Heel pain is a common foot complaint people of all ages can experience. It is often associated with plantar fasciitis, which is recognised as the leading causes of heel pain. You may be surprised to know that there are over 200 other conditions that can cause heel pain. Here are just some of the ones we see at Shellharbour Podiatry.
If you have any concerns regarding heel pain please do not hesitate to get in touch. Heel pain can be a frustrating and debilitating condition. Seeking professional help can be the first step towards recovery.
The plantar fascia is a thick fibrous band that runs from the heel attaching to the toes, playing an important role in supporting the arch of the foot. The band can become thickened and inflamed with repeated stress, leading to microtears in the tissue. The pain is often localised to the base of the heel where the plantar fascia attaches, but it can occur anywhere along its structure. Plantar fasciitis is often characterised by ‘first step’ pain when getting out of bed in the morning that eases with activity.
Baxter’s Nerve Entrapment
This refers to entrapment or compression of the inferior calcaneal nerve located under the arch of the foot. Baxter’s nerve entrapment accounts for 20% of cases for heel pain, and can present very similarly to plantar fasciitis. However, unlike plantar fasciitis, people with this condition may have heel pain that progressively worsens with activity and throughout the day. This may also be accompanied by numbness along the inside of the heel.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is a type of entrapment neuropathy of the posterior tibial nerve as it passes through the tarsal tunnel behind the inside ankle bone (medial malleolus) and branches off to the base of the foot. The tarsal tunnel is packed with many other structures including the flexor tendons, posterior tibial tendon, artery and vein, which is all held in place by a seatbelt-like fibrous band. Inflammation and swelling of the structures in the tarsal tunnel can cause compression of the posterior tibial nerve. Consequently this can cause sharp, shooting, burning pain under the heel. The affected nerve supplies sensation to the entire sole of the foot so symptoms can radiate down the arch to the toes.
Achilles tendinopathy is a broad term referring to overuse injuries to the Achilles tendon. The Achilles tendon is a long tendon that connects to the calf muscle and inserts onto the back of the heel bone. Repetitive stress and strain to the Achilles can lead to increased pain, stiffness and weakness in the back of the heel. Overtime it can lead to degenerative changes in the tendon fibres, resulting in microtears. Achilles tendinopathy can occur at the back of the heel, or higher up in the tendon towards the calf.
Pain at the back of the heel can often be caused by an inflamed bursa. The retrocalcaneal bursa is a fibrous sac full of fluid which sits between the Achilles tendon and the heel bone (calcaneus). It acts as a cushion to minimise friction but can become irritated with repeated compression, especially with overuse of the Achilles tendon. Retrocalcaneal bursitis can often be the result of Achilles tendon injuries and/or shoes that are too tight around the heel.
Haglund’s Deformity refers to a bony enlargement that presents on the back of the heel, where the Achilles tendon inserts. It forms usually as a result of excessive traction of the Achilles tendon during adolescence. The bony lump itself is not usually symptomatic, however, the soft tissue surrounding the area can be painful with irritation from shoes.
Calcaneal Stress Fracture
This refers to a small fracture in the heel bone caused by overuse. Excessive and repetitive activity can cause small amounts of trauma to the bone, and without adequate healing time it can result in microscopic damage, eventually progressing to a stress fracture. Stress fractures can occur either with excessive loading on healthy bone, or normal loading in weakened bone. Tenderness over the fracture site and pain intensifying with activity may be experienced. The calcaneus is the second most common location for stress fractures to occur in the foot.
Heel Pad Atrophy
Heel pad atrophy is a degenerative condition where the fat pad under the sole of the foot gradually thins out or displaces. The fat pad on the plantar surface of the heel serves to cushion the underlying structures from the impact of heel strike during gait. The change primarily occurs as part of the natural aging process but can result in pain and hypersensitivity. A healthy fat pad measures 1-2cm in thickness, and anything below 1cm can produce symptoms. People often report a bruise-like sensation with weight bearing, or feel they are almost walking on bone. Diabetics are often affected by this condition and may be associated with the formation of ulcers on the plantar heel.
Sever’s disease, otherwise known as calcaneal apophysitis, is an inflammation of the growth plate of the heel, affecting children aged 7-14. During growth spurts in active children, the heel bone tends to grow more quickly than the calf muscles. As a result, there is increased traction of the Achilles tendon against the growth plate of the heel, which is particularly vulnerable to injury as it has not fully matured. This condition will eventually resolve once the growth plate ossifies (develops into mature bone) but pain and symptoms can be debilitating and it is important to seek treatment. Read more about Sever’s disease
Plantar fasciitis and heel pain can be the same thing. It is really important that if you do have heel pain, especially if it has been there for a few days and not improving, then you need to see your podiatrist for an assessment. The earlier we can intervene, often the easier it is to resolve.
Standing all day, in a single position is somewhat unnatural. If possible try and do small walks on regular intervals to get the feet moving and blood circulating..
Once again good footwear is the key. Ensure that footwear is supportive and comfortable. Supportive innersoles assist with prolonged periods of pressure on the foot. Rest, ice and massage are all great ways to minimise pain. In addition, aids such as standing matts or soft surfaces reduce pressure from hard floors.
Altered gait patterns such as limping, misalignment of the knee and favouring of one leg, can result in heel pain as compensatory muscles and ligaments are overworked and pressure distributions on the foot are compromised. The hip connects to the thigh and knee, and knee to the leg and foot. All these parts work together as one and if one is injured, it affects the other parts.
Increased stress of the foot is the most common cause of heel pain. This can be from a dramatic increase in activity (walking, running) to moving house (lifting boxes etc) to starting a new job that requires you to be on your feet more often.
It is essential that your foot is working to its maximum potential to allow these stresses to be handled more easily. Things like changes to shoe wear and orthotics are very effective ways to optimise your foot function. We have been doing this for years and can help you get back in control of your foot pain.