Heel Pain Causes

Heel pain can cause excruciating pain for many people and can be the result of a number of conditions. The most common cause of heel pain is Plantar Fasciitis. Other common heel pain causes include Achilles Tendonitis, Retrocalcaneal Bursitis and Tarsal Tunnel Syndrome. Less common causes of heel pain are conditions such as stress fractures, bone spurs and heel pad degeneration. It is important to determine which type of heel pain is occurring before attempting treatment. Here are five common causes of heel pain as following:

Diagnosis of Heel Pain

The heel bone is known as the calcaneus. The location and type of pain will be important in determining the cause of heel pain. A podiatrist or foot specialist will be able to diagnose the cause of calcaneal pain by questioning the patient about the type of pain and examining the foot. Physical exam may include visual inspection of the foot and visual observation of stance and gait along with palpation or feeling for bony prominences while noting tenderness along with manipulation of foot movement to note pain triggers and range of motion. A physician or podiatrist may also order x-rays to check for bone spurs, joint deformity and fractures.

Plantar Fasciitis

The plantar fascia is thick fibrous sheet that covers the bones of the bottom of the foot. It is attached at 3 locations including the bottom middle of the heel bone. Plantar Fasciitis is degeneration or inflammation of the plantar fascia causing pain at the middle, bottom section of the heel. It is more likely to occur in the morning or upon standing after a long period of sitting. Pain will also occur while flexing the toes toward the ankle.

Plantar fascia is quite common and is reported in up to 10% of the population over life. It is more common in those who are obese and who are required to carry heavy objects repetitively. It may also be more common in those who have flat feet with little arches and those who have highly arched feet. A sudden onset of plantar fasciitis pain may indicate and injury which has ruptured the tissue. Plantar fasciitis is most often treated by rest of the feet, over the counter pain medication and with orthotics or specially designed shoe inserts.

Achilles tendonitis

Heel pain caused by Achilles tendonitis is inflammation of the Achilles tendon which connects to the front of the heel bone inside the foot. It will be experienced by pain in the mid section of the heel that mostly occurs while running, jumping or making quick turns. Achilles tendonitis results from overuse of calf muscles, high impact activities such as running and jumping or abnormal stress on foot and ankle.

Though much less common, other tendons of the feet such as the Posterior Tibialis tendons may become inflamed which cause middle and side heel pain. Tendonitis is best treated by rest, limitation of high impact activities, physical therapy and surgery if other treatments fail to relieve the pain.

Retrocalcaneal bursitis

Each joint has a fluid filled sac known as a bursa that helps in cushioning of the joint but is prone to injury and inflammation. Inflammation of the bursa at the back of the heel, known as the Retrocalcaneal bursa may cause redness, pain and swelling at the back of the heel. It will be tender to direct touch. It is often caused by ill fitting foot wear with a stiff rear of the shoe that rubs the Achilles tendon. It can also be worsened by a condition known as Haglund’s disease which causes a bony spur to develop on the top, back portion of heel bone. Rheumatoid arthritis may also make it more likely to develop Retrocalcaneal bursitis. It is best treated by application of cold compresses, rest, physical therapy and getting appropriately fitting shoes.

Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome is similar to Carpal Tunnel Syndrome of the hands but occurs in the feet. It is characterized by pain, a burning sensation and tingling on the bottom of the foot which worsens as day progresses. It is caused by compression of the tibial nerve which runs down the back of the leg splits off into 3 sections which attach to the bottom of the feet. The calcaneal portion of this nerve attaches to the heel.

Tarsal tunnel syndrome may cause pain, tingling, burning or numbness in the heel but also in the arch, and lower leg along the path of the tibial nerve. It is most common in active adults who exercise frequently. Large calf muscles, ankle trauma and scar tissue development from injury are common causes but flat feet, cysts, and diabetes may increase the risk of developing Tarsal Tunnel Syndrome. It can be treated with physical therapy, medication, rest, massage, orthotics and surgery depending upon the severity.

Stress Fractures and Other Conditions

The heel is one of the most common areas for the development of stress fractures. Running and jumping or other high impact activities are frequent causes. Persons who have low bone density or osteopenia of the calcaneus are more likely to develop stress fractures of the heel. It is characterized by diffuse heel pain and tenderness on mid and side. Stress fractures will be treated by application of cold compresses, rest and a cut back of activities,but may need immobilization and crutches.

Bone spurs on the heel and other disorders such as heel pad degeneration may occasionally contribute to heel pain though this not as common as other causes. Bone spurs on the calcaneus bone are often asymptomatic but can sometimes cause pain, particularly if they contribute to bursitis or tendonitis. Bone spurs that are causing heel pain may need to be removed surgically. Heel pad degeneration or breakdown of the fibrous and adipose tissue beneath the heel bone usually occurs in older persons but may be a sports related injury. It is characterized by mid heel pain that does not increase when flexing the feet and will likely be treated with shoe inserts to cushion the heel.

Regardless of the cause, most cases of heel pain can be treated with a conservative approach including rest, physical therapy and orthotics. After rest and application of cold compresses to treat the initial pain, custom made orthotics can often provide immediate relief. Thoughtful, conservative treatment will often result in a complete relief of heel pain.