Heel pain is one of the most common complaints to present to a podiatrist’s office. With technology now at one’s fingertips, many people try to self-diagnose and treat before even seeing the doctor, but they may not be treating the right condition. Check out some of the more common causes of heel pain below and learn how to diagnose them on your own.
(*Note, the list below is not a complete list of the causes of heel pain. Also, the information in this blog is meant for educational purposes only and should not be construed as medical advice. You should always consult your healthcare professional with questions and concerns related to your health).
The plantar fascia is the large ligament located along the bottom of the foot, extending from the heel bone to the forefoot. It functions to help support the arch of the foot. When added stress is placed on the ligament (i.e. excessive walking, high impact activities, change/absence of shoe gear), it can become inflamed, tear, and/or cause pain. The pain is typically felt along the bottom-inside part of the heel. This is where the plantar fascia inserts into the bone. Others may experience pain along the arch of the foot. The pain is noted with standing, excessive walking, and/or other weight-bearing activities, and is improved with rest. One may also experience pain with first steps in the morning or after periods of rest. This is called post-static dyskinesia.
The Achilles tendon is the soft tissue structure that connects your calf muscles (gastrocnemius and soleus) to the back of the heel bone and functions during the gait cycle to help you propel forward and lift your heel off the ground. When injured, increased warmth, swelling, and/or pain may be experienced. The pain is felt along the back of the heel bone itself or within the tendon just before it inserts into the heel bone. If the pain is higher in the calf, where the tendon and muscle belly meet, you may have a gastrocnemius muscle strain instead. If there is a palpable defect and you are unable to feel the Achilles tendon in the lower leg near the heel, you may have an Achilles tendon rupture. In this case, you should stay off the foot and seek medical help right away.
Like plantar fasciitis, pain associated with Achilles tendinitis can occur with first steps after periods of rest, with excessive ambulation, or with over-use. Walking up hill, or with an incline, can also aggravate the tendon as it is being stretched out.
There are two bursas located along the back of the heel. One lies between the heel bone and the Achilles tendon (called the retrocalcaneal bursa) and the other one is between the Achilles tendon and the skin at the back of the heel (called the retroachilles bursa). The most common reason for developing these types of bursitis is ill-fitting shoes with a rigid heel counter that rubs against the back of the heel. It is important to differentiate this pain from other causes of posterior heel pain. If the rigid shoe is removed and there is still pain, the pain may be due to Achilles tendinitis instead. If there is a palpable bump along the back of the heel, the pain may be related to the enlarged bony prominence (aka Haglund’s deformity or “pump bump”) (1).
CALCANEAL (HEEL) STRESS FRACTURE
The heel bone is one of the most common bones in the foot to sustain a stress fracture. It is usually the result of high-impact activities (e.g. running, jumping), but it can also occur in those with weakened bone (i.e. osteopenia). The pain may not be localized to one specific area of the heel bone, but squeezing the heel from the sides may reproduce the symptoms If the pain persists, further imaging studies may be necessary to rule-out other etiologies, including a bone cyst or other osseous lesion (1).
As you can see from the information above, there are several causes of heel pain. This list is not complete, though, and does not include infectious and systemic processes that may also result in heel pain. That is why it is important to consult your healthcare professional to make sure your heel pain is diagnosed and treated properly.
Disclaimer: The above information is meant for educational purposes only and should not be construed as medical advice. Should you be suffering from heel pain or another foot-related problem, it is recommended that you consult your healthcare professional.
1. Aldridge, T. (2004). Diagnosing heel pain in adults. American family physician, 70, 332-342.