Heel Pain

Heel pain is a very common foot problem. The sufferer usually feels pain either under the heel (plantar fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone. There is also a type of heel pain specific to children called Sever’s disease.

Even though heel pain can be severe and sometimes disabling, it is rarely a health threat. Heel pain is typically mild and usually disappears on its own; however, in some cases the pain may persist and become chronic (long-term).

What can be done about heel pain?

First a bit of science so you can better appreciate just what your foot has to deal with on a daily basis. There are 26 bones in the human foot, of which the heel bone is the largest. The human heel is designed to provide a rigid support for the weight of the body. When we are walking or running it absorbs the impact of the foot when it hits the ground, and springs us forward into our next stride. The stress placed on the feet when walking 1.25 times our body weight, and this increases to nearly 3 times when running. As a result, the heel is extremely vulnerable to damage, and pain.

In the majority of cases, heel pain has a mechanical cause.

Common causes of heel pain include:

Plantar fasciitis - inflammation of the strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot.

When the plantar fasciitis is stretched too far its soft tissue fibers become damaged and inflamed, usually where it attaches to the heel bone The patient experiences pain under the foot, especially after long periods of rest. It is often described like walking with a stone under the heel.

Heel bursitis - inflammation of the sack of fluid that sits between the heel bone and the Achilles tendon. Can be caused by landing awkwardly or hard on the heels. It is commonly caused by pressure from footwear. Pain is typically felt either deep inside the heel or at the back of the heel. It can also be associated with Achilles tendinopathy.

Heel bumps (common in teenagers). The heel bone is not yet fully mature and rubs excessively, resulting in the formation of too much bone. It can be caused by having a flat foot. Among females it can be caused by starting to wear high heels before the bone is fully mature.

Tarsal tunnel syndrome – a trapped nerve in the back of the foot.

Chronic inflammation of the heel pad – This occurs as the fibrous fatty pad under the heel begins to wear out and become inflamed.

Stress fracture – this is particularly common in runners, especially those with poor running mechanics.

Severs disease – this is the most common cause of heel pain in child/teenage athletes, caused by irritation of the growth plates of the calcaneus (heel bone). Children aged from 7-15 are most commonly affected.

Achilles tendonosis (degenerative tendinopathy) - also referred to as tendonitis, tendinosis and tendinopathy. This is a chronic (long-term) condition associated with the degeneration of the Achilles tendon. Sometimes the Achilles tendon does not function properly because of multiple, minor tears of the tendon, which cannot heal and repair correctly - the Achilles tendon receives more tension than it can cope with and microscopic tears develop. Eventually, the tendon thickens, weakens and becomes painful. Commonly the overload of the Achilles tendon is associated with other weakness in the hips and knees.


Treatment options

Obviously the best treatment options depend on the specific cause of heel pain and the severity. It is also dependent on patient variables such as age, sport/activity level, other injuries and comorbidities.

Broadly though treatment can be divided into the following groups.

Medication – many of the above conditions respond to Non-steroidal Anti-inflammatory Drugs (NSAIDs). On some occasions, steroidal drugs such as Cortisone may be injected into the painful area.

Physiotherapy and exercise – All of the above conditions respond well to suitable physiotherapy intervention, and often it is used in conjunction with other methods to manage the problem. Interventions can include manual therapy to release tight structures, electrotherapy and exercise. Depending on the specific condition the type of treatments and exercises applied can vary so getting an accurate diagnosis of the problem is extremely important.

Podiatry – Naturally a problem in the foot area will get benefit from podiatry. Generally, if the problem is coming from poor walking habits and biomechanics, then orthotics can quickly correct poor movement habits and enable correct walking and performance of exercises. Often getting advice on the correct footwear can have a big impact as well.

If you are having problems with foot pain or would like further information, call our friendly team on 3350 2596. Our Physiotherapists and Sports Physicians have extensive experience in treating heel pain of all kinds.