We put a great deal of stress on our feet every day because they carry the weight of the entire body. As a result, heel pain is one of the most common problems in the feet. If you spend lots of time running on hard surfaces or if you wear shoes with poor support, you may irritate the tissues in your heel and develop pain. There are many different conditions that can cause heel pain, but it's usually categorized as either pain under the heel or pain behind the heel.
What causes heel pain?
There are 26 bones in each foot, and the heel bone (calcaneus) is the largest. The heel is designed to provide support for the weight of the body and absorb its impact as the foot makes contact with the ground when we stand, walk and run. The stress placed on each foot is greater while walking and can be as much as three times our body weight when we run. Too much of this increased force on the feet can lead to damage and cause heel pain.
In most cases, heel pain is not caused by a single injury. Instead, it develops over time from putting too much stress on the feet on a regular basis. This is why heel pain is so common in runners and athletes of sports that involve lots of running. But heel pain can result from many different conditions, and in some cases running may not be responsible.
The most common cause of heel pain is plantar fasciitis, which is the inflammation of the tendon that connects the heel to the ball of the foot (plantar fascia). Plantar fasciitis leads to pain under the heel, and is seen most in runners and people who were shoes that don't fit properly. Achilles tendonitis, which results in pain behind the heel, and heel spurs, which is sometimes mistaken for plantar fasciitis, are also common causes of heel pain. Other conditions that lead to heel pain include: Achilles bursitis, Achilles tendon rupture, ankle stress fractures, gout, tarsal tunnel syndrome and stone bruises. Wearing high heels, pumps, sandals or shoes that don't fit properly-especially while running or exercising-as well as obesity and standing for prolonged periods can all increase the risk for heel pain, too.
What are the symptoms?
As the name implies, the main symptom is heel pain, but the type and location of the pain will vary depending on the condition. Heel pain typically comes on in a gradual manner, and most people will experience pain and tenderness under the foot, towards the front of the heel. In other cases-like Achilles tendinitis-these symptoms are felt behind and/or above the heel. Depending on the condition, symptoms may get worse after getting out of bed in the morning, running for a long time, or when frequently wearing improper footwear like sandals or high heels. In most cases, symptoms will get better throughout the day unless the heel is put through more stress.
What is the treatment?
As with many other types of pain, heel pain may occur every so often, especially if you're a runner. But if you've been regularly experiencing pain when you're not walking or standing, or if the pain lasts for more than a few weeks, you should see a podiatrist or physical therapist. He or she will carry out a physical examination, take down your medical history and ask you some questions about the pain and your habits regarding exercise and shoe choice. In some cases, a blood test or imaging scan like an MRI or x-ray may be needed to confirm the diagnosis.
Unless it is severe, heel pain will usually improve after following some conservative (non-surgical) treatments. The amount of time needed to get better will vary greatly depending on the condition that's causing the pain, and may take a few months or more for a complete recovery. This is why it's so important to determine the cause of the heel pain before deciding on treatment. Recommendations are different based on what is causing the pain, but these treatments are generally helpful:
- Rest: avoid activities that put stress on the heels like running, walking on hard surfaces or standing for long periods of time
- Ice: apply an ice pack or cold compress to the heel for 15-20 minutes, 3-4 times a day
- Shoe replacement: not wearing the right shoes-especially during physical activities-can be harmful to your heels; do an inventory and replace any old or worn-out shoes with newer ones that offer enough support; it also helps to wear the right type of shoes for each particular type of activity
A course of physical therapy may also be needed to accelerate the healing process. Treatment will differ based on the condition causing the pain, but most programs will include:
Muscular weaknesses and imbalances can lead to excessive strain on the heel; heel raises and other exercises with resistance bands will help you to regain strength in this area.
Range of motion exercises
Many people also have issues moving their foot or ankle properly, which can be making the problem worse; to address these issues, your therapist may recommend different exercises-such as using a frozen water bottle or tennis ball-to increase the flexibility of the muscles in your foot.
Your therapist will perform some hands-on treatments to move your muscles and joints in order to increase their strength and flexibility.
If you are an athlete, your therapist will work on specific exercises for your sport and show you how to avoid putting too much strain on your heels when you return.
Night splint or brace
Your therapist may also recommend a splint to be worn at night or a brace during physical activities to manage symptoms; the ProCare Plantar Fasciitis Night Splint and AirCast AirHeel Arch & Heel Support are effective options to accomplish this.
If these treatments aren't effective and symptoms continue to be bothersome, a corticosteroid injection may be recommended. This anti-inflammatory medication is injected directly into your heel and will temporarily relieve pain for a few months.
If none of these treatments work and you still have pain after more than six months, it may be time to consider surgery. Surgery is usually more strongly recommended for professional athletes and very active individuals who want to return to their sport as quickly as possible. Plantar release surgery is the most commonly used procedure for heel pain, and either an orthopedic or podiatric surgeon typically performs it.
Can heel pain be prevented?
Making some basic changes in your lifestyle and habits may reduce your risk of experiencing heel pain. Here are some ways you can keep your chances to a minimal:
- Keep your feet and lower legs flexible, and be sure to stretch them well before engaging in any physical activity
- If you're overweight, try losing some weight, which will mean less pressure on the heels and less chance of developing heel pain
- Only increase the intensity and frequency of your training regimen gradually
- Be aware of the surfaces you exercise on and try to limit your time on hard surfaces
- Make sure you're using appropriate footwear choices for all types of physical activity; each pair of shoes should fit properly and support the foot without putting too much strain on the heel
- Get enough rest, especially on days that you exercise