Heel pain is one of the most common forms of foot pain in adults and can also affect children too (Sever's disease). It often occurs as a result of daily activities and exercise. The heel bone (calcaneus) is the largest bone in the foot and the heel is the first part of the foot to contact the ground during walking.
Two structures located on the bottom (sole) of the foot are primarily associated with heel pain: the plantar fascia, a band of fibrous connective tissue, and the flexor digitorum brevis muscle, which supports the arch and flexes the four small toes.
Normally, as the foot absorbs the weight of the body during walking, the arch area joint locking mechanism provides about 80% of the stability of the foot. The other 20% of biomechanical stability is provided by the plantar fascia and muscles, tendons, and ligaments.
Gait abnormalities can cause inflammation of the structures attached to the heel bone, resulting in heel pain. Inflammation of the plantar fascia, called plantar fasciitis, is the most common cause of heel pain.
Plantar fasciitis often causes pain that is more severe following a period of rest (e.g., after sleeping).
Sometimes, muscle strain and tension pull at the origin site on the bottom surface of the heel bone producing an inflammatory response that begins making new bone. This interim condition is called periostitis. The forming bone spur grows forward in the direction of this pulling. Heel spurs can irritate nerves and cause pain.
Risk Factors and causes
Misalignments caused by abnormalities in the structure of the feet increase the risk for heel pain. Other risk factors include the following:
- Engaging in strenuous exercise (especially repetitive jumping and running)
- Standing for prolonged periods
- Wearing shoes that do not fit properly
To reduce the risk for heel pain, it is important to wear shoes or sneakers that fit correctly and to warm up properly before exercising.
The most common cause for heel pain is inflammation of the fibrous connective tissue on the sole of the foot (plantar fasciitis). Other causes include the following:
- Achilles tendonitis
- Bone bruises
- Excessive pronation (tendency of the foot to roll inward)
- Haglund's deformity (bony growth at the back of the heel that usually occurs when shoes repeatedly aggravate tissue and underlying bone)
- Heel spurs (also called bone spurs)
- Inflammatory conditions (e.g., ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, rheumatoid arthritis, bursitis)
- Sever's disease (relatively common condition in active growing children and adolescents)
- Soft-tissue sarcoma of the foot (rare)
- Stress fractures
- Tarsal tunnel syndrome (nerve entrapment that may cause pain on the sole of the foot)
Diagnosis of heel pain may involve a history of symptoms, a physical examination, and imaging tests (e.g., x-rays, ultrasound, MRI] scan). Imaging tests are used to detect heel spurs, stress fractures, and hardened deposits (calcifications) that may contribute to heel pain.
Heel pain is difficult to cure and often takes months to subside, but most cases can be resolved using conservative treatment methods. Conservative treatment includes the following:
- Avoiding activities that worsen the condition (e.g., prolonged standing, strenuous exercise)
- Applying ice to the area to reduce pain and inflammation
- Wearing well-cushioned shoes that fit properly
Orthotics and shoe inserts can provide proper support, correct misalignments and imbalances in the foot, and alleviate pressure on heel spurs. Anti-inflammatory medications such as ibuprofen may be used to reduce pain and inflammation. Physical therapy also may be used to relieve heel pain.
If you are suffering from heel pain contact Footfit Podiatry Tauranga 0508 366 834 and we will be happy to help.