What causes heel pain?
Heel pain is the most common foot and ankle problem, because your feet do a lot of work bearing your weight – especially if you play sports. Soreness typically goes away on its own with rest and time, but if you ignore the early signs of heel pain it will get worse and may become a chronic condition. In most cases heel pain can be attributed to plantar fasciitis, although bruises, calcaneal stress fractures, tendinitis and nerve entrapment are also possible causes. If you are experiencing heel pain that does not go away after a few days of rest, book an appointment. We will examine your heel for signs of swelling or tenderness, and will perform some basic physical tests and x-rays to help find the cause of your heel pain.
Treating heel pain
Treating heel pain typically begins with rest, ice, and taking a break from sports that involve walking, running, or jumping. If rest is not sufficient, special exercises and stretches may be prescribed as well as shoe inserts and anti-inflammatory medication. If the pain is caused by a bruise, it will usually heal in time just like a bruise anywhere else would. If you experience pain while exercising, first thing in the morning, or when you first stand after sitting for awhile, it is likely caused by plantar fasciitis (also known as subcalcaneal pain). This occurs when the fascia (a long, thin ligament that connect the heel to the front of the foot) is overstressed and becomes inflamed. Plantar fasciitis is very common, especially in athletes. If it persists for a long time and you do not allow it time to heal, you may develop calcium deposits where the fascia tissue connects to your heel bone. Heel spurs do not cause pain, so they do not need to be removed. If your heel pain persists, we may prescribe orthotics, night splints, physical therapy, or noninvasive extracorporeal shockwave therapy (ESWT) during which a shockwave stimulates the healing process of the damaged plantar fascia tissue. Surgery is rarely needed but may be considered after a year of aggressive treatment, if no improvement is seen.
Calcaneal Stress Fractures
Stress fractures of the calcaneus can be very painful and symptoms can include swelling, pain with walking or activities, and pain when squeezing the heel. Stress fractures may be caused by overuse, repetitive stress or trauma from increased frequency or intensity of activities or weakness in the bone due to osteoporosis. To diagnose this we will take a careful history and do a physical examination. X-rays are taken but MRI may be necessary for diagnosis. Initial treatment includes rest, activity modification, protective immobilization and possibly a cast. Stress fractures typically heals in 6-8 weeks.
Nerve Entrapment Around the Heel
Heel pain may also be caused by pressure on the nerves around the heel or nerve entrapment. Symptoms include burning pain, pain when the area of nerve entrapment is pressed, pain that increases with prolonged standing and activity but may occur at rest or at night as well, tingling or even numbness. The tibial nerve may be entrapped and this is known as tarsal tunnel syndrome, but this branches of the nerve may also be entrapped. Diagnosis begins with history and physical examination. X-rays are ordered and lab work may also be needed. Special studies like an MRI and electromyography and nerve conduction studies may also be ordered. Initial treatment is often with nonsteroidal anti-inflammatories, and orthotic devices may be used to correct alignment problems. Surgery may be necessary to release entrapped nerves or remove any space occupying masses that are pressing on the nerve.
Posterior Heel Pain
Pain on the back of your heel may be due to insertional Achilles tendinitis, Haglunds deformity or retrocalcaneal bursitis. Insertional Achilles tendinitis is an inflammation of the tendon where it inserts at the back of the heel bone or calcaneus. Retrocalcaneal bursitis is an inflammation of the fluid-filled sac behind the ankle bones and in front of the Achilles tendon. Haglunds deformity is a bony enlargement on the back of the heel. Symptoms may include pain, inflammation, swelling or discomfort from shoes rubbing over the area. It can occur from repetitive stress, increased in intensity or frequency of exercise, bone spur development at the insertion site or trauma. Diagnosis includes history and physical examination. X-rays will be ordered an MRI may be needed if symptoms do not improve with treatment. Initial treatment includes relieving pressure in the area by wearing clogs or shoes with low or no backs. Nonsteroidal anti-inflammatories, activity modification, heel lifts, RICE protocol, stretching exercises or physical therapy may be recommended. Surgery may be necessary if symptoms do not resolve with treatment.
