Why do my heels hurt and what can I do about it?

Heel pain is a common problem affecting the foot. Pain usually occurs under or just behind the heel, where the Achilles tendon is connected to the bone of the heel. This can often impact the heel side.

Pain that takes place beneath the heel is known as plantar fasciitis. That is the most frequent source of heel pain.

Achille tendinitis is a pain behind the heel. Pain can also affect the inner or outer side of the heel and foot.

For most cases, an injury isn’t causing pain. It is usually mild at first, but can get severe and sometimes disabled. This usually goes away without medication, but may often continue and become chronic.

Causes include arthritis, cancer, autoimmune disease, trauma, or a neurological problem.

Important facts about heel pain

  • Heel pain is usually felt either under the heel or just behind it.
  • Pain typically starts gradually, with no injury to the affected area. It is often triggered by wearing a flat shoe.
  • In most cases the pain is under the foot, towards the front of the heel.
  • Home care such as rest, ice, proper-fitting footwear and foot supports are often enough to ease heel pain.

Causes

Plantar fasciitis is a common cause of pain under the heel.
Plantar fasciitis is a common cause of pain under the heel.

Heel pain is typically not caused by a single injury, such as twisting or dropping but by repeated stress and heel pounding.

Popular causes encompass:

Plantar fasciitis, or inflammation of the plantar fascia: The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot.

That form of pain also arises due , for example, to the way the foot is made, if the arches are especially high or low.

When the plantar fascia is extended too far it inflames the soft tissue fibers. This usually happens where it is attached to the bone of the heel, but it sometimes affects the foot centre. Under foot pain is felt especially after long rest periods. Calf-muscle cramps may occur if the Achilles tendon tightens too.

Heel bursitis: Inflammation can occur in a fibrous sac full of fluid at the back of the heel, in the bursa. This may result from an uncomfortable or hard landing on the heels, or from footwear pressure. Pain can be felt deep inside the heel or behind the heel. Achilles tendon will swell occasionally. The pain typically gets worse as the day progresses.

Heel bumps: These are also known as pump bumps, which are common in adolescents. The heel bone is not yet fully mature, and it rubs excessively, causing too much bone to form. Sometimes, it is caused by a flat foot. This may be caused by starting to wear high heels before the bone is fully mature.

Tarsal tunnel syndrome: A large nerve is pinched or clogged (compressed) in the back of the foot. This is a type of compression neuropathy that can occur either in the ankle or foot.

Chronic heel pad inflammation: This is caused either by too thin a heel pad, or by heavy footsteps.

Stress fracture: This is linked to repetitive stress, strenuous exercise, sports, or heavy manual work. The runners are particularly vulnerable to stress fracture in the foot’s metatarsal bones. It could be due to osteoporosis, too.

Severs disease: This is the most common cause of heel pain among child and adolescent athletes, caused by overuse and repetitive microtrauma of the heel bone growth plates. It most frequently affects children aged 7 to 15.

Achilles tendinosis: Degenerative tendinopathy, tendonitis, tendinosis and tendinopathy are also known as this. It is a chronic disorder related to the progressive Achilles tendon degeneration.

The Achilles tendon sometimes does not function properly due to the tendon ‘s multiple, minor microscopic tears which can not heal and repair themselves properly. Microscopic tears form when the Achilles tendon is getting more tension than it can cope with. The tendon gradually grows thick, weak, and becomes painful.

Other causes of pain to the heel include:

  • Achilles tendon rupture, where the tendon is torn
  • a plantar fascia tear
  • Baxter’s nerve entrapment
  • calcaneal stress fracture
  • calcaneal cysts
  • soft tissue mass
  • short flexor tendon tear
  • systemic arthritis (lupus, rheumatoid arthritis, psoriatic arthritis)
  • bone bruise
  • problems with circulation
  • poor posture when walking or running
  • bone cyst, a solitary fluid-filled cyst in a bone
  • gout, when levels of uric acid in the blood rise until urate crystals start to build up around the joints, causing inflammation and severe pain
  • neuroma, or Morton’s neuroma, when a nerve becomes swollen in the ball of the foot, commonly between the base of the second and third toes
  • osteomyelitis, an infection of the bone or bone marrow leads to inflammation of the bone

Osteomyelitis can result from injury or surgery, or from the bloodstream, the infection can get into bone tissue. Symptoms include both deep pain and muscle spasms in the area of inflammation, and fever.

Peripheral neuropathy involves damage to the nerves, and can cause pain and numbness in the hands and feet.

It may be attributed to serious injuries , infections, metabolic disorders and toxin exposure. One common cause is diabetes.

Rheumatoid arthritis is a progressive and disabling autoimmune condition that causes inflammation and discomfort in the joints, tissue around the joints and other human body organs.

It usually affects the joints in the hands and feet first, but any joint may become affected.

Side foot pain

Lateral foot pain affects the outside of the heel or foot and inside edge is affected by medial foot pain.

