What is heel pain?
Heel pain describes any discomfort in or around the heel. It can occur suddenly, but often develops gradually over time and it can make walking uncomfortable. Overuse injuries, such as plantar fasciitis or tendinopathy, can cause heel pain.[1] Pain may also be due to poorly fitted footwear, prolonged periods of standing, or ligament sprains.[2]
The heel is the prominent area at the back of the foot that cushions the weight of the body. The heel bone, known as the calcaneus bone, is the largest bone in the foot. The heel is supported by muscles, ligaments, and other soft tissue.
As heel pain may present in a similar way to other conditions, it is important to speak to a health practitioner to assess the cause of pain.
What are the symptoms of heel pain?
Common symptoms of heel pain may include:
-
Pain in the heel
-
Stiffness in the ankle or foot
-
Often has a gradual onset, but can be sudden
-
Worse with weight bearing
-
Pain with activities such as walking, jumping, or running
-
Reduced range of motion
-
Swelling.
What causes heel pain?
1. Plantar fasciitis
Plantar fasciitis is an inflammation of the plantar fascia that runs underneath the foot. It is commonly an overuse injury, and causes pain and stiffness particularly first thing in the morning.[3] Bone spurs or poorly fitted footwear can worsen the symptoms.
2. Sprains and strains
Muscle strains and ligament sprains (such as a rolled ankle) are common injuries that often result from physical activity. It can cause heel pain and the symptom severity can range from mild to severe.
3. Fractures
A fracture (bone break) may be the cause of the heel pain. This can occur suddenly from an injury or accident, or may develop over time (stress fracture). Fractures require medical input as they can cause damage to the nerves, blood vessels, and other soft tissue in the area.
4. Achilles tendinopathy
Achilles tendinopathy is an overuse injury that affects the Achilles tendon (the tendon of the calf muscles). It passes over the calcaneus, and can become irritated and cause heel pain. Inflammation plays a role in this and it is becoming more common.[4]
5. Bursitis
A bursa is a fluid-filled sac that reduces friction between structures, such as bone and tendons. Retrocalcaneal bursitis is where the bursa behing the heel becomes inflamed and cause heel pain.
6. Sever’s disease
Sever’s disease is a common cause of heel pain in children. It occurs when there is an inflammatory reaction in the calcaneus growth plate.[5]
7. Arthritis
Osteoarthritis and rheumatoid arthritis can affect the joints in the ankle and foot, and cause heel pain.
Other causes of heel pain can include heel spurs, tendon rupture, bone deformities, osteomyelitis, peripheral neuropathy, and more.
When to see a doctor?
If the pain is severe or persistent, or is progressively worsening, it is important to seek medical attention.
In some cases, heel pain can be caused by a serious underlying medical issue. If there is any redness, swelling, loss of strength or sensation, if the pain is caused by an injury, if it is not possible to walk because of the pain, or if there are any other unexplained symptoms, a doctor should be consulted immediately.
How is heel pain diagnosed?
There are many different causes of heel pain. A health practitioner can perform a physical examination and take a history of any symptoms. This is to determine the cause of the pain and rule out any other serious underlying medical issues.
In some cases, a doctor may request an X-ray or MRI to help diagnose the cause of the pain. It is important to have a diagnosis before any treatment begins, as it may worsen any symptoms otherwise.
How is heel pain treated?
Heel pain often resolves on its own. However, there are some treatments that may help alleviate the symptoms and discomfort. It is important to address the underlying causes of heel pain, as the injury can recur.
Some treatment options may include:
-
Resting the affected area
-
Elevating the leg
-
Applying ice appropriately
-
Taking pain relief
-
Consulting a podiatrist for shoe fitting or shoe inserts
-
Education.
Depending on the cause of the pain, a doctor may also prescribe pain relief medications. Some conditions such as arthritis are chronic and require management over time.
Physiotherapy
A physiotherapist can guide the rehabilitation of heel pain. Initially, this may involve decreasing or modifying the load through the heel, such as taking a break from sport. Any biomechanical factors or strength deficits will be addressed with specific exercises or other treatment options.
Surgery
In rare cases, a doctor may recommend a review with a surgeon to discuss procedures that may help resolve the cause of the pain. The surgeon may prescribe an orthotic boot after the surgery to help protect the surgical area. A physiotherapist is often involved after surgery to help rehabilitate the leg and foot.
Preventing heel pain
There are some simple steps that can help reduce the risk of injury to the heel.
This may include:
-
Wearing properly fitted shoes
-
Using prescribed orthotics
-
Choosing the right footwear for exercise
-
Completing a warm-up and cool-down for sport
-
Gradually increasing any new activity
-
Maintaining a healthy diet and weight
-
Allowing adequate recovery between training.
Key takeaways
Heel pain can recur or worsen if left untreated. A health practitioner can assess the symptoms and recommend different treatment options, depending on the cause.
In rare cases, surgery or other medical treatments may be required to settle or resolve the cause of the symptoms.
