Heel pain

Heel Pain (Plantar Fasciitis) Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation or, rarely, a cyst.

Your foot and ankle are made up of 26 bones, 33 joints, and more than 100 tendons. The heel is the largest bone in your foot.

If you overuse or injure your heel, you may experience heel pain. This can range from mild to disabling. In many cases, if you have heel pain, you will need a doctor or podiatrist to diagnose the cause.

What Are Common Causes of Heel Pain?

Heel pain has a number of causes that are typically associated with overuse of the heel bone. You can strain your heel by pounding your feet on hard surfaces, being overweight, or wearing shoes that do not fit properly.

These strains can irritate the heel’s bones, muscles, or tendons. Other common causes of heel pain include the following conditions.

Heel Spurs

Heel spurs develop when the lining that covers the heel is continuously stretched. When this occurs, pieces of the lining may break off. Heel spurs typically develop in athletes who frequently run or jog. They are also common in people who are obese.

Plantar Fasciitis

Plantar fasciitis develops when the tendinous tissue connecting the heel to the ball of the foot becomes inflamed. Plantar fasciitis also occurs in athletes who frequently run or jog. It can also result from wearing shoes that do not fit properly.

Excessive Pronation

Excessive pronation is a condition where the foot rolls inward (toward the arch) and the ligaments and tendons at the back of the heel are stretched too much. This can occur when injuries to the back, hips, or knees change the way you walk.

Achilles Tendinitis

Achilles tendinitis can result from inflammation of the Achilles tendon, which runs along the back of the heel. This condition is common in people with active lifestyles who frequently run or jog, professional athletes, and frequent dancers.

When Should You Contact Your Doctor?

If you develop heel pain, you may first try some home remedies, such as rest, to ease your symptoms. If your heel pain does not get better within two to three weeks, you should make an appointment with your doctor.

You should call your doctor immediately if:

• your pain is severe
• the pain starts suddenly
• you have redness in your heel
• you have swelling in your heel
• you cannot walk because of the pain in your heel

Introduction 

Heel pain is a common foot condition. It’s usually felt as an intense pain when using the affected heel.

Heel pain usually builds up gradually and gets worse over time. The pain is often severe and occurs when you place weight on your heel.

In most cases, only one heel is affected, although estimates suggest that around a third of people have pain in both heels.

The pain is usually worse first thing in the morning, or when you first take a step after a period of inactivity. Walking usually improves the pain, but it often gets worse again after walking or standing for a long time.

Some people may limp or develop an abnormal walking style as they try to avoid placing weight on the affected heel.

What causes heel pain?

Most cases of heel pain are caused when a band of tissue in the foot, known as the plantar fascia, becomes damaged and thickens.

Plantar fasciitis is the medical term for the thickening of the plantar fascia.

The plantar fascia

The plantar fascia is a tough and flexible band of tissue that runs under the sole of the foot. It connects the heel bone with the bones of the foot, and acts as a kind of shock absorber to the foot.

Sudden damage, or damage that occurs over many months or years, can cause tiny tears (microtears) to develop inside the tissue of the plantar fascia. This can cause the plantar fascia to thicken, resulting in heel pain.

The surrounding tissue and the heel bone can also sometimes become inflamed.

Read more about the causes of heel pain.

When to see your GP

See your GP or a podiatrist (foot problems specialist) if you’ve had persistent heel pain for a number of weeks and it hasn’t cleared up despite trying the self-help measures listed below. They should be able to diagnose the cause of your heel pain by asking about your symptoms and medical history and examining your heel and foot.

Further tests will only usually be needed if you have additional symptoms that suggest the cause of your heel pain isn’t inflammation, such as:

• numbness or a tingling sensation in your foot, which could be a sign of nerve damage in your feet and legs (peripheral neuropathy)
• your foot feels hot and you have a high temperature (fever) of 38°C (100.4°F) or above, which could be a sign of a bone infection
• your heel is stiff and swollen, which could be a sign of arthritis

Possible further tests that may be recommended include blood tests, X-rays, a magnetic resonance imaging (MRI) scan or an ultrasound scan.

 Heel pain is a very common foot problem. The sufferer usually feels pain either under the heel (plantar fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone.

Even though heel pain can be severe and sometimes disabling, it is rarely a health threat. Heel pain is typically mild and usually disappears on its own; however, in some cases the pain may persist and become chronic (long-term).

There are 26 bones in the human foot, of which the heel (calcaneus) is the largest. The human heel is designed to provide a rigid support for the weight of the body. When we are walking or running it absorbs the impact of the foot when it hits the ground, and springs us forward into our next stride. Experts say that the stress placed on a foot when walking may be 1.25 times our body weight, and 2.75 times when running. Consequently, the heel is vulnerable to damage, and ultimately pain.

In the majority of cases, heel pain has a mechanical cause. It may also be caused byarthritis, infection, an autoimmune problem trauma, a neurological problem, or some other systemic condition (condition that affects the whole body).

