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Heel pain is one of the most common foot problems we see and with no surprise – every time we stand, our feet bear all of our body weight, moving it from foot to foot as we walk. This can place enormous pressure on the bones, tendons and ligaments supporting the feet.
When there is excess pressure on our body past the point that it can safely handle, damage occurs. As a result, there are a range of injuries that can affect the heels. These include:
Plantar fasciitis is one of the most common causes of heel pain that we see and treat. This term describes the inflammation of a tissue called the plantar fascia that starts at the bottom of the heel bone and fans out across the arch to attach to the toes.
Often patients experience pain at the bottom of the heel, which may radiate to the inside of the heel and occasionally into the arch. This pain is felt most prominently first thing in the morning when taking those first few steps out of bed. After some walking around, the pain can ease, but may worsen towards the end of the day if you have been on your feet for a long time, or if you stand again after a period of rest.
Overusing or excessively loading the plantar fascia tissue past the point that it can naturally safely handle can result in micro tears through the tissue. If the overuse continues without the right care, a partial tear may also develop through the fascia.
Examples of what may overload the fascia include sudden changes in the intensity or type of physical activity that sees the demand on your fascia rapidly increase without proper training, poor foot mechanics (like from flat feet), unsupportive or poor footwear, prolonged standing, walking or running on hard surfaces, and increases in weight.
When you have ongoing plantar fasciitis, the insertion of the plantar fascia tissue at the bottom of the foot may develop a bony growth called a heel spur. Heel spurs look sharp and painful on x-rays and many people link them to their heel pain, however, research shows that only approximately 3% of heel spurs are in an anatomical position to cause irritation to the plantar fascia. Moreover, many of those with heel pain on one foot have been shown in research to have heel spurs on both feet, and in some cases, those with heel pain in one foot have been shown to have a heel spur on the opposite foot.
Your Achilles tendon is the strong, cord-like tendon at the back of your heel. When there is damage to the tendon at its attachment point at the heel, the tenderness can sometimes radiate around the heel and cause pain and tenderness on walking.
If you have damaged your Achilles tendon, you will likely notice pain when pinching the Achilles tendon at the back of your heel. Movements like walking up and down the stairs may also produce painful symptoms, as will standing on your toes on the affected foot.
Achilles pain may develop from sudden overuse, or from degradation over time. When the tendon is under large amounts of force or strain, it can become overloaded, causing the tendon fibres to become damaged and sustain micro-tears. At its worst, partial tears or even complete ruptures may result. Activities that can overload the tendon include:
You have a fat pad beneath the bottom of your heel that serves to protect the heel, providing cushioning to minimise the effects of the pressure and friction on the foot that arises from daily life. It also works as an anchor to help shift the body weight through the foot without overloading and damaging the connective tissues in the foot.
Fat pad degeneration, or atrophy, refers to the gradual loss of the fat pad at the bottom of your heel. As it thins, it exposes the sensitive connective tissues in your feet to strain and pressure. As a result, inflammation and micro-tears occur, and bring with them pain and discomfort. You may notice:
Fat pad atrophy may occur as a result of:
Despite being referred to as a ‘disease’, Sever’s is a temporary growth-related condition affecting the growth plate in the heel in growing kids, often between ages 8-14 years. It is commonly referred to as growing pains in the heels.
These growing pains tend to come on during or after exercise, particularly in sports that involve running. This is why growing pains are said to commonly affect active kids, though they can affect anyone. Children will typically complain of pain at the back of the heels, which may radiate up into the calves. The pain tends to ease with rest, and can return during exercise.
Children’s bones contain areas called growth plates, through which the body adds new bone so that the bones grow. These growth plates are made of cartilage and are weaker than the surrounding bone, making them more vulnerable to damage when the heel bone is stressed or strained from daily activities like running. This is exactly what happens with growing pains in the heels, with strain from an often tight Achilles tendon pulling on the back of the heel, and irritating or damaging the growth plate.
A stress fracture is a slow fracture that develops gradually over time, as opposed to an instant fracture (bone break) that occurs upon impact.
As stress fractures develop and worsen gradually over time, many people cannot attribute their pain to a specific event – all they know is that their pain one day just starts. You may start with a mild, dull ache in the heel that worsens to a severe pain.
Stress fractures develop when a bone is repetitively overloaded, meaning that the force applied to the bone from regular activity like exercise or walking exceeds the limit that the bone can safely handle, so tiny, hairline cracks form, and then grow if the cause of the stress is not addressed.
Another common cause of heel pain that we see and treat actually starts with the skin overlying the heels. Specifically, skin that develops painful cracks, calluses, corns or warts. This can make it feel like you’re walking with a pebble beneath your heel, and this can irritate the heels generally leading to heel pain. In most cases, this is a simple fix in one appointment with our podiatrists.
Treating heel pain starts with getting the right diagnosis, which is done during a comprehensive assessment with our podiatrists. Based on the results of your assessment, your diagnosis, and the likely causes of your heel pain, we’ll then create a custom treatment plan that may involve:
A combination of these treatments will likely be used to formulate the treatment plan that our podiatrist deem will give you an optimal, speedy recovery.
