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Heel Pain

The heel is a highly specialized part of the body designed to absorb the shock of walking and running. Most heel pain tends to be caused by mechanical injury, i.e. small but repetitive injuries that occur at a rate faster than the body can heal them. Sometimes it may be caused by injuries to the lower back or diseases such as inflammatory joint conditions.

If I experience heel pain what should I do?
If you experience heel pain, you could follow the simple self-care measures shown at the bottom.  However, if the pain persists longer than 3 weeks and it is affecting you, it may be appropriate to seek professional advice. This is necessary, as there are many types of heel pain, each with different causes and sometimes requiring quite different forms of treatment. To ensure that you receive the right treatment, you need to see someone who specializes in heel pain. Podiatrists or Chiropodists, as part of their training, specialise in heel pain, its cause and treatment. They will also be able to determine if the pain is being caused by problems elsewhere in the body, for example back pain.

What could cause heel pain?
The following are some of the more common types of heel pain. This list however, is not exhaustive but may help you appreciate the complexity of heel pain and why specialist advice can be helpful.

Plantar Fasciitis
Probably the most common cause of pain in the heel results from damage to the tissue band (fascia) connecting the heel bone to the base of the toes. It tends to be painful when you take your first steps after resting and especially when getting out of bed in the morning. Most often associated with middle age, however, it can occur in all ages.

Tarsal Tunnel Syndrome
This sometimes feels like a burning sensation and at other times a tingling sensation underneath the heel and in the arch of the foot. Occasionally there can be loss of sensation on the bottom of the foot. It is caused by compression of the tibial nerve as it passes the inside of the ankle and tapping of the nerve will stimulate the symptoms known as Tinel’s sign.

Calcaneal Bursitis
An inflammation of a bursa (a fluid filled fibrous sac) under the heel bone. Typically the pain is more to the centre of the heel than that which is experienced with plantar fasciitis and significantly it worsens during the day.

Chronic Inflammation of the Heel Pad
Caused by a heavy heel strike or sometimes a reduction in the thickness of the heel pad, this can give rise to a dull ache in the heel when standing and walking that increases during the day.

Stress Fracture
Can occur following injury, for example falling from a height. If this is suspected an X-ray would be required to confirm diagnosis and determine the extent of the injury and therefore treatment protocol

Severs Disease
This condition affects young children, normally between the ages of 8 and 12. It occurs when part of the heel bone suffers a temporary loss of blood supply, and as a result the bone dies only to reform when the blood supply is later restored.
It is a condition known as osteochondrosis that can occur in growing bones, and one that fortunately is self-limiting, but can be painful at the time.

Achilles Tendonosis
This can occur where the Achilles tendon is placed under more tension than it is able to cope with and so as a result small tears develop. These then become a source of further injury and gradually a swelling may develop within the tendon - this is called Achilles tendonosis (sometimes inappropriately referred to as tendonitis).

Simple self-care measures that can sometimes help with heel pain

  • If the pain is associated with a particular shoe, avoid wearing those shoes for a while
  • Avoid walking on hard ground
  • Rest if possible, or maybe do not walk so fast
  • Wear a slightly raised heel, only 6-10mm higher than normally worn
  • Use a heel cushion to reduce the pressures on your heel when walking.