What is Heel Pain?
Heel pain encompasses any discomfort felt in the area at the rear of your foot. It could be underneath at the back or front of the heel.
The heel bone is the largest of 26 bones in the human foot. Pain in this area is a sign that something is wrong. It tells us that we may need to seek medical advice. (1)
The heel is an integral part of the foot and helps us to walk properly. Looking after it is in our best interests.
There are many causes of heel pain. Knowing the cause can help treat and prevent further pain. We will look at the main causes:
A heel spur is a bony growth on the underside of the heel bone. It is caused by calcium deposits. It can be the result of running or jogging. Wearing improperly fitting or excessively worn shoes and also obesity can cause heel spurs.
A spur can be greater than 10mm in size and is detected with an x-ray. It causes pain in the heel. (2)
The plantar fascia are bands of tissue which extend from the heel to the toes underneath the foot. This broad band of tissue supports the arch of the foot. (3)
When this band of tissue is strained over time it causes tears in the soft tissue fiber. This can happen along its length.
The result is inflammation and pain in the heel. It can also contribute to the formation of heel spurs. This pain may be more apparent when you get out of bed in the morning or after sitting for a long time. (4)
Pronation is the term for normal flexible motion of the foot. As we walk we flatten the arch of the foot allowing it to adapt to the type of ground we are walking on. This also absorbs shock.
When we walk the heel makes the initial contact with the ground. Our weight shifts to the outside of the foot. It then moves toward the big toe. The arch rises and the foot rolls upwards and outward. It becomes rigid and stable so the body can lift it and move it forward.
Excessive pronation or inward movement creates an abnormal amount of stretching and pulling on the ligaments and tendons. These are attached to the bottom of the heel and this is where we feel the pain it causes. (5)
An injury to the bone in the heel can cause pain. This could be a broken bone or a stress injury.
Stress injuries are common in athletes and active people. They arise as a result of repetitive use of the heel. The bone becomes weak to the point of almost or actually breaking.
This type of injury may be accompanied by swelling. (6)
It is also possible to bruise the heel by stepping on something hard and uneven. This will also cause pain.
A pain behind your heel may indicate damage where your achilles tendon joins your heel. It may be more painful after a period of rest.
This can happen when you run too much or wear shoes that rub or cut into the back of the heel.
The skin at the back of the heel can thicken become red and swell up. A bump can develop that feels tender and warm to the touch. It can also hurt too much to wear your normal shoes. (7)
A bursa is a small fibrous sac that acts as a cushion between the bones and other moving parts of the body. These include tendons, muscles and skin.
The sac can become inflamed or irritated, causing it to swell. This in turn can cause pain. (8)
This deformity takes its name from Patrick Haglund who first described it in 1927.
It’s an enlargement of the bony section of the heel at the point the achilles tendon joins. This large bony lump can rub against rigid shoes causing pain and inflammation. (9)
Our bodies have a network of nerves which travel from the spine out to the extremities. Damage to the nerves can cause pain, tingling or numbness in the feet including the heel.
The pain sometimes feels like a stabbing or burning sensation. (11)
Tarsal Tunnel Syndrome
The tarsal tunnel is found on the on the inside of the ankle. A branch of the sciatic nerve called the tibial nerve passes through this tunnel. If it is compressed or damaged you will feel pain in your heel. (12)
Children’s Heel Pain
This is a common complaint in children and adolescents. It can be a result of trauma or overuse. It is important to seek medical advice to find the cause. (13)
The main symptom of this condition is pain in the area of the heel. It might be at the back, the front or underneath depending on the cause.
Injuries might cause the pain to be worse when you walk or attempt activities.
Damage to nerves associated with the heel will produce tingling, burning or numbness. There may also be pain which can be consistent, short or stabbing.
Bruising to the heel pad will cause pain in the middle of the heel.
If there is damage to the achilles tendon or the bursar then the pain will be in the back of the heel.
Plantar fasciitis and tarsal tunnel syndrome causes pain in the middle of the heel. This pain is often worse when you have had periods of non weight bearing like sleeping or sitting. (14)
Whatever the cause, heel pain can be disabling. We rely on our feet to be able to move around and carry on with our day to day life.
Ascertaining the cause of heel pain is important to ensure you get the correct treatment.
Your doctor will carry out a physical examination. They will look at your heel and foot for signs of swelling and tenderness. They will ask you about the type of pain and its duration.
You may be asked to do some physical tests like standing on one foot or walking to help the doctor work out what is actually wrong. (15)
There may be further tests required. These can include x-rays or other types of imaging scans. You may also be referred to a foot specialist called a podiatrist or a physiotherapist. (16)
What is heel pain? This is any discomfort or pain felt in the area at the back of your foot. The pain can be consistent or may be described as stabbing or burning.
What causes heel pain? There are many causes of heel pain. These include injury and damage to the bones, nerves or tendons. There may be an underlying medical condition like a form of arthritis.
How do doctors test for heel pain? The doctor will initially carry out a physical examination. They might ask you to perform some simple activities like walking or standing on on foot. Dependent on the outcome further tests may be required. You can also be referred to a specialist for treatment.
When should you go to the doctors with heel pain? If your pain lasts more than a couple of days or you are unable to walk you should seek medical care. (17)
Can you prevent heel pain? It is impossible to predict or avoid certain injuries or conditions. However, there are steps you can take to help prevent some of them. Wear shoes that fit properly and support your feet. When exercising warm up properly. This includes stretching the calves and feet. Wear appropriate sports shoes. Avoid walking barefoot on hard surfaces. (18)
What can relieve heel pain? You can take an over the counter painkiller to help relieve the pain. An ice pack applied to the heel for about 20 minutes every 2-3 hours can help. Try wearing shoes with a small heel, 2-3 cm in height or use heel pads. You could also do some gentle stretching exercises. Avoid standing or walking for long periods and don’t walk around barefoot. (19)
Can heal pain be treated? Most heel pain can be treated without surgical intervention. Some of the treatments include exercises, weight loss and physiotherapy. Some conditions benefit from specially made insoles for shoes. You may be given oral or injectable anti inflammatory medicines. (20,21)
Are there any natural remedies for heel pain? Turmeric has been used for many years in traditional medicines. It has many health benefits including anti inflammatory properties. A supplement containing turmeric may help with pain and swelling. Soaking your heel in epsom salts may also relieve pain and reduce inflammation. (22,23)
Heel pain describes discomfort and pain in the area at the back of your foot. It may be underneath at the arch or on the heel pad, it can also be at the rear of the heel.
There are many causes of heel pain. Diagnosis and treatment are essential for a speedy recovery.
There are many things you can do to prevent heel pain. These include maintaining a healthy weight and wearing appropriate good fitting shoes.
However, heel pain can generally be treated successfully without the need for surgical intervention.