Heel Pain : Causes, Types, Treatment and Symptoms

Heel (calcaneus) pain, the most common problem in the foot and its surrounding tissues, is discomfort or tenderness in the heel caused by excess stress, various inflammatory conditions, or injuries. This pain can range from mild to severe, affecting a person’s mobility and daily activities.

Most common Heel pain symptoms:

• A sharp stabbing pain, or a constant and dull ache
• Under and behind the heel or within the heel bone
• Sensitivity or tenderness on touching the area
• Swelling and redness indicate inflammation
• Stiffness in the heel and its surrounding areas
• Difficulty walking and other weight-bearing tasks
• Burning numbness or tingling sensation

Common, Uncommon or Underlying Causes of Heel Pain

Due to the wide range of causes for heel pain, a correct diagnosis is essential for effective treatment, ranging from overuse injuries to rare systemic disorders; consult a specialist for persistent pain, especially if it mimics other conditions.

• Plantar fasciitis – Inflammation of the plantar fascia, the most common cause of heel pain. The plantar fascia is a thick band of tissue connecting the heel bone to the toes.
• Heel spurs – A bony growth on the underside of the heel bone, often caused by the strain from plantar fasciitis.
• Achilles tendinitis – An inflammation of the Achilles tendon, which connects the calf muscles to the heel bone, causing pain and stiffness in the back of the heel.
• Bursitis – An inflammation of the fluid-filled sacs that cushion joints, which can cause a bruise-like pain in the back or bottom of the heel.
• Calcaneal Stress fracture – Tiny cracks in the heel bone caused by repetitive stress, leading to pain that worsens with activity.
• Sever’s disease – A common cause of heel pain in children and adolescents, caused by inflammation of the growth plate in the heel bone.
• Bone Bruise (Contusion) – A heel contusion, or bruise, is caused by stepping on a hard or sharp object, leading to pain and tenderness.
• Haglund’s deformity – Known as “pump bump,” Haglund’s deformity is a bony swelling at the back of the heel that becomes painful when irritated by stiff shoes.
• Heel fat pad atrophy – When the heel’s protective fat pad diminishes due to ageing or injury, it can lead to deep, aching heel pain originating from the centre.
• Tarsal tunnel syndrome – Occurs when the posterior tibial nerve in the ankle is compressed, resulting in pain, tingling, and numbness in the heel and foot.
• Rheumatoid arthritis – An autoimmune disease that can cause inflammation of joints throughout the body, including the feet and ankles.
• Reactive arthritis (Reiter’s syndrome) – A type of arthritis triggered by an infection, which can cause inflammation and pain in the heels.
• Alkalosis spondylitis – An inflammatory arthritis that primarily affects the spine but can also cause pain and inflammation where tendons and ligaments attach to bones, including the heel.
• Sarcoidosis – An inflammatory disease that can affect multiple organs, and can sometimes cause heel pain.
• Diabetes – Peripheral neuropathy is a type of nerve damage complication associated with diabetes, which can cause pain and tingling in the feet and heels.
• Gout – An inflammatory arthritis caused by a buildup of uric acid crystals in a joint, which can affect the heel.
• Neurological issues – Entrapped baxter nerve, radiculopathy due to a pinched nerve, can cause pain in the heel. Additionally, sciatica can also cause discomfort to radiate down the heel.

When to Seek a Specialist for Your Heel Pain?

You should see a podiatrist (treats conditions affecting the foot and ankle) or orthopedic specialist (treats a wide range of bone and joint issues) for severe or persistent heel pain, especially when accompanied by other serious symptoms, as they can diagnose and treat the underlying cause, from overuse to more serious conditions like stress fractures.

• Abnormal appearance of your ankle or foot.
• Hear a popping, grinding, or snapping sound at the time of injury.
• Unable to put weight on your foot, walk normally, bend your foot downwards, or stand on your toes.
• When heel pain worsens and is accompanied by numbness, tingling, and fever, even after following a home care routine like icing and taking some bed rest.
• If your heel pain does not improve after 2-3 weeks and you experience it during resting or at intervals.

Don’t wait for signs to grow severe. Consult our ortho specialists today

Diagnostic Approach for heel pain

The diagnostic steps for heel pain typically begin with a patient’s medical history and a physical exam, which are often sufficient for diagnosis. If the causes are unclear, several diagnostic tests are performed, including screening tests (X-rays, MRI, ultrasound, and electrophysiologic studies) to achieve a more comprehensive view.

• Determining the exact location, timing, and nature of pain
• Documenting your physical activity, type of sports, footwear, and work environment.
• A “calcaneal squeeze test”, where the sides of the heels are compressed to confirm stress fractures, may be performed to pinpoint the areas of tenderness, like in the case of plantar fasciitis.
• Assessment of the flexibility of your ankle or foot indicates limited upward movements as a sign of plantar fasciitis.
• Identification of any biomechanical irregularities (gait analysis) as tilting body, flat foot, or a higher arch.
• Your specialist may look for a Tinel sign or perform other tests to check for numbness, tingling, or burning sensations.

How to Treat Heel Pain Symptoms?

For mild to moderate heel pain, home remedies or adjusting your daily routine can treat many cases, but a doctor may recommend further targeted treatments, such as physical therapy, immobilzation techniques, or surgery if the pain is severe or persistent.

For underlying causes, treatments & management strategies include:

• Modify your activity by swapping high-impact exercises like running with low-impact options, such as swimming or indoor games, to rest your heels.
• Apply ice wrapped in a towel to your heel for 15-20 minutes or a frozen water bottle under your foot to help with plantar fasciitis.
• Wear supportive footwear that provides good arch support and thick, cushioned soles with a firm heel counter.
• Consult with your specialist on how to perform calf and plantar fascia stretching exercises.
• Take over-the-counter pain relievers, and maintain a healthy weight.
• Utilizes custom-fitted shoe inserts, such as heel cups or gel pads, for extra support and cushioning.
• Wear night splints to provide a gentle, continuous stretch to the plantar fascia and prevent severe morning pain.
• The specialist may administer a corticosteroid injection in the affected area.
• To restore the heel’s fat pad cushioning, go with advanced fat pad restoration options such as fat grafting or injectable fillers.
• Extracorporeal shockwave therapy to stimulate healing when other therapies do not respond to chronic plantar fasciitis.

What if Heel Pain is Left Untreated?

Some possible complications of an untreated Heel pain include:

• Chronic inflammation that becomes resistant to other treatments.
• Constant stress on the inflamed tissue may develop small tears or micro-injuries, causing permanent tissue damage.
• Intermittent pain limits your daily activities and mobility.
• Secondary pain that originates in response to the body’s physical adaptation to the heel pain, for instance, knee, hip, back pain or other foot issues.
• Risk of developing other health conditions, such as hypertension, diabetes, or heart disease.
• Untreated pain may lead to a sedentary lifestyle, causing weight gain that adds more stress to your heels, plantar fascia, other joints, and compresses the heel fat pad.
• Addition of heel spurs that cause sharp pain and require complex treatments
• A much longer and painful healing process for any treatment.

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