Common causes of heel pain and how it is treated
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. It’s possible you’ll need to have a doctor or podiatrist diagnose the cause if simple home remedies don’t ease the pain.
Heel pain is a common foot and ankle problem. Pain may occur underneath the heel or behind it. Many conditions can cause pain in the heels.
What are common causes of heel pain?
There are several common causes.
- Plantar fasciitis. Plantar fasciitis occurs when too much pressure on your feet damages the plantar fascia ligament, causing pain and stiffness.
- Sprains and strains. Sprains and strains are injuries to the body, often resulting from physical activity. These injuries are common and can range from minor to severe, depending on the incident.
- Fracture. A fracture is a broken bone. This condition is considered a medical emergency. Urgent care may be required
- Achilles tendonitis. Achilles tendonitis occurs when the tendon that attaches the calf muscles to the heel becomes painful or inflamed due to overuse injuries.
- Bursitis. Bursae are fluid-filled sacs found about your joints. They surround the areas where tendons, skin, and muscle tissues meet bones.
- Ankylosing spondylitis. This form of arthritis primarily affects your spine. It causes severe inflammation of the vertebrae that might eventually lead to chronic pain and disability.
- Osteochondroses. These disorders directly affect the growth of bones in children and adolescents.
- Reactive arthritis. An infection in the body triggers this is a type of arthritis.
It’s important to have a medical evaluation to help you determine the exact cause of your heel pain so that the proper treatment regimen can begin. Heel pain can make it difficult to walk and participate in daily activities. Most painful heel conditions improve with nonsurgical treatments, but your body needs time to recover.
Where does heel pain develop?
You might experience pain, soreness or tenderness anywhere in the heel. You typically feel heel pain:
- Behind the heel.
- Beneath the heel.
- Within the heel bone itself.
What is plantar fasciitis?
You probably never thought much about your plantar fascia until the pain in your heel jolted you. A thin ligament that connects your heel to the front of your foot, the plantar fascia, can be a trouble spot for many people. Heel pain affects more than 50 percent of Americans, and the most common cause is plantar fasciitis. Repetitive motion from running or step aerobics, or added pressure from weight gain can damage or tear the plantar fascia, causing inflammation and pain.
Along with runners, plantar fasciitis is common among pregnant women because the extra weight on the ligament can cause inflammation, leading to pain. If you have heel pain, don’t be discouraged. There are simple steps you can take to ease the pain so that you can resume running or another exercise.
Taut muscles in your feet or calves aggravate plantar fasciitis. Soothe or prevent the pain with some of these easy stretches recommended by personal trainer and triathlete Deborah Lynn Irmas of Santa Monica, CA. Irmas is certified by the American Council on Exercise (ACE). She endured bouts of plantar fasciitis after overtraining with too many sprints. This stretching routine, which she practices and recommends to her clients, keeps her free of heel pain.
Stretch your calves
- Stand an arm’s length from a wall.
- Place your right foot behind your left.
- Slowly and gently bend your left leg forward.
- Keep your right knee straight and your right heel on the ground.
- Hold the stretch for 15 to 30 seconds and release. Repeat three times.
- Reverse the position of your legs, and repeat.
This stretch targets the gastrocnemius muscle in your calf. As your plantar fascia begins to heal and the pain diminishes, you can deepen this stretch by performing it with both legs slightly bent, says Irmas. Done this way, the stretch loosens the soleus muscle in the lower calf. Irmas cautions that it’s important not to hold the stretches for too long.
Grab a chair and stretch your plantar fascia
These three seated stretching exercises will also help relieve plantar fasciitis. Remember to sit up straight while you do them:
- While seated, roll your foot back and forth over a frozen water bottle, ice-cold can, or foam roller. Do this for one minute and then switch to the other foot.
- Next, cross one leg over the other for the big toe stretch. Grab your big toe, pull it gently toward you, and hold for 15 to 30 seconds. Do this three times, then reverse and do the same with the other foot.
- For the third seated exercise, fold a towel lengthwise to make an exercise strap. Sit down, and place the folded towel under the arches of both feet. Grab the ends of the towel with both hands, and gently pull the tops of your feet toward you. Hold for 15 to 30 seconds, and repeat three times.
Not only can these stretches help to reduce heel pain, but doing them faithfully before your workout “absolutely can prevent plantar fasciitis,” says Irmas.
What are the risk factors for heel pain?
Anything that puts a lot of pressure and strain on your foot can cause heel pain. The way you walk (foot mechanics) and your foot’s shape (foot structure) are also factors.
You may be more likely to develop heel pain if you:
- Are overweight (have obesity).
- Have foot and ankle arthritis, flat feet or high foot arches.
- Run or jump a lot in sports or for exercise.
- Spend a lot of time standing, especially on concrete floors.
