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