HEEL PAIN

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What is heel pain?
The heel is a specialised part of the body designed to absorb the impact of your body weight when walking, running or undertaking any other form of physical exertion or weight-bearing exercise. When pain does develop, it can be very disabling, making every step a problem, which in turn affects your overall posture.

What causes the problem?
Heel pain is a common occurrence and in most cases the pain is caused by some form of mechanical injury due to small repetitive injuries that occur at a rate faster than the body can heal them. 
Heel pain can also be caused by lower back problems or inflammatory joint conditions.
The following types of heel pain are not exhaustive but may help you appreciate the complexity of heel pain and why specialist advice can be helpful.

Plantar fasciitis (or fasciopathy):
This is the most common, caused by damage to the fascia ‘band’ (similar to a ligament) which connects the heel bone to the base of the toes. This condition can be caused in various ways including extensive running, walking or standing for long periods of time, especially when you have a sedentary lifestyle. In particular, a change of surface (e.g. road to track), poor shoe support, being overweight, overuse or sudden stretching of your sole, as well as a tight Achilles tendon, can lead to this condition.

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Heel bursitis (subcalcaneal bursitis):
This is an inflammation of a bursa (a fluid-filled fibrous sac) under the heel bone where the pain is typically more in the centre of the heel than that experienced with plantar fasciitis and significantly worsens during the day. This condition can be caused following a fall from a height on to the heel.

Heel bumps:
These are firm bumps on the back of the heel, usually caused by excessive shoe rubbing in the heel area, or the thickening of the tissues associated with a tight Achilles tendon.

Tarsal tunnel syndrome:
This can feel like a burning or tingling sensation under the heel within the arch of the foot with occasional loss of sensation on the bottom of the foot. This is caused by compression of the tibial nerve as it passes the inside of the ankle. 

Chronic inflammation of the heel pad:
This is caused by a heavy heel strike or sometimes a reduction in the thickness of the heel pad which can give rise to a dull ache in the heel which increases during the day.

Sever's disease (calcaneal apophysitis):
This painful condition affects young children, usually between the ages of 8 and 12, especially those who are physically active or undergoing a growth spurt. It results from inflammation of the Achilles tendon where it attaches to the heel.

Fracture:
Often caused following injuries such as falling from a height or landing on an uneven surface.

Who gets it?
Heel pain can affect everyone, whatever your age, but those more commonly affected include those in middle age (over 40s age group), those who are overweight or stand for long periods of time, as well as athletes.

How do I know I have it?
With plantar fasciitis, there are often no visible features on the heel but deep localised painful spots are found in or around the middle of the sole of the heel, and pain is usually worse on standing after long periods of rest, particularly first thing in the morning.
With bursitis, pain can be felt at the back of the heel when the ankle joint is moved and there may be a swelling on both sides of the Achilles tendon. Or you may feel pain deep inside the heel when it makes contact with the ground.

Is it serious?
Heel pain is a common condition and in most cases will diminish following some routine self-care measures. If the pain persists longer than three weeks, it is best to seek professional advice from a podiatrist, as there are many types of heel pain, each with their own different causes and separate forms of treatment. 

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What are the treatments?
If you experience heel pain, some simple self-care measures include:

 Avoid wearing ill-fitting or uncomfortable shoes 

Wear shoes with good heel cushioning and effective arch support 

Minimise walking or exercising on hard ground 

Rest regularly and try not to walk or run too fast 

Wear a raised heel (no more than 6-10 mm higher than normal) 

Lose weight if you are overweight 

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It may take between 6 and 18 months for pain to completely resolve.

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A treatment plan is much more effective than any single treatment on its own.

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If the pain is severe, non-steroidal anti-inflammatory drugs such as Ibuprofen can be taken.

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Your Podiatrist may prescribe strengthening and stretching exercises.

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If the heel pain is caused by a biomechanical abnormality, orthotics can be made by your Podiatrist to correct the underlying problem. 

If these do not resolve the pain, more specialist treatments may be needed.