Heel pain is a complex condition that requires accurate diagnosis. Pain can occur in the front, back, or bottom of the heel. It is important that the source of the pain is accurately diagnosed so that treatment is accurately tailored to the condition.
Causes will depend on where on the heel the pain is, however here are few:
- Walking gait abnormalities or biomechanical alignment issues that place too much stress on the heel and surrounding structures in the foot.
- Injury or a bruise sustained while walking, running, or jumping on hard surfaces
- Wearing flimsy footwear, such as thongs
- Excess weight
- Sudden change in activity level or type of activity.
Types of heel pain
Common types of heel pain include:
Plantar Fasciitis: Plantar Fasciitis is a most commonly attributed cause of heel pain. The reason why it is so common is because it is the most commonly diagnosed problem. Unfortunately, it is also most often a misdiagnosed problem. It is an inflammation of the fascia, a band of fibrous connective tissue that runs along the plantar aspect (underside) of the foot. The condition occurs when the soft tissue fibres of the fascia are torn or stretched.
Plantar Fasciosis: Also affecting the fascia, with the same symptoms as plantar fasciitis, this condition is more chronic and results in pain with little or no inflammation present. The mechanism by which this pathology occurs is poorly understood but it is thought to also involve tearing of the fascia due to abnormal forces. This condition is often termed “Plantar Fasciitis” and for the most part it is difficult to distinguish one condition from the other.
Heel Spurs: A heel spur is a calcium deposit on the underside of the heel bone. This bony protrusion can grow to be more than a centimetre in length. Heel spurs result from strain on the muscles and ligaments of the foot, by stretching the plantar fascia and by the tearing away of the lining of the heel bone. Having a heel spur does not necessarily guarantee that this is the cause of pain in the heel as many people go around with heels spurs and never experience associated pain. This condition is also difficult to distinguish from plantar fasciitis/fasciosis.
Excessive Pronation or Flat foot: Heel pain sometimes results from excessive pronation, an inward motion of the arch of the foot when walking. This can put stress on the ligaments and tendons that attach to the back of the heel bone. Pain associated with over pronation is sometimes associated with plantar fasciitis, but can also exist on its own. This cause of heel pain is also often confused with plantar fasciitis, although podiatrists can easily distinguish this problem from others.
Achilles tendinitis: Achilles tendinitis is the inflammation of the Achilles tendon which runs behind the ankle and connects to the back of the heel bone. This condition will often present with pain at the back of the heel. The condition arises when the tendon is strained over time, causing the fibres to tear or stretch. This results in inflammation and pain at the back of the heel, and sometimes may lead to the growth of a bone spur on the back of the heel bone.
Heel Fat Pad Syndrome: Fat surrounds the heel to protect and cushion it from the forces of walking and running. When it becomes inflamed and tender to touch or bear weight on, this can be called heel fat pad syndrome. This condition is also often confused with Plantar fasciitis however requires a different type of treatment.
Retrocalcalneal Bursitis: Inflammation of the superficial calcaneal bursa, known as superficial retrocalcaneal bursitis, can occur due to shear stresses on the posterior lateral aspect of the calcaneus as it rubs against the heel counter of the shoe due to repetitive eversion of the calcaneus as a compensation for a number of biomechanical deformities. This condition may be confused with tendinitis and requires accurate diagnosis.
Haglunds deformity or “Pump Bump”: When retrocalcanel bursitis is chronic, a bony spur can develop which is called a haglund’s deformity or Pump Bump.
Nerve Entrapment pathologies: There are several nerves that can become entrapped due to abnormal forces acting on them in and around the heel. Accurate diagnosis requires intimate knowledge of the anatomy of the foot. Nerve pain can vary in intensity and nature. Nerve entrapment can coincide with plantar fasciitis and is also difficult to distinguish from fasciitis, despite it being a very different problem.
Tendon and tendon sleeve pathologies: Tendinitis and tenosynovitis can cause heel pain, especially on the lateral (out)side on the heel and ankle. This may be acute or chronic and be a result of lateral ankle instability following ankle injury.
Stress Fractures: Stress fractures in the heel can occur as a result of high intensity or repetitive impact forces such as running long distances. People with low bone density or other medical conditions may also sustain heel bone stress fractures.
Signs and Symptoms
Signs and symptoms can be very similar for all the above-mentioned types of heel pain.
Subtle differences in the presentation and history of the problem help the podiatrist distinguish one from the other. A classic complaint associated with plantar fasciitis/fasciosis/heel spurs is called post-static dyskinesia, where there is a sharp pain in the bottom of the heel for the first few steps taken in the morning, or after sitting/lying down for a while.
Heel Pain requires accurate diagnosis, as management will vary substantially depending on the underlying cause of the pain.
At Ned Buckley Podiatry, we offer the following treatment for heel pain:
- Conduct a thorough examination and biomechanical assessment to determine the cause of your heel pain.
- Anti-inflammation advice
- Strapping techniques or compression devices to achieve immediate relief
- Prescription of custom orthotics as appropriate
- Footwear advice
- Manual Therapy
- Referral for specialist treatment