It is one of the most common conditions that affect the foot.
Severe pain is usually felt when the affected heel is used when walking.
The pain is usually worse when the patient gets out of bed in the morning or after a long period of activity.
After walking, the pain usually subsides, however, it is common for it to be very painful when first taking a step after a period of rest, and the pain is often worse at the end of the day.
Heel pain is often caused by thickening of the plantar fascia. The bone and surrounding tissue in the heel become inflamed and can cause pain.
Due to long walks and daily movement, there is always the risk of injury or trauma to the heel area.
Causes of pain in the heel of the foot
Heel pain can be due to several factors. Abnormalities of the skin, nerves, bones, blood vessels, and soft tissues in the heel can cause pain.
The most common cause of heel pain is caused by thickening of the plantar fascia which accounts for four out of five cases.
Plantar fasciitis is when the “bowstring-like” tissue on the sole of the foot that runs from the heel to the front of the foot, connecting the heel bone to the plantar fascia, is damaged and thickened.
There are thought to be two main ways that damage can occur:
- Sudden damage, such as damaging the heel when jogging, running, or dancing, this usually affects younger and more physically active people.
- Gradual wear on the tissues that make up the plantar fascia; this usually affects adults 40 and older.
Risk factors for wear and tear causing plantar fasciitis
Risk factors for damage from gradual wear and tear include:
- Obese or overweight patients with a body mass index of 30 or more.
- Carrying out a daily job that requires spending long periods of time on your feet.
- Frequently wearing flat-soled shoes, such as sandals or flip-flops.
Less common causes
Some of the less common causes of heel pain are described as:
A stress fracture can occur if the heel bone is damaged during an injury.
Fat pad atrophy is where the layer of fat under the heel bone begins to shed due to excessive stress placed on the pad.
Women who wear high heels over a period of many years have a higher risk of developing fat atrophy.
Bursitis is the inflammation of one or more bursae, which are small fluid-filled sacs under the skin that are usually found in the joints and between the tendons and bones.
Bursitis can develop anywhere on the human body, not just the foot.
Tarsal tunnel syndrome
The nerves in the sole of the foot pass through a small tunnel inside the ankle joint (tarsal tunnel).
If a cyst forms or there is damage or malfunction of the foot, the nerves can become compressed (crushed). Nerve compression can cause pain anywhere on the nerve, even below the heel.
Sever’s disease is a common cause of heel pain in children.
It is the result of the hamstring and calf muscles and tendons stretching and tightening in response to growth spurts.
Stretching the calf muscle pulls on the Achilles tendon, this pushes the bone growth area at the back of the heel (growth plate), causing heel pain.
The pain is further aggravated by activities such as soccer and gymnastics. The pain is usually on one side of the heel, but can also be felt under the heel.
Calf and hamstring stretches and, if needed, heel pads are often effective treatments for Sever’s disease.
Bone spurs are an overgrowth of bone formed in normal bone.
On a lateral X-ray, the bone appears to have formed a spur, but it is actually a protruding part of the bone.
Other causes of heel pain include blisters and corns.
Sometimes diseases that affect other diseases such as fibromyalgia, a chronic condition that causes pain in the muscles, osteomyelitis, a bone infection, peripheral vascular disease, or arthritis, can also cause foot or heel pain.
Risk factors for heel pain
Two main groups of people are affected by heel pain are:
- People who exercise regularly by running.
- Adults aged between 40 to 60 years.
Symptoms of foot heel pain
Heel pain often feels like a sharp, severe pain that occurs when weight is placed on the heel.
Additional symptoms that suggest that the cause of the pain is not inflammation of the tissue within the heel (plantar fasciitis), are:
- Numbness or tingling sensation in the foot: This could be a sign of damage to the nerves in the feet and legs (peripheral neuropathy).
- The affected foot feels hot and you have a high temperature (fever) of 38ºC (100.4ºF) or higher; these could be signs of a bone infection.
- You also have stiffness and swelling in your heel, which could be signs of arthritis.
Your doctor or podiatrist (a healthcare professional who specializes in foot care) should be able to make a sure diagnosis of the cause of your heel pain by:
- Asking the patient about their symptoms and medical history.
