Our bodies are put through a lot during the course of our day, none more than our feet. Our feet are responsible for carrying our entire weight, getting us from point A to point B and very rarely get a chance to rest properly. Heel pain is one of the most common types of foot pain, and can continue to get worse over time if not properly addressed.
Heel pain is generally located in one of two locations, either the back of the heel or on the underside of the heel near the arch of the foot. Pain under the heel is more than likely a result of plantar fasciitis, while pain at the back of the heel may be attributed to Achilles tendinitis.
What Causes Heel Pain?
Heel pain, like most foot pain, has a variety of potential causes. Heel pain is usually the result of biomechanical issues (walking or gait abnormalities) where stress is placed on the heel bone and soft tissues connected to it. This stress can also result from bruises or other injuries to the heel or foot.
Heel spurs are bony growths (calcium deposits) located on the underside of the heel bone that result from strain on the muscles and ligaments of the foot. Heel spurs can be directly related to plantar fasciitis, as they can occur due to the repeated stretching of the tissue band (plantar fascia) that connects to the heel, as well as from biomechanical issues, running or heightened activity or improperly fitted shoes.
One of the most common causes of heel pain, plantar fasciitis is often associated with heel spurs and other pain in the foot. Plantar fasciitis is the result of degeneration of the plantar fascia, the band of tissue that runs along the bottom of the foot. Plantar fasciitis is extremely common in runners and athletes, and anyone who spends extended periods of time on their feet. Plantar fasciitis can affect any type of person.
Over time, stress is placed on the plantar fascia, causing tiny tears and degeneration of the soft tissue, leading to pain and inflammation at the heel or arch of the foot. This pain can be increased and exaggerated by improperly fitted shoes, added stress on the foot from activity or obesity. Workers on their feet all day are prone to feeling pain from this common degenerative condition.
The Achilles tendon, a band of tissue connecting the calf muscles to the heel bone, can become injured due to overuse, which results in Achilles tendinitis. This condition is common in athletes and runners whose activity and stress level can increase drastically in short spurts, putting additional stress on the Achilles tendon.
Overtime and with added stress, the Achilles tendon can tear and stretch, causing heel pain at the insertion of the tendon to the heel bone. Partial tearing may occur and generally does not cause any structural loss of strength.
Symptoms of Heel Pain
The symptoms of heel pain will vary depending on the root cause of the pain, but can include:
- Pain on the bottom or top of the heel
- Pain in the arch of the foot
- Pain that gets worse upon standing or walking
- Pain that increases over time
- Pain that occurs after waking up in the morning or after extended periods of rest
- Pain that radiates into the muscles of the leg
In order to receive a proper diagnosis of heel pain, your doctor will conduct a brief examination of the foot to identify areas of the foot causing the pain, and will discuss your lifestyle and any activities that may be leading to the heel pain. Your doctor should also examine shoe wear and discuss any orthotics with you.
In some cases, diagnostic imaging may be used to help differentiate the various potential causes of heel pain. In many cases, your doctor may be able to identify heel spurs with a simple x-ray.
Once the cause of your heel pain has been identified, your doctor may recommend a variety of non-surgical treatments for heel pain, including:
- Shoe Modification
- Strapping or splinting
- Orthotic devices
- Physical therapy
In rare cases, surgical treatments may be required to address your heel pain. Surgical intervention can occur in severe cases of plantar fasciitis where non-surgical procedures have no reduced or eliminated the heel pain.