These may result from:

  • a stress fracture
  • a sprain
  • cuboid syndrome, when a small bone in the foot becomes dislocated arthritis
  • peroneal tendonitis, when repeated tension irritates the tendon
  • tarsal coalition, a congenital foot problem
  • bunions, corns, and callouses
  • posterior tibial tendonitis, which results from stress and overuse

Most causes of foot pain are mechanical, related to strain, injury, or bone structure problems.

Treatment

Most people recover with conservative treatments within months.

Treatment options include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce pain and swelling.
  • Corticosteroid injections may work if NSAIDs are not effective, but these should be used with caution, because long-term use can have adverse effects.
  • Physical therapy can teach exercises that stretch the plantar fascia and Achilles tendon and strengthen the lower leg muscles, resulting in better stabilization of the ankle and heel.
  • Athletic taping gives the bottom of the foot better support.
  • Orthotics, or assistive devices, and insoles can help correct foot faults and cushion and support the arch during the healing process.

Extracorporeal shock wave therapy aims for encouraging and stimulating healing of sound waves in the affected area. It is recommended only for cases which have not responded to conservative therapy in the long term.

Surgery


If nothing else works, the plantar fascia may be detached from the heel bone by a surgeon There is a possibility this could weaken the foot arch.

Night splints


Calf and foot may be fitted with a night splint and kept on during sleep. It overnight retains and extends the plantar fascia and Achilles tendon in a lengthened role.

Treatment for heel bursitis

If heel bursitis can be distinguished from plantar fasciitis as a separate condition, use of a cushioning insole or heel cup to restrict the movements that cause the problem can be an effective treatment.

Sleep is also recommended, and can require a steroid injection.

Treatment for heel bumps

Ice, compression and a change in footwear can relieve inflammation behind the heel.

Achilles pads, tortoise and heel grip pads may offer temporary relief.

Injections of cortisone can help with the pain.

For most cases, heel pain should be gone within 6 weeks of treatment. However, surgery may be necessary in severe cases and where pain persists.

Exercises

Calf stretches can help prevent or treat heel pain.
Calf stretches can help prevent or treat heel pain.

Here are some examples:

  • Sit in a chair, hold the leg out straight, and flex and extend at the ankle joint. Repeat 10 times on each foot.
  • Stand facing a wall. Place the foot that has the heel pain behind the other foot. Keep the front knee bent and the back leg straight, with the foot on the ground. Pull the hips forward toward the wall until you feel a stretch in the calf of the lower leg. Repeat 10 times. If there is pain in both heels, stretch both calves.

Home remedies

Home care can help get rid of heel pain that is not severe.

This includes:

Rest: avoid long periods of running or standing, walking on hard surfaces and any activities that may stress the heels.

Ice: Place an ice-pack wrapped in cloth for about 15 minutes on the affected area, but not directly on the skin.

Footwear: Shoes that fit properly and that offer good support are important for athletes in particular.

Supports for the foot: Wedges and cups for the heel may help to relieve symptoms.

Some recent studies have suggested Botox may be helpful in treating plantar fasciitis.

Another research indicated that a normal dose of external beam radiation therapy, similar to that used in an x-ray or cancer treatment, may be beneficial.

Prevention

Preventing heel pain involves lowering the stress on that part of the body.

Tips include:

  • wearing shoes when on hard ground, and not going barefoot
  • maintaining a healthy body weight to reduce stress on the heels
  • choosing footwear with heels made of material that can absorb some stress, or using inserted heel pads
  • ensure shoes fit properly and do not have worn down heels or soles
  • avoid shoes that seem to trigger pain
  • rest your feet rather than standing if you are susceptible to heel pain
  • warm up properly before engaging in sports and activities that may place lots of stress on the heels
  • wear suitable sports shoes for each task

Symptoms

Typically heel pain begins gradually and gets severe. Often there is no injury to the affected area. Wearing a flat shoe can trigger this. Flat footwear can stretch the fascia of the plantar until the area is swollen, or inflamed.

However, pain can be serious when there is a tear. At the time of the injury the person will have noticed a popping sound and there will be immediate pain.

Heel pain is usually felt under the foot, toward the front of the heel.

Symptoms may get worse just after getting out of bed in the morning, and after a rest period in the daytime, and then they improve with a little activity. They could deteriorate again towards the end of the day.

When to see a doctor

See a doctor if you experience:

  • severe pain with swelling near the heel
  • pain, numbness or tingling in the heel, and fever
  • pain in your heel and fever
  • difficulty walking normally
  • difficulty bending the foot downward or standing on tiptoe

You should arrange to see a doctor if:

  • heel pain continues for more than a week
  • heel pain persists when you are not standing or walking

Diagnosis

A doctor will examine the foot and inquire about the discomfort, how much the person uses to walk and stand, what kind of footwear they need and the specifics of their medical history.

Starting from the hip, they can check the muscles, and search for any irregular shape or skin changes. These may help to distinguish between a growth, psoriasis, and other conditions.

Squeezing the heel can help to detect nerve problems, the presence of a cyst or a fracture of stress.

This can suffice to make a diagnosis, but blood tests or imaging scans are often needed.

The most Pain / Anesthetics type of heel pain is plantar fasciitis but many other causes are possible. Accurate diagnosis is more likely to result in an effective treatment.

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