Contents of this article:

1. Causes of heel pain
2. Symptoms of heel pain
3. When to call a doctor
4. Diagnosing heel pain
5. Treatments for heel pain
6. Prevention

You will also see introductions at the end of some sections to any recent developments that have been covered by MNT‘s news stories. Also look out for links to information about related conditions.

Fast facts on heel pain

Here are some key points about heel pain. More detail and supporting information is in the main article.

• Heel pain is usually felt either under the heel or just behind it.
• Heel pain has a prevalence of 3.6%.
• US studies estimate that 7% of older adults report tenderness under the heel.
• Plantar fasciitis is estimated to account for 8% of all running-related injuries.
• There are 26 bones in the human foot, of which the heel is the largest.
• Pain typically comes on gradually, with no injury to the affected area. It is often triggered by wearing a flat shoe.
• In most cases the pain is under the foot, towards the front of the heel.
• The majority of patients recover with conservative treatments within months.
• Home care such as rest, ice, proper-fitting footwear and foot supports are often enough to ease heel pain.
• To prevent heel pain, it’s recommended to reduce the stress on that part of the body.

Causes of heel pain

Heel pain is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel.

Common causes of heel pain include:

A heel pain sufferer commonly feels pain either under the heel (plantar fasciitis) or just behind it (Achilles tendinitis).

• Plantar fasciitis (plantar fasciosis) – inflammation of the plantar fascia. The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot.
• When the plantar fasciitis is stretched too far its soft tissue fibers become inflamed, usually where it attaches to the heel bone. Sometimes the problem may occur in the middle of the foot. The patient experiences pain under the foot, especially after long periods of rest. Some patients have calf-muscle cramps if the Achilles tendon tightens too.
• Heel bursitis – inflammation of the back of the heel, the bursa (a fibrous sac full of fluid). Can be caused by landing awkwardly or hard on the heels. Can also be caused by pressure from footwear. Pain is typically felt either deep inside the heel or at the back of the heel. Sometimes the Achilles tendon may swell. As the day progresses the pain usually gets worse.
• Heel bumps (pump bumps) – common in teenagers. The heel bone is not yet fully mature and rubs excessively, resulting in the formation of too much bone. Often caused by having a flat foot. Among females can be caused by starting to wear high heels before the bone is fully mature.
• Tarsal tunnel syndrome – a large nerve in the back of the foot becomes pinched, or entrapped (compressed). This is a type of compression neuropathy that can occur either in the ankle or foot.
• Chronic inflammation of the heel pad – caused either by the heel pad becoming too thin, or heavy footsteps.
• Stress fracture – this is a fracture caused by repetitive stress, commonly caused by strenuous exercise, sports or heavy manual work. Runners are particularly prone to stress fracture in the metatarsal bones of the foot. Can also be caused byosteoporosis.
• Severs disease (calcaneal apophysitis) – the most common cause of heel pain in child/teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the calcaneus (heel bone). Children aged from 7-15 are most commonly affected.
• Achilles tendonosis (degenerative tendinopathy) – also referred to as tendonitis, tendinosis and tendinopathy. A chronic (long-term) condition associated with the progressive degeneration of the Achilles tendon. Sometimes the Achilles tendon does not function properly because of multiple, minor microscopic tears of the tendon, which cannot heal and repair itself correctly – the Achilles tendon receives more tension than it can cope with and microscopic tears develop. Eventually, the tendon thickens, weakens and becomes painful.

Heel pain may also be caused by:

• Achilles tendon rupture – the tendon of the heel cord behind the ankle is torn.
• Bone bruise.
• Bone cyst – a solitary fluid-filled cyst (cavity) in a bone.
• Gout – levels of uric acid in the blood rise until the level becomes excessive (hyperuricemia), causing urate crystals to build up around the joints. This causes inflammation and severe pain when a gout attack happens.
• Neuroma (Morton’s neuroma) – a swollen nerve in the ball of the foot, commonly between the base of the second and third toes.
• Osteomyelitis – osteomyelitis means infection of the bone or bone marrow; inflammation of the bone due to infection. Osteomyelitis sometimes occurs as a complication of injury or surgery. In some cases, the infection may get into bone tissue from the bloodstream. Patients with osteomyelitis typically experience deep pain and muscle spasms in the inflammation area, as well as fever.
• Peripheral neuropathy – neuropathy is a collection of disorders that occurs when nerves of the peripheral nervous system (the part of the nervous system outside of the brain and spinal cord) are damaged. The condition is generally referred to as peripheral neuropathy, and it is most commonly due to damage to nerve axons. Neuropathy usually causes pain and numbness in the hands and feet. It can result from traumatic injuries, infections, metabolic disorders and exposure to toxins. One of the most common causes of neuropathy is diabetes.
• Problems with your gait – wrong posture when walking/running.
• Rheumatoid arthritis – rheumatoid arthritis, sometimes referred to as rheumatoid disease, is a chronic (long lasting), progressive and disabling auto-immune disease condition that causes inflammation and pain in the joints, the tissue around the joints, and other organs in the human body. Rheumatoid arthritis usually affects the joints in the hands and feet first, but any joint may become affected. Patients with rheumatoid