Common causes include:
- Plantar fasciitis, or inflammation of the plantar fascia: The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot.
- This type of pain often happens because of the way the foot is made, for example, if the arches are especially high or low.
- When the plantar fascia is stretched too far, its soft tissue fibers become inflamed. This usually happens where it attaches to the heel bone, but sometimes it affects the middle of the foot. Pain is felt under the foot, especially after long periods of rest. Calf-muscle cramps may occur if the Achilles tendon tightens too.
- Heel bursitis: Inflammation can occur at the back of the heel, in the bursa, a fibrous sac full of fluid. It can result from landing awkwardly or hard on the heels or from pressure from footwear. Pain may be felt deep inside the heel or at the back of the heel. Sometimes, the Achilles tendon may swell. As the day progresses, the pain usually gets worse.
- Heel bumps: Also known as pump bumps, these are common in teenagers. The heel bone is not yet fully mature, and it rubs excessively, resulting in the formation of too much bone. It is often caused by having a flat foot. It can be caused by starting to wear high heels before the bone is fully mature.
- Tarsal tunnel syndrome: A large nerve in the back of the foot becomes pinched or entrapped (compressed). This is a type of compression neuropathy that can occur either in the ankle or foot.
- Chronic inflammation of the heel pad: This is caused either by the heel pad becoming too thin, or through heavy footsteps.
- Stress fracture: This is linked to repetitive stress, strenuous exercise, sports, or heavy manual work. Runners are particularly prone to stress fracture in the metatarsal bones of the foot. It can also be caused by osteoporosis.
- Severs disease: This is the most common cause of heel pain in child and teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the heel bone. It most commonly affects children aged 7 to 15 years.
- Achilles tendinosis: This is also known as degenerative tendinopathy, tendonitis, tendinosis, and tendinopathy. It is a chronic condition associated with the progressive degeneration of the Achilles tendon.
- Sometimes the Achilles tendon does not function properly because of multiple, minor microscopic tears of the tendon, which cannot heal and repair themselves correctly. As the Achilles tendon receives more tension than it can cope with, microscopic tears develop. Eventually, the tendon thickens, weakens, and becomes painful.
Treatment options include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce pain and swelling.
- Corticosteroid injections may work if NSAIDs are not effective, but these should be used with caution, because long-term use can have adverse effects.
- Physical therapy can teach exercises that stretch the plantar fascia and Achilles tendon and strengthen the lower leg muscles, resulting in better stabilization of the ankle and heel.
- Athletic taping gives the bottom of the foot better support.
- Orthotics, or assistive devices, and insoles can help correct foot faults and cushion and support the arch during the healing process.
Surgery
If nothing else works, a surgeon may detach the plantar fascia from the heel bone. There is a risk that this may weaken the arch of the foot.
Night splints
A night splint may be fitted to the calf and foot and kept on during sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and stretches them.
These are available to buy online, but it is best to consult a medical professional before using them.
Treatment for heel bursitis
If it is possible to distinguish heel bursitis as a separate condition from plantar fasciitis, an effective treatment may be to use a cushioning insole or heel cup to limit the movements that are causing the problem.
Rest is also recommended, and a steroid injection may be needed.
Treatment for heel bumps
Inflammation behind the heel may be relieved with ice, compression and a change of footwear.
Achilles pads, tortoise and heel grip pads may offer temporary relief.
Cortisone injections may help with pain.
For most people, treatment will get rid of heel pain within 6 weeks. However, in severe cases, and if pain persists, surgery may be necessary.
Home remedies
Home care can help get rid of heel pain that is not severe.
This includes:
Rest: Avoid running or standing for long periods, walking on hard surfaces, and any activities that may stress the heels.
Ice: Place an ice-pack wrapped in cloth on the affected area for about 15 minutes, but not directly onto the skin.
Footwear: Shoes that fit well and provide good support are crucial, especially for athletes.
Foot supports: Wedges and heel cups can help relieve symptoms.
Some recent studies have suggested that Botox may help treat plantar fasciitis.
Another study has suggested that delivering a standard dose of external beam radiation therapy, similar to that used in an x ray or in cancer treatment, may help.
Prevention
Prevention of heel pain involves reducing the stress on that part of the body.
Tips include:
wearing shoes when on hard ground, and not going barefoot
maintaining a healthy body weight to reduce stress on the heels
choosing footwear with heels made of material that can absorb some stress, or using inserted heel pads
ensure shoes fit properly and do not have worn down heels or soles
avoid shoes that seem to trigger pain
rest your feet rather than standing if you are susceptible to heel pain
warm up properly before engaging in sports and activities that may place lots of stress on the heels
wear suitable sports shoes for each task
