Heel Pain

What is Heel Pain?

The most frequent causes of heel pain are not single injuries, such as a fall or twist, but repetitive or excessive heel pounding. Tenderness and swelling may be present. Plantar fasciitis, which is an inflammation of the ligament that is attached to the front of the heel bone and runs forward along the bottom of the foot, can be caused by:

Feet that flatten and roll inward when walking or running

Shoes with poor arch support

Stiff-soled shoes

Quick turns that put stress on the ligaments

Too much distance running

Heel bursitis (inflammation of the back of the heel) can be caused by landing hard or awkwardly on the heel, or by pressure from shoes.

Achilles tendonitis, which occurs when the calf muscles repeatedly contract suddenly or with much force, can be caused by:

Shortening of and lack of flexibility in the calf muscle

Shoes with inadequate stability or shock absorption

Sudden inward or outward turning of the heel when hitting the ground

Running on hard surfaces, such as concrete

Home Care

For plantar fasciitis, when the pain is usually on the bottom of the foot about 1 to 2 inches from the back edge of the heel:

Rest as much as possible for at least a week.

Use over-the-counter analgesics for pain relief, if needed.

Wear proper-fitting shoes.

Avoid shoes with excessively low heels.

A heel cup, felt pads in the heel area, or an orthotic device may help.

The most important thing to do is refrain from the activity that caused the problem and allow the injury to heal. Be patient; this problem can take a year or more to go away.

For bursitis, when the pain and swelling is just above the back of the heel or on the bottom of the heel near the back edge):

Rest as much as possible for at least a week.

Use over-the-counter analgesics for pain relief, if needed.

Wear new shoes or stretch your old shoes to avoid rubbing against the heel.

Pressure from the bump may be relieved by applying moleskin to the affected area.

For Achilles tendonitis, when the pain and tenderness is in the Achilles tendon, usually about 2 to 3 inches above the bottom edge of the heel:

Avoid exercise and apply ice twice a day to the tendon.

Use over-the-counter analgesics for pain relief and to reduce inflammation.

Following a week or more of rest, proper stretching is the most important treatment.

Treatment

The physical examination will include a detailed examination of the foot and leg.

Diagnostic tests that may be performed include a foot X-ray (extremity X-ray), focusing on the heel.

If either plantar fasciitis or bursitis is diagnosed and if shoe changes and the use of orthotics have not been successful, cortisone injections may be tried. Surgery is a last resort and is seldom necessary.

If Achilles tendonitis is diagnosed, an oral anti-inflammatory medicine may be prescribed. Heel lifts may be used. In particularly unresponsive cases, a walking cast may be helpful. Surgery is not usually necessary.