{"id":336,"date":"2021-04-09T07:10:00","date_gmt":"2021-04-09T14:10:00","guid":{"rendered":"https:\/\/heelthatpain.com\/?page_id=336"},"modified":"2022-02-07T06:24:36","modified_gmt":"2022-02-07T14:24:36","slug":"heel-pain","status":"publish","type":"page","link":"https:\/\/heelthatpain.com\/heel-pain\/","title":{"rendered":"Heel Pain Overview: Causes, Symptoms, & Treatments"},"content":{"rendered":"

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<\/i><\/i><\/i><\/p>\n

By\u00a0Dr. Dina Elsalamony MD, MScPH\u00a0<\/em><\/p>\n

Despite the stress that we continuously put on our feet through the pressure of various movements and the weight of our bodies, our heels are designed to absorb most of that impact and to provide cushioning to the underlying structures of the feet, including the heel bone (calcaneus), muscles and ligaments. However, heel pain is a very common condition that can negatively impact our ability to bear weight on our feet, causing significant discomfort, interfering with daily activities, and if left untreated for a long period, it can lead to serious complications. <\/span><\/p>\n

The pain is usually felt under the heel, on the inner or outer side of the heel, or behind the heel. In a lot of cases, heel pain is treated easily with rest, orthotics<\/a>, or other home remedies, however sometimes the pain and the risk of further damage may persist, requiring more advanced interventions and treatments.<\/span><\/p>\n

Heel pain can be attributed to numerous reasons, from injury to inflammation to neurological or autoimmune, hence, it is very important to get an accurate diagnosis to ensure an effective treatment that addresses the symptoms in addition to any underlying conditions if present.<\/span><\/p>\n

In this article, we will provide an overview of the possible causes of heel pain, how it is diagnosed, available treatments, and what measures we can take to prevent it.<\/span><\/p>\n

<\/center><\/p>\n

Start By Defining Your Heel Pain Symptoms<\/h2>\n

You may be experiencing a sudden onset of discomfort<\/a> in one of your feet today, or you may have been trying to ignore recurring foot pain that has bothered you for months or years. The most important first step you can take toward recovery is to spend a few moments thinking carefully about your symptom history. Review the following nine-point list and make a mental note of the symptoms that apply to you.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
True or False:<\/b><\/td>\n<\/tr>\n
True or False<\/td>\nThe most tender part of my foot seems to be my heel.<\/td>\n<\/tr>\n
True or False<\/td>\nMy heel hurts most when I get out of bed in the morning.<\/td>\n<\/tr>\n
True or False<\/td>\nMy heel pain seems worse when I get to my feet after I’ve been sitting down for some time.<\/td>\n<\/tr>\n
True or False<\/td>\nThe pain in my heel seems to get a bit better after a few minutes of standing or walking.<\/td>\n<\/tr>\n
True or False<\/td>\nI walk or run for exercise and one or both of my heels hurt terribly after this activity.<\/td>\n<\/tr>\n
True or False<\/td>\nMy heel pain seems to be aggravated by the long hours I spend standing at work.<\/td>\n<\/tr>\n
True or False<\/td>\nMy heel pain is causing me to limp.<\/td>\n<\/tr>\n
True or False<\/td>\nI’ve been experiencing this type of pain in my heel on and off for months or years.<\/td>\n<\/tr>\n
True or False<\/td>\nI’ve been having periodic bouts of heel pain as I’ve gotten older.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Understanding your symptoms will help you determine if the cause of your pain is plantar fasciitis<\/a> or a different condition.<\/p>\n

Common causes of heel pain<\/h2>\n

Some of the common conditions causing heel pain are categorized into the following:<\/span><\/p>\n

Local conditions that cause heel pain:<\/i><\/b><\/span><\/h3>\n

Local conditions are conditions that only affect one part of the body, in this case, the heel of the foot.<\/p>\n

<\/i>1. Plantar Fasciitis: <\/span><\/h4>\n

This condition is considered to be the most commonly reported cause of heel pain, accounting for 11% to 15% of all foot symptoms requiring professional medical care, it is more commonly diagnosed among athletes, particularly runners with incidence reported as high as 22%. (1) Women<\/a> also tend to have a higher prevalence than men, for example, in the US, it was found that women are 2.5 times more likely to experience this condition, with the highest incidence occurring between the ages of 45-65. (2)<\/span><\/p>\n