- Wear improperly fitted shoes without arch support and/or cushion.
What are the symptoms of heel pain?
Heel pain symptoms vary depending on the cause. In addition to pain, you may experience:
- Bony growth on the heel.
- Discoloration (bruising or redness).
- Pain after standing from a resting/sitting position.
How is heel pain diagnosed?
Your healthcare provider will assess your symptoms and perform a physical exam. You may also get X-rays to check for arthritis, bone fractures, bone alignment and joint damage.
Rarely, you may need an MRI or ultrasound. These can show soft tissue problems which X-rays don’t reveal.
How can heel pain be treated?
If you develop heel pain, you can try these methods at home to ease your discomfort:
- Rest as much as possible.
- Apply ice to the heel for 10 to 15 minutes twice a day.
- Take over-the-counter pain medications.
- Wear shoes that fit properly.
- Wear a night splint, a special device that stretches the foot while you sleep.
- Use heel lifts or shoe inserts to reduce pain.
If these home care strategies don’t ease your pain, you need to see your doctor. They’ll perform a physical exam and ask you about your symptoms and when they began. Your doctor may also take an X-ray to determine the cause of your heel pain. Once your doctor knows what’s causing your pain, they’ll be able to provide you with the appropriate treatment.
These treatments include:
- Injections: Steroid injections can ease pain and swelling. Steroid injections should rarely, if ever, be given for a tendon problem but may certainly help for plantar fasciitis and bursitis.
- Orthotic devices: Over-the-counter or custom-made shoe inserts (orthotics) can take pressure off the heel. Some people find relief by wearing a splint at night, especially if they get morning pain. A walking boot may be necessary for more severe symptoms. You may also need to switch to more supportive shoes for everyday wear and exercise.
- Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) combined with ice packs ease pain and swelling.
- Physical therapy: Massage, physical therapy and ultrasound therapy can break up soft tissue adhesions. These treatments may reduce pain and inflammation.
- Stretching exercises: Your healthcare provider can show you how to do heel stretching exercises for tight tendons and muscles.
- Taping: You can use athletic or medical tape to support the foot arch or heel.
In many cases, your doctor may prescribe physical therapy. This can help to strengthen the muscles and tendons in your foot, which helps to prevent further injury. If your pain is severe, your doctor may provide you with anti-inflammatory medications. These medications can be injected into the foot or taken by mouth.
Most problems that cause heel pain get better over time with nonsurgical treatments. Therapies focus on easing pain and inflammation, improving foot flexibility and minimizing stress and strain on the heel. Your doctor may also recommend that you support your foot as much as possible — either by taping the foot or by using special footwear devices.
In very rare cases, your doctor may recommend surgery to correct the problem, but heel surgery often requires a long recovery time and may not always relieve your foot pain.
What are the complications of heel pain?
Heel pain can interfere with your ability to get around, work, exercise and complete daily tasks. When it hurts to move, you can become sedentary. An inactive lifestyle can lead to weight gain. You may also become depressed because you can’t do the things you love.
Untreated Achilles tendonitis can cause the tendon to break down (tendinosis). In time, the Achilles tendon can tear or rupture. This problem may require surgery.
How can you prevent heel pain?
It may not be possible to prevent all cases of heel pain, yet there are some easy steps that you can take to avoid injury to the heel and prevent pain:
- Wear shoes that fit properly and support the foot.
- Wear the right shoes for physical activity.
- Stretch your muscles before exercising.
- Pace yourself during physical activity.
- Maintain a healthy diet.
- Rest when you feel tired or when your muscles ache.
- Maintain a healthy weight.
To prevent heel pain or keep pain from returning, it’s important to keep your foot and heel tendons flexible. You should stretch regularly and wear properly fitted, supportive shoes. Runners are especially prone to heel pain. You can prevent running injuries by covering fewer miles and running on softer surfaces.
What is the prognosis (outlook) for people who have heel pain?
Heel pain typically goes away with nonsurgical treatments, but recovery takes time. You need to be patient and give your body time to mend. If you return to your usual activities too quickly, it can set back your recovery. In rare situations, you may need surgery.
When should I call the doctor?
You should call your healthcare provider if you experience:
- Pain that doesn’t improve in a few weeks with rest or pain relievers.
- Pain that makes walking or movement difficult.
- Severe foot or heel swelling, inflammation or stiffness.
Heel pain often improves over time with nonsurgical treatments. Your healthcare provider can determine what’s causing the pain. Your provider can also show you stretching exercises and recommend orthotics and other methods if needed. Many people try to ignore heel pain and continue with activities that make the problem worse. But it’s essential to give your body time to recover. Otherwise, you may develop chronic heel pain that sidelines you for an extended time. The longer you have heel pain the harder it is to effectively treat, so it’s important to get evaluated.
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