The heel is a highly specialised body part designed to absorb large amounts of shock from day to day activities. When walking or running stresses on the feet can increase to almost three times your body weight and it is therefore no surprise that sometimes heel pain is a common injury.

Most causes of heel pain are due to mechanical injury eg. Increases in pressure on the heel from weight gain or a new activity. This can cause small but repetitive injuries that occur faster than the body can heal them leading to heel pain.  Other causes of heel pain include referred pain from the lower back or diseases such as inflammatory joint conditions.

Types of heel pain

There are many types of heel pain, below outlines some of the most common types however is not exhaustive hopefully highlighting the complexity of heel pain and why specialist advice can often be helpful!

Plantar Fasciopathy (commonly called plantar fasciitis)

One of the most common types of heel pain caused by damage to the plantar fasciia. The plantar fasciia is a band of connective tissue connecting the heel bone to the toes and its main role is to support the arch of the foot and provide shock absorbency to the foot.  Pain first thing in the morning which eases as the day goes on is characteristic of this condition. An ultrasound scan of the plantar fasciia can be helpful to confirm clinical diagnosis.  Treatment for this condition can include stretching exercises, foot orthoses and shockwave therapy.

Tarsal Tunnel Syndrome

This condition can cause strange sensations such as burning or tingling sensation underneath the heel and into the arch of the foot. Occasionally you may experience numbness in the heel or sole of the foot. Tarsal Tunnel Syndrome is caused by compression of the tibial nerve which runs along the inside of the ankle and down into the foot. Treatment for this condition can include the use of foot orthoses and local injections of medication such as local anesthetic and corticosteroid.

Calcaneal Bursitis

This condition is caused by inflammation of the bursa (a fluid filled sac) located underneath the heel bone.  Pain typically is in the centre of the heel and worsens during the day. Treatment can include anti-inflammatory medication, foot orthoses, ultrasound and injection therapy.

Chronic Inflammation of the heel pad

This is caused by heavy heel strike or reduction in the fat pad under the heel bone.  Pain is usually a dull ache underneath the heel bone which worsens with prolonged standing and walking. Treatment can include footwear modifications and the use of cushioned heel pads inside the shoe.

Stress Fracture

This can occur following a fall from a height.  Certain medical conditions can increase the likelihood of developing a stress fracture in this area and if suspected imaging may be required to confirm and evaluate the extent of the injury.

Insertional Achilles tendinopathy

This can occur due to irritation of the Achilles Tendon where it inserts on the back of the heel bone. Irritation can be caused by a number of factors such as poorly fitting footwear and excessive ankle motion to name a few. Symptoms associated with this condition include stiffness in the morning, swelling and pain.    Treatment can include temporary heel raises to reduce pain, exercises to load the Achilles tendon, shockwave therapy and injection therapy.

If I Experience Heel Pain What Should I Do?

If you experience heel pain, follow these simple self-care measures that can often help with heel pain:

• If the pain is associated with a certain shoe, avoid wearing these shoes for a while
• Avoid walking barefoot, particularly first thing in the morning
• Rest or reduce activities, particularly if you have increased your activity recently
• Wear footwear with a slightly higher heel height, 6-10mm higher than normal
• Use heel cushions from the pharmacy to reduce pressure on the heel

If your pain persists for longer than 3 weeks it may be advisable to seek professional advice. There are many different types of heel pain each with different management and treatments options therefore it is essential to have the correct diagnosis in order to treat your heel pain effectively.

To ensure you receive the right treatment you need to see someone who specialises in heel pain.  Podiatrists as part of the training specialise in heel pain, its cause and treatment.

If you have any further questions please don’t hesitate to get in touch with our Podiatrist Suzanne Hamilton.