The plantar fascia is a thick sheath that exists in the bottom of the feet, arising from the calcaneus bone, connecting the heel to the front of the feet. Planter fascia contains type 1 collagen and plays a significant role in ensuring the normal biomechanics of the foot as it acts as a shock absorber and provides cushioning and support to the arch of our feet during walking, running, jumping, or any weight-bearing activity.<\/span><\/p>\n

Plantar fasciitis is a degenerative disorder, meaning that the fibers of the plantar fascia start degenerating gradually over time. Multiple factors contribute to this outcome, however, overuse and repetitive strain on the feet lead to chronic micro-tearing of the plantar fascia, which is thought to be the most common cause.<\/span><\/p>\n

Certain populations are at a higher risk of developing plantar fasciitis than others, such as pregnant women, obese individuals, those in occupations that require prolonged standing or weight-bearing actions, runners or athletes, particularly those with a sudden increase in the intensity or duration of their exercise, and those who wear inappropriate footwear.<\/span><\/p>\n

Individuals with muscular issues, including weak or tight calf muscles, or those with structural problems in the feet such as low\/high-arch feet or overpronation, also have a high risk of experiencing plantar fasciitis. The normal process of aging can also pose a risk since it can lead to some degree of fat padding loss leaving the plantar fascia more exposed and susceptible to repetitive microtraumas. Heel spurs<\/a> are also associated with this condition as they exist in approximately 50% of those diagnosed with plantar fasciitis, however, a heel spur is not the same as plantar fasciitis nor is considered a cause for this condition.<\/span><\/p>\n

\"Medical<\/a><\/p>\n

Plantar fasciitis is characterized by pain in the bottom of the feet, involving either the arch or the heel or both, it is usually felt when taking the first few steps in the morning then subsides or disappears after resting or gently walking, however, the pain returns when walking or standing for extended periods of time. The pain is also worsened when walking barefoot or on a hard surface, and for athletes, high-impact fast movements such as sprinting usually increase the intensity of the pain.<\/span><\/p>\n

Plantar fasciitis is often found in one foot, however, around a third of the cases are diagnosed with plantar fasciitis in both feet.
\n<\/span><\/p>\n

2. Stress Fracture: <\/span><\/h4>\n

Stress fractures<\/a> differ from the other regular fractures in the way that stress fracture symptoms, in most cases, are not proceeded by a trauma or a particular incident, as it results from repetitive and recurrent loading of the bone, most commonly in the feet, the calcaneus or metatarsal bones. The normal physiologic response of a bone to increased compression or load is by forming minor microdamage that gets repaired through a process known as remodeling, however, when extensive micro damages occur before the bone had a chance to properly remodel, stress fracture develops. (3) Similar to plantar fasciitis, people may recall changing the intensity, duration, or frequency of their high impact or weight-bearing exercise recently, some of the most common activities that are associated with stress fractures are plyometrics, jumping, running, military training, and gymnastics.<\/span><\/p>\n

A number of risk factors have been associated with stress fractures, such as low bone density (as in osteoporosis), caloric restriction with lower dietary calcium, females with irregular menstruations, and those who have differences in leg length or muscle weakness. (4) In males, decreased testosterone level has also been considered as a risk factor for stress fractures. (5)<\/span><\/p>\n

Symptoms of a stress fracture usually have an insidious onset, with the pain associated with a certain activity or when repeatedly loading on the affected foot. The pain can be often accompanied by local swelling or tenderness, and it decreases with rest but returns when resuming the original activity. Sometimes the beginning of the pain can be traced back to a change in training methods or equipment.<\/span><\/p>\n

Stress fracture makes the bone fragile and if ignored, it can lead to a true fracture. Some stress fractures\u2019 locations, such as the fifth metatarsal, are associated with a higher incidence of certain complications such as non-union (which is the failure of natural healing of broken bones unless surgery is performed).
\n<\/span><\/p>\n

3. Tarsal tunnel syndrome: <\/span><\/h4>\n

Tarsal tunnel is a condition that involves the tibial nerve or any of its associated branches being compressed or trapped as a result of consistent compression. The tibial nerve runs through a narrow passage inside the ankle called the tarsal tunnel. The compression of the tibial nerve can be a result of one of many causes, including traumas or injuries resulting in changing of the position of the structures around the nerve or swelling which compresses the nerve; high degrees of flat feet can cause also tension on the nerve; diabetic neuropathy; any lesions, masses, tumors or varicose veins around this area which all put more compression on the nerve. (6)<\/span><\/p>\n

