What causes heel pain?

When walking, your heels repeatedly hit the ground with considerable force. They have to be able to absorb the impact and provide a firm support for the weight of the body.

When pain develops in the heel, it can be very disabling, making every step a problem, affecting your posture.

There are various types of heel pain. The most common are: plantar fasciiopaathy, heel bursitis and Haglund’s deformity and Sever’s disease in children.

Plantar fasciopathy

Plantar fasciopathy means a disease process causing structural changes of your plantar fascia. Your plantar fascia is a strong band of tissue (a bit like a ligament) that stretches from your heel to your middle foot bones. It supports the arch of your foot and also acts as a shock-absorber in your foot.

Symptoms: 

You will feel pain in the heel (normally in one spot under the heel) usually in the morning mostly.

Treatments:

 Rest. The plantar fascia needs time to heal.
Ice therapy will help to reduce the inflammation of the plantar fasica.

Heel cushioning and heel raises to prevent too much trauma through the plantar fascia. Pain relief such as ibuprofen tablets or gel. Make sure you get advice from a pharmacist before administering painkillers.

Gentle stretches and exercises of the foot and calves can be prescribed by a registered podiatrist that will tailored to your ability and needs.

Outcome:

So long as the cause is identified and treated, then there is no reason why the pain should not be eradicated totally.

Heel bursitis and Haglund’s deformity

A bursa is a fluid filled sac that lies between your achilles tendon and heel bone. It acts to reduce friction between the tendon and the bone.

Heel bursitis is common in runners and is caused by overuse and excessive pressure put through the heel. Bursitis may also be caused by a bony lump that has grown out from the back of the heel (known as a Haglund’s deformity). This bony lump can irritate the bursa and cause inflammation.

Symptoms:

Often, you will feel pain at the back of the heel where the achilles tendon meets the heel and you will see redness and swelling.

Treatments: 

Rest is required to allow the inflammation to subside.

Painkillers and anti-inflammatory drugs. Seek advice from a pharmacist before taking these.

Ice therapy will help to reduce the inflammation of the heel and bursa.

Cushioning and orthotics may be required to alter the running and walking style to reduce pressure through a specific area.

Outcome:

A bursitis should resolve itself after some rest. If the underlying cause is identified and treated, then there is no reason why the condition should not totally resolve.

Sever’s disease: 

This is known as a ‘Calcaneal apophysitis’. It is not a true disease.

In active children (around 10-11 yrs old) the calf muscles contract and work too much which can slightly pull the calf muscle tendon away from the growth plate of the heel bone.

Symptoms:

A pain at the back of the heel where the bone meets the tendon is classic. Children will find walking painful and will opt out of sports.

 Treatment: 

Understanding the cause is key here. Overuse is most common although poor structural mechanics of the foot, obesity and tight muscles can all play a role. Your podiatrist can offer immobilisation techniques if needed, simple orthoses, foot wear advice, stretches and exercises and advice regarding their sporting activities to get them back to participating safely again.

Outcome: 

Prognosis is generally very good. Your podiatrist will be able to identify how best to offer a safe return to activity to minimise recurrence.