RS Podiatry Clinic

Heel Pain

AKA/alternative diagnosis: Plantar Heel Pain, Plantar Fasciopathy, Plantar Fasciitis, ‘policeman’s heel’, Heel Spur, Heel Bursitis, Severs Disease, Stress Fracture, Fat Pad atrophy and more.

Symptoms: A dull ache or throbbing pain, sometimes a sharp pain on the bottom of or side of the heel, but can be on the inside of the arch. Typically, this is felt upon initial weight-bearing or after long periods on your feet

Contributing Factors: Often thought of as being simply due to over-pronating, however, over pronation is just one factor. Poor walking &/or running biomechanics, neural involvement, running technique, training error, muscle weakness, flat feet, BMI and lifestyle choice, footwear choices, pregnancy, weak foot muscles, and more.

Treatment Considerations: Analysing your gait and correcting biomechanics, Shockwave Therapy, orthotics, assessing/adjusting your training programme, specific isometric/isotonic exercises addressing factors such as strength, flexibility or co-ordination, assessing footwear, gait re-training, kinesiology taping, weight-loss, sticking to your treatment plan, consistent following of treatment advice and more.


Understanding Heel Pain: Causes and Symptoms

Heel pain is a common complaint that can greatly affect a person’s mobility and overall quality of life. It can be caused by a variety of factors, ranging from mechanical issues to inflammatory conditions. Some of the possible causes of heel pain include:

  1. Achilles Tendonitis: Achilles tendonitis is the inflammation of the Achilles tendon, which connects the calf muscles to the heel bone. It is often caused by overuse or repetitive strain, leading to pain and stiffness in the back of the heel.

  2. Ankylosing Spondylitis: Ankylosing spondylitis is a chronic inflammatory condition that primarily affects the spine. However, it can also cause heel pain due to the enthesitis, inflammation where ligaments and tendons attach to the bone.

  3. Bone Tumor: While relatively rare, a bone tumor can develop in the heel bone or nearby bones, leading to localised pain. It is important to rule out this possibility, especially if the pain is severe and persists over time.

  4. Bursitis: Bursitis occurs when the small fluid-filled sacs (bursae) that cushion the joints become inflamed. Retrocalcaneal bursitis, specifically, affects the bursa located at the back of the heel, leading to pain and swelling.

  5. Haglund’s Deformity: Haglund’s deformity, also known as “pump bump,” is a bony enlargement at the back of the heel. It can cause pain and irritation as it rubs against shoes, particularly high heels or stiff-backed footwear.

  6. Heel Spur: A heel spur is a bony growth that forms on the underside of the heel bone. Although heel spurs themselves may not be painful, they can contribute to the development of other conditions, such as plantar fasciitis.

  7. Osteomyelitis: Osteomyelitis is a bone infection that can occur in any bone, including the heel bone. It often presents with localized pain, tenderness, and swelling.

  8. Paget’s Disease of Bone: Paget’s disease is a chronic disorder that disrupts the normal bone remodeling process, leading to weakened and enlarged bones. Heel pain may occur when Paget’s disease affects the heel bone.

  9. Peripheral Neuropathy: Peripheral neuropathy refers to nerve damage that affects the peripheral nerves, often causing pain, numbness, and tingling sensations. If the peripheral nerves supplying the heel are affected, it can result in heel pain.

  10. Plantar Fasciitis: Plantar fasciitis is one of the most common causes of heel pain. It is characterised by potential inflammation of the plantar fascia, although more recently this thought process on inflammation has shifted. Plantar fasciitis typically causes pain in the bottom of the heel especially pain with the first few steps when getting out of bed in the morning.

  11. Plantar Warts: Plantar warts are caused by a viral infection and can develop on the soles of the feet, including the heel. These warts can be painful, especially when walking or standing.

  12. Psoriatic Arthritis: Psoriatic arthritis is a chronic inflammatory condition that affects joints and is often associated with psoriasis. Heel pain may occur due to the involvement of the joints in the foot, such as the ankle or subtalar joints.

  13. Reactive Arthritis: Reactive arthritis is a form of inflammatory arthritis that can develop after an infection, often in the gastrointestinal or genitourinary tract. It can cause heel pain along with joint inflammation.

  14. Retrocalcaneal Bursitis: Retrocalcaneal bursitis, similar to regular bursitis, affects the bursa at the back of the heel. It is often caused by repetitive activities or excessive pressure on the area.

  15. Rheumatoid Arthritis: Rheumatoid arthritis is a chronic autoimmune disease that primarily affects the joints. When the joints in the foot, including those in the heel, are involved, it can lead to pain and stiffness.

  16. Sarcoidosis: Sarcoidosis is a multisystem inflammatory disorder that can affect various organs, including the bones. Heel pain may be present if the disease involves the heel bone or surrounding tissues.

  17. Stress Fractures: Stress fractures are tiny cracks that can occur in bones due to repetitive stress or overuse. They can cause localized pain in the heel or other weight-bearing bones.

  18. Tarsal Tunnel Syndrome: Tarsal tunnel syndrome is a compression of the tibial nerve in the tarsal tunnel, located on the inside of the ankle. It can lead to heel pain along with tingling, burning, or numbness in the foot.

Accurate identification of the underlying cause is vital for effective pain management and relief, enabling the restoration of mobility and improvement of overall quality of life.