The symptoms of tarsal tunnel syndrome can manifest differently from one person to another; as the pain can be felt either on the bottom of the heel, inside the ankle, or in both area. It can be accompanied by one or more of the following: tingling, numbness<\/a>, burning sensation, a feeling of electric shock, or pins and needles. These symptoms can either start mildly and gradually then progress, or start abruptly. The pain usually gets worse during physical activity, and in advanced cases, symptoms can also manifest during rest.<\/span><\/p>\n

Complications can arise if this condition is not treated in time, such as irreversible nerve damage which leads to a permanent impact on the person\u2019s ability to perform everyday activities.
\n<\/span><\/p>\n

4. Calcaneal bursitis: <\/span><\/h4>\n

Calcaneal bursitis<\/a> is inflammation of the bursa; which is a structure that resembles a sac and lined by synovial tissue and produces fluid that helps with lubrication and the reduction of friction between various structures like the between tendons or ligaments and bones or between skin and bones. There are 2 bursae located above the entrance of the Achilles tendon, and inflammation to one or both of them will lead to pain in the back of the heel and the ankle.<\/span><\/p>\n

This inflammation is typically caused by repetitive trauma and overuse, particularly in those who wear inappropriate shoes or tight-fitting ones. Other conditions might also be associated with bursitis such as Haglund deformity, seronegative spondyloarthropathies, rheumatoid arthritis, and gout. (7,8)<\/span><\/p>\n

The primary complaint presented in this condition is dull aching pain in the back of the heel that is worsened when the person starts a certain activity after rest. Swelling, tenderness, redness, and limping can also occur, and these symptoms can be either unilateral or bilateral.
\n<\/span><\/p>\n

5. Heel fat pad syndrome: <\/span><\/h4>\n

Fat pad syndrome<\/a> usually results from the chronic wear and tear of the heel pad fatty tissues, which is responsible for cushioning and supporting our feet bones, leading to changes in the thickness and\/or the elasticity of the heel fat pad. Various risk factors play a role in the development of this syndrome, such as aging, repetitive high impact activities, obesity, inappropriate footwear, injury to the heel pad, performing exercises or walking on hard surfaces, having high arch feet, the use of corticosteroid injections as a treatment for other feet conditions, and genetic or family history.<\/span><\/p>\n

Symptoms associated with heel fat pad syndrome include dull aching pain that usually is felt like a bruise in the center of the heel when walking, running, or standing for long; pain that is recreated by pressing on the center of the heel and is aggravated by coming in contact with a hard surface. In some cases, this condition is mild or asymptomatic, while in some advanced cases the nerves located in the superficial part of the heel are compressed causing some additional neurological symptoms such as pins and needles, tingling, cold, or burning sensation<\/a>.
\n<\/span><\/p>\n

6. Haglund\u2019s deformity: <\/span><\/h4>\n

Haglund’s deformity is an abnormality of the foot soft tissues and bone. It is a bony bump appearing on the posterior part of the heel where the Achilles tendon is attached to the heel, and when that large bony bump rubs against shoes, the surrounding soft tissues in the back of the heel become irritated and cause pain.<\/span><\/p>\n

This condition is also known as \u201cpump bump\u201d, as it was thought at first to affect mostly women who wear high-heeled pump footwear, however, despite having a higher incidence in females than males, it can affect anyone at any age.<\/span><\/p>\n

The exact cause for that enlarged bony prominent part is not fully known, but a number of potential causes have been linked to this condition, such as heredity, having high arched feet, or having a tight Achilles tendon.<\/span><\/p>\n

Other risk factors that are thought to aggravate the irritation of bony bump is over-training in athletes and wearing tight, rigid or poorly fitting shoes.<\/span><\/p>\n

In addition to causing pain, the site of irritation may also get inflamed causing redness, tenderness, and swelling. (9)<\/span><\/p>\n

7. Heel osteomyelitis<\/span>: <\/span><\/h4>\n

Osteomyelitis of the heel is an inflammation of the heel due to an infection, resulting from either an injury, surgery, or a bloodstream infection. The infection can be acute or persist for months leading to chronic osteomyelitis. The symptoms of osteomyelitis can be non-specific at times, which leads to delayed diagnosis in some cases. The general symptoms include fatigue, fever, and lethargy, while local and more specific symptoms include heel pain, redness, tenderness, swelling, and decreased range of motion.
\n<\/span><\/p>\n

8. Achilles tendon issues: <\/span><\/h4>\n

The Achilles tendon is the largest tendon in the human body, consisting of fibrous tissues that connect the heel bone to the calf muscles. A number of problems affect the Achilles tendon causing heel pain, such as: <\/span><\/p>\n