- Physically examining the heel and foot.
Usually only additional tests are required which could include:
- X-rays – when radiation is used to find problems with your bones and tissues.
- Blood test.
- A more detailed scan, such as a magnetic resonance imaging (MRI) scan or ultrasound.
Treatment of pain in the heel of the foot
Treatments for heel pain depend on the particular cause.
Treatment for heel pain generally involves trying a combination of techniques, such as pain relievers and exercise, to relieve pain and speed recovery time.
Surgery is generally considered a “last resort treatment” if symptoms do not improve after 12 months. Only 1 in 20 people will need surgery.
Rest the affected foot whenever possible, avoiding standing for long periods of time or walking long distances.
However, it is important to regularly exercise your feet and calves with stretching exercises.
Nonsteroidal anti-inflammatory drugs, such as ibuprofen, are a type of pain reliever that is often effective in helping to relieve pain.
Some people also find that applying an ice pack to the affected heel for 5 to 10 minutes can help relieve pain and inflammation.
Do not apply the ice pack directly to the skin as it could damage it, instead wrap the ice pack in a towel. If you don’t have an ice pack, use a package of frozen vegetables.
Regular exercises designed to stretch the calf muscles and the plantar fascia (band of tissue that runs under the sole of the foot) should help relieve pain and improve flexibility in the affected foot.
In general, it is recommended that you do the exercises with both legs, even if only one of your heels is affected by pain.
This will improve your balance and stability, as well as help relieve heel pain.
Keep a long towel next to your bed.
Before getting out of bed in the morning, wrap the towel around your foot and use the towel to pull your toes toward your body while keeping your knees straight.
Repeat three times for each of your feet.
Place both hands on a wall at shoulder height with one of your feet in front of the other.
The front of the foot should be 12 inches (30 cm) from the wall.
With one knee bent and the other knee straight, lean toward the wall until you feel tension in the calf muscles at the back of your leg, then relax.
This procedure is repeated 10 times, then the leg is changed and the cycle is repeated. Wall stretching is recommended twice a day.
You must stand on the stairs facing upwards using the railing for support. Your feet should be slightly apart and your heels should hang off the back of the ladder.
Lower your heels until you feel tension in your calves, hold this position for about 40 seconds, then lift your heels back to normal. Repeat this procedure six times, at least twice a day.
Sitting in a chair with the feet pointing in opposite directions, lift the affected foot upward while keeping the heel on the ground.
Then you should feel the calf muscles and the Achilles tendon (the band of tissue that connects the heel bone to the calf muscle) contract.
Hold this position for several seconds, and then relax. This procedure is repeated 10 times, performing the exercise five or six times a day.
While sitting, roll the arch of the foot (the curved bottom of the foot between the toes and the heel) on a round object, such as a tennis ball or a drink can.
Move your foot and ankle in all directions on the object and continue the exercise for several minutes and repeat the exercise twice a day.
Depending on your usual choice of footwear, your doctor or podiatrist (a healthcare professional who specializes in foot care) may advise you to change your footwear.
Shoes with flat soles should be avoided, as they will not support the heel and could make pain worse.
Ideally, you should wear shoes that provide good support to the arches of your feet while cushioning your heels, such as lace-up athletic shoes.
Wearing high heels can provide short-term pain relief as they help reduce pressure on the heel.
But this type of footwear may not be suitable in the long term, as it can lead to more episodes of heel pain.
Orthotics are insoles that fit inside your shoe to support your foot and help your heel heal.
If your pain keeps recurring, does not respond to simple treatment measures, or if you have an abnormal foot shape or structure, there are custom orthoses available.
They are made specifically to adapt to the shape of the feet.
However, there is currently no evidence that custom orthoses are more effective than those purchased on the market.
Straps and splints
An alternative to wearing orthotics is to have your heel tied with sports strap tape (zinc oxide). The straps will help relieve pressure on your heel.
Night splints can also be useful in some cases, they look like a kind of boot, they are designed to keep the toes and toes up during sleep.
This will stretch both the Achilles tendon and the plantar fascia while you sleep, which should help speed up your recovery time.
