The heel supports the weight of your body and takes repeated stress when you walk, run and jump. Heel pain can result from overstretching and tearing of ligaments, being overweight, wearing shoes that do not fit properly or exercising on hard surfaces.
Most cases of heel pain respond to simple at-home treatments, such as icing, night splints and shoe modifications. Some people find relief with oral medications and injections.
Causes
The heel is a padded cushion of fatty tissue that supports the weight of your body and absorbs shock from movement. Most people have pain in their heels from time to time. It usually improves with rest, ice packs and foot exercises to stretch tight muscles and tendons.
Heel pain typically develops from injury or overuse of the connective tissues that support your arch and foot’s arch (called the plantar fascia). Overtime, the ligament may tear and bleed. This causes inflammation that calcifies into a bony growth called a heel spur. This spur is tender to the touch and appears most often on the bottom of your heel. The problem can worsen if you have flat feet or walk in unsupportive shoes.
Other causes of heel pain include a condition that irritates the fluid-filled sacs (bursae) that cushion your joints. This is called chronic heel pain syndrome and often occurs after prolonged activity, especially running or jumping. It is more common in obese people and people who work for long periods of time on their feet.
Heel pain can also occur from a condition known as Haglund’s deformity, which is an enlarged bump on the back of your heel bone. It’s more common in people who wear high-heeled shoes, such as pumps. Heel pain can also develop from a stress fracture of the heel bone or from an overuse condition that affects the growth plate of your heel bone. This is called Sever’s disease and is more common in active children between the ages of 8 and 14.
Treatment
Heel pain is most often caused by biomechanical abnormalities, putting excessive stress on the heel bone and ligaments that attach to it. These include poor footwear, especially shoes that do not absorb shock; running and jumping on hard surfaces; tight calf muscles; overuse; being overweight; aging; or a trauma or injury.
Early treatment usually focuses on relieving pain and inflammation. This includes oral or injectable anti-inflammatory medication, rest, ice, and stretching of the foot and calf muscle to make them stronger and more flexible. Taping or strapping the foot supports the structure, reducing stress on overworked muscles and ligaments. Shoe inserts (orthoses) professionally fitted by a podiatrist can also help.
Other treatments are available for more severe cases of pain in the heel. These include extracorporeal shockwave therapy (ESWT), which uses sound waves to stimulate the body’s natural healing processes in soft tissue injuries. This is particularly effective in heel spurs and Achilles tendinitis, as well as a condition called plantar fasciitis.
Heel pain that does not improve with conservative treatments may require surgery. Surgical options include release of the plantar fascia or heel spur, removal of a cyst or bursa, or removal of a neuroma. If you have persistent heel pain, it is important to see a podiatric surgeon for an evaluation and proper treatment. Delaying treatment can worsen the problem and lead to more serious complications.
Prevention
The most common cause of heel pain is plantar fasciitis (PLAN-tur fas-EYE-tis), inflammation of a thick band of tissue that supports the arch of the foot. It often causes stabbing pain that’s most sharp with the first steps in the morning or after long periods of inactivity. The pain usually decreases with walking, but it may return after extended activity or when you stand up after sitting for a long time. The condition is more common in people who are overweight, those who run or jump frequently, and those who wear shoes with poor arch support.
Another common cause of heel pain is Achilles tendinitis, which is inflammation of the tendon that connects the calf muscles to the heel bone. The condition typically occurs when the tendons are tight, as can occur with overuse or sudden increases in exercise intensity, especially for those who are new to running or jumping. People with flat feet, overpronation, or high arches are also prone to the condition.
The good news is that most cases of heel pain respond well to rest, icing the area, and using over-the-counter pain relievers such as acetaminophen or ibuprofen. It’s important to make sure shoes fit properly and aren’t worn out, which can put extra stress on the heel. Cross-training during exercise can help reduce strain on the feet and ankles, as can keeping weight down to avoid excess stress on the heels.
Diagnosis
Heel pain may result from a variety of conditions. Generally, excessive strain over time on the feet can push the bones and ligaments of the foot over their limits. This results in inflammation, pain and possibly a bony spur forming at the heel bone or the area of the plantar fascia. The most common cause of heel pain is plantar fasciitis. This condition occurs when a thick band of tough connective tissue that runs across the bottom of the foot and attaches to the heel bone is strained over time beyond its normal extension. This stretching of the tissue may cause tiny tears and chronic inflammation. The most common sign of this is stabbing pain when one first steps on the feet in the morning or after sitting for long periods of time. This pain usually decreases with walking as the foot stretches the tissue.
Other causes of heel pain include calcaneus stress fracture, Achilles tendonitis and insertional Achilles tendinosis (see Heel Pain — Different Causes). Heel pain can also occur as a result of being overweight, wearing poorly constructed shoes or running or jumping on hard surfaces, or having flat feet or overpronation.
Most cases of heel pain improve with rest, icing and a change to properly constructed shoes that are not too narrow in the toe box or have high heels. Other treatment options include shoe inserts (orthoses) professionally fitted by a podiatrist and stretching exercises before exercising or playing sports. Medications including anti-inflammatory drugs and steroid injections can help relieve some types of heel pain.