Heel Pain & Injury
What Causes Heel Pain?
Heel pain is a prevalent foot complaint and may involve bone, fat pad, ligaments, tendons or muscles.
Common Causes of Heel Pain
The most common cause of heel pain is plantar fasciitis, a condition where your main arch ligament (fascia) becomes inflamed and causes pain.
More info: Plantar Fasciitis
Plantar fasciitis can develop into a heel spur (calcaneal spur) when delayed fascia healing and bone is laid down due to excessive load through the injured soft tissue. Heel spurs are often related to flat feet or pes planus.
The attachment of your Achilles tendon can cause Achilles heel issues onto your heel, and this can be due to tendonitis or a related Achilles tendinopathy. While not necessarily painful, a ruptured Achilles tendon causes functional limitations such as an inability to rise on your toes, walk or run.
Peroneal tendonitis is a common lateral heel condition due to altered foot biomechanics or hind-foot control issues. Medially (inside your heel), another tendinopathy known as tibialis posterior tendinopathy can cause heel pain.
Bursitis is another source of heel pain, and it can cause pain between your Achilles tendon and heel.
More info: Retrocalcaneal bursitis
Posterior Impingement Syndrome
Heel pain can also be associated with posterior impingement syndrome conditions, common in dancers or athletes who need to plant their foot, e.g. cricket fast bowlers. It can also occur in any athlete with a relatively unstable ankle, e.g. poorly rehabilitated sprained ankle.
More info: Posterior Impingement Syndrome
Your heel pain can arise from osteoarthritis affecting the subtalar joint or talocrural (ankle) joint.
More info: Heel Arthritis
Bone injuries such as fractures can occur from a trauma such as a fall from a height onto your heel. Athletes, especially runners and landing sports, can also suffer overload fractures known as calcaneal stress fractures.
More info: Stress Fracture
Children’s Heel Pain
Sever’s disease is a ubiquitous source of children’s heel pain. Sever’s is related to overactivity and overloading of the calcaneal growth plate.
More info: Sever’s disease.
You must be thoroughly assessed to ensure an accurate diagnosis and subsequent treatment. Heel pain can also be referred to from a pinched nerve in your lower back, e.g. sciatica. Neural-origin pain such as sciatica and sural nerve pathologies can be tricky to diagnose and requires the professional opinion of an experienced spinal health care practitioner such as your physiotherapist.
Who Suffers Heel Pain?
Anyone can suffer from heel pain, but certain groups seem to be at increased risk, including:
- Middle-aged men and women
- Active people, e.g. running sports
- People who are very overweight
- Children aged between 8 and 13 years
- Pregnant women
- People who stand for long periods.
Common Sources of Heel Pain
Some of the many causes of heel pain can include:
- Abnormal walking style (such as rolling the feet inwards)
- Ill-fitting shoes, e.g. narrow toe, worn-out shoes
- Standing, running or jumping on hard surfaces
- Recent changes in an exercise programme
- Heel trauma, e.g. stress fractures
- Bursitis (inflammation of a bursa)
- Health disorders, including diabetes and arthritis.
Foot, Ankle & Heel Pain FAQs
- What are the Common Ankle Injuries?
- How to Strap an Ankle?
- What Causes Ankle Impingement?
- What is a High Ankle Sprain?
- Is There Such a Thing As A "Simple Easy Ankle"?
- Why Do Your Joints Click?
- What are the Common Causes of Foot Pain?
- How Can You Relieve Foot Pain?
- What are the Disadvantages of Barefoot Running?
Balance & Proprioception
Common Heel Pain & Injury Conditions
Traumatic Ankle Ligament Injuries
- Achilles Tendon Rupture
- Achilles Tendinopathy
- FHL Tendinopathy
- Peroneal Tendinopathy
- Tibialis Posterior Tendinopathy
- Ankle Fracture (Broken Ankle)
- Stress Fracture
- Stress Fracture Feet
- Severs Disease
- Heel Spur
- Shin Splints
Soft Tissue Inflammation
Common Treatments For Foot Pain
With accurate assessment and early treatment, most foot pain responds extremely quickly to physiotherapy allowing you to quickly resume pain-free and normal activities of daily living.
Please ask your physiotherapist for their professional treatment advice.
- Early Injury Treatment
- Avoid the HARM Factors
- Walking Boot
- Brace or Support
- Electrotherapy & Local Modalities
Subacute Treatment Options
- Acupuncture and Dry Needling
- Joint Mobilisation Techniques
- Physiotherapy Instrument Mobilisation (PIM)
Other Treatment Options
- Active Foot Posture Correction Exercises
- Strength Exercises
- Stretching Exercises
- Closed Kinetic Chain Exercises
- Gait Analysis
- Running Analysis
- Video Analysis
- Biomechanical Analysis
- Agility & Sport-Specific Exercises
FAQs about Heel Pain & Injury
Common Youth Leg Injuries
Why are Children's Injuries Different to Adults?
Adolescent Leg Injuries
Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.
In the adolescent leg, common injuries include:
Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. Because of excessive participation in running and jumping sports, the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.
More info: Osgood Schlatter's Disease
Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. Because of excessive participation in running and jumping sports, the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.
More info: Sinding Larsen Johansson Syndrome
Anterior Knee Pain
Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.
More info: Patellofemoral Pain Syndrome
The cartilage between the leg bones has a better blood supply and is more elastic in adolescents than adults. As adolescents near the end of bone growth, their injuries become more adult-like. Hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.
More info: Knee Ligament Injuries
ACL (Anterior Cruciate Ligament) Injuries
This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.
More info: ACL Injury
Your meniscus is crescent-shaped cartilage between the thigh (femur) and lower leg (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these damages within six weeks, they may require arthroscopic surgery.
Heel pain is commonplace in young adolescents due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury due to excessive training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are the best ways to manage this debilitating condition for the active young athlete.
More info: Sever's Disease
An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. With the correct treatment, a low ankle sprain usually improves in two to six weeks. Your ankle physiotherapist should check even simple ankle sprains to eliminate high-ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issues.
More info: Sprained Ankle
Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.
More info: Patella Dislocation
The separation of a bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.
Growth Plate Fractures
A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.
Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children
An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow, and ankle are the most common locations for lower limb avulsion fractures in young sportspeople.
Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This active rest period is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.
An excessive gap between the avulsed bone fragment and main bone may not rejoin naturally in rare cases. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.
For more information regarding your youth sports injury, please consult your physiotherapist or doctor.
Youth Leg Injuries
Pelvis & Hip
- Osgood Schlatter's Disease
- Sinding Larsen Johannson Disease
- Patellofemoral Pain Syndrome
- Patella Dislocation
- Meniscus Tear
- Discoid Meniscus
- Juvenile Osteochondritis Dissecans
Heel & Ankle
Common Youth & Teenager Sports Injuries
Acute Injury Signs
Acute Injury Management.
Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.
For detailed information on specific injuries, check out the injury by body part section.
Don't Ignore these Injury Warning Signs
Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.
If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.
Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.
Reduced Range of Motion
If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.
Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.
Immediate Injury Treatment: Step-by-Step Guidelines
- Stop the activity immediately.
- Wrap the injured part in a compression bandage.
- Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
- Elevate the injured part to reduce swelling.
- Consult your health practitioner for a proper diagnosis of any serious injury.
- Rehabilitate your injury under professional guidance.
- Seek a second opinion if you are not improving.