If none of the above treatments help relieve pain symptoms, your doctor may recommend a corticosteroid injection.
Corticosteroids are a type of medicine that has a powerful anti-inflammatory effect.
They should be used in moderation because overuse can cause serious side effects, such as weight gain and high blood pressure (hypertension).
As a result of this, it is generally not recommended to administer more than three corticosteroid injections within a year to any part of the body.
Before receiving a corticosteroid injection, a local anesthetic (pain reliever) may be used to numb the foot so that the injection is not painful.
If all of the above-mentioned treatments and corticosteroid injections do not relieve your heel pain, your GP may recommend:
- Orthopedic Surgeon – A surgeon who specializes in surgery involving the bones, muscles, and joints.
- Podiatrist: Podiatrist specializing in foot surgery.
Surgery is sometimes recommended for professional athletes and other athletes whose heel pain negatively affects their career.
Plantar release surgery is the most commonly used type of surgery for heel pain known as plantar release surgery.
This is when the surgeon cuts the fascia to free it from the heel bone.
This should reduce stress on the plantar fascia, which in turn should reduce inflammation and relieve pain symptoms.
There are two ways the surgery can be done:
- Open surgery: the section of the plantar fascia is released by making a cut in the heel.
- Endoscopic and Minimal Incision Surgery – A smaller incision is made and special instruments are inserted through the incision to access the plantar fascia.
Endoscopic and minimal incision surgery has a faster recovery time, so you will be able to walk normally much faster (almost immediately) compared to two to three weeks for open surgery.
A practical disadvantage of endoscopic surgery is that it requires a specially trained and specialized surgical team, so you may have to wait longer for treatment than if you choose open surgery.
Endoscopic surgery also carries an increased risk of damaging nearby nerves, which could lead to symptoms such as numbness, tingling, or loss of movement in the foot.
The pros and cons of both approaches should be discussed with the surgical team.
As with all surgeries, plantar release carries the risk of causing complications, such as:
- Infection after surgery.
- Nerve damage
- Symptoms get worse after surgery, although this is rare.
Extracorporeal shock wave therapy
A new type of non-invasive treatment is known as extracorporeal shock wave therapy.
Extracorporeal shock wave therapy involves the use of a device to deliver high-energy sound waves into the heel.
These waves can sometimes cause pain, so local anesthesia can be used to numb the heel.
Extracorporeal shock wave therapy has been claimed to work in two ways:
- Sound waves have a “numbing” effect on the nerves that transmit pain signals to the brain.
- Sound waves help stimulate and speed up the healing process.
Some studies have reported that extracorporeal shock wave therapy is superior to both traditional surgery and non-surgical treatments.
While other studies found that extracorporeal shock wave therapy was no better than placebo (sham treatment).
Extracorporeal shock wave therapy may work well for some people but may not work for others.
keep a healthy weight
Being overweight or obese means that your feet, and particularly your heels, are being placed under a level of pressure that they were never designed to withstand.
This increases the risk of damaging your heel and other parts of your feet.
If you are overweight or obese, you should lose weight and maintain a healthy weight by combining regular exercise with a calorie-controlled diet.
Choosing suitable footwear
It is important to always wear footwear that is appropriate for your environment and your daily activities.
Wearing high heels when going out on a date or socializing with friends is unlikely to be harmful.
But wearing high heels during a work week, when the job involves a lot of walking or standing, can hurt your feet.
Ideally, lace-up shoes with low to moderate heels (but not shoes without heels), which support and cushion the arches and heels, should be worn.
Walking barefoot on hard terrain should be avoided, many cases of heel pain occur when a person protects their feet for 50 weeks of the year and suddenly tries to walk barefoot when on vacation.
The feet are not used to the added pressure, resulting in heel pain.
If you regularly run or do other physical activity that puts additional pressure on your feet, it is important to replace athletic shoes regularly.
Most sportswear experts recommend that athletic shoes be replaced once you have traveled more than 500 miles in them.
For an active runner who can run a mile in 10 minutes and jog about 30 minutes a day five days a week, this would be the equivalent of changing his athletic shoes every eight to nine months.
The most active athletes would have to change their shoes more frequently.