Heel Pain

Heel Pain

Article by John Miller

What Causes Heel Pain?

Heel pain is a prevalent foot complaint and may involve injury to the bone, fat pad, ligaments, tendons or muscles.

Common Causes of Heel Pain

Plantar Fasciitis

The most common cause of heel pain is plantar fasciitis. This is a condition where your main arch ligament (fascia) becomes inflamed and causes pain.

More info: Plantar Fasciitis

Heel Spur

Plantar fasciitis can develop into a heel spur (calcaneal spur) when your fascia healing is delayed and bone is laid down in response to excessive load through the injured soft tissue. Heel spurs are often related to flat feet or pes planus.

More info:

Achilles Heel

The attachment of your Achilles tendon can cause Achilles heel issues onto your heel. This can be due to tendonitis or a related Achilles tendinopathy. While not necessarily painful, a ruptured Achilles tendon causes functional limitation such as an inability to rise on your toes, walk or run.

More info:

Other Tendinopathies

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.

More info:

Retrocalcaneal Bursitis

Bursitis is another source of heel pain. In particular, retrocalcaneal bursitis is common. It can cause pain in between your Achilles tendon and heel.

More info: Retrocalcaneal bursitis

Posterior Impingement Syndrome

Heel pain can also be associated with posterior impingement syndrome, 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

Heel Arthritis

Your heel pain can arise from osteoarthritis affecting the subtalar joint or talocrural (ankle) joint.

More info: Heel Arthritis

Stress Fracture

Bone injuries such as a fracture 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

Sever’s disease is a prevalent source of children’s heel pain. Sever’s is related to overactivity and overloading of the calcaneal growth plate.

More info: Sever’s disease.

Referred Sources

A pinched nerve can also refer to heel pain in your lower back, e.g. sciatica. This can be tricky to diagnose and requires the professional opinion of an experienced spinal health care practitioner such as your physiotherapist. It is important to have you thoroughly assessed to ensure an accurate diagnosis and subsequent treatment.

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 of time.

Common Sources of Heel Pain

Some of the many causes of heel pain can include:

  • Abnormal walking style (such as rolling the feet inwards)
  • Obesity
  • 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.

Heel Pain Treatment

Most heel pain is caused by a combination of poor biomechanics, or muscle weakness or tightness. The good news is that heel pain can be effectively managed once the cause is identified.

You can successfully treat most heel pain via:

Suppose you feel that your footwear or sports training schedule is potentially causing your heel pain. In that case, we recommend that you seek the advice of a sports physiotherapist, podiatrist or trained footwear specialist. It is essential to see if your shoe matches your foot or discuss your training regime to see if you are doing too much.

Heel pain and injury are widespread. With accurate assessment and early treatment, most heel pain injuries respond extremely quickly to physiotherapy allowing you to resume pain-free and normal activities of daily living quickly.

Please ask your physiotherapist for their professional treatment advice.

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

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.

Tenderness

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.  

Swelling

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.

Weakness

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.