Heel pain is an incredibly common issue for people of all ages. The cause of heel pain can be a variety of things. Examples include heel spurs, stress fractures, neoplasms, tendinitis, nerve entrapments, arthritis and most commonly Plantar Fasciitis. So – how do you know which of these is the cause of your heel pain? Visit an expert! The first step in healing and getting rid of that pain is a thorough evaluation by a podiatrist. Our organization has many locations to suit your needs. We also have the resources needed to get your feet feeling better so you can get back to all the things you love without that nagging heel pain.
A very important part of your visit to one of our offices is when you tell us your story. Before we even look at your feet, some clues are offered simply from your description of your condition. When it comes to heel pain, things can feel worse with the first few steps in the morning, but settle down slightly (if not completely) after walking around a bit. In some cases, the pain gets worse as you continue to walk on your foot. Pain that is worse to the point that it stops you in your tracks while walking is yet another important detail to note. Knowing whether you have experienced an injury, new activity, change in activity level, change in shoes are also important details. The character of the pain you experience is helpful to know as well. Is the pain sharp/shooting? Is the pain dull/achy? Does it hurt when you are off of your feet? Has your pain been impacted by any attempted self-treatments including exercises or medications? These and many other questions really help us to determine the most likely cause of your pain and then we can get your treatment started and help guide you to better foot health.
Heel spurs are another possible cause of heel pain. A heel spur is a projection of extra bone that develops off of the calcaneus (heel bone) usually due to excess strain at the attachment point of a tendon (achilles) or ligament (plantar fascia). In the back of the heel, these spurs can be irritated not only by the pulling/tightness of the achilles tendon but also from the pressure of the back of a shoe. On the bottom of the heel, the spur we often see may not be the cause of pain but rather a sign that the ligament which attaches here (the plantar fascia) has been tight for a while. Some spurs develop as a result of other less common underlying conditions. When it comes to pain associated with heel spurs, treatments can be both conservative and surgical. Accommodating the heel spur with orthotics or altered/modified shoes or padding may provide just the relief you need. If not, or if there are other pathologies at play, removal of the spur can also be performed.
Stress fractures of the calcaneus (heel bone) occur in some patients. A stress fracture is most often linked with an increase in baseline activity, use of old or worn out shoes for extensive activity and/or a change in bone health. Stress fractures are not often associated with traumatic injury. However, this pain will often hurt enough that you literally feel like you cannot walk another step. Your body protects you in this way, as stress fractures represent weakening in the bone. If you ignore that pain, those areas of weakness can result in a true fracture of the bone. Stress fractures do not always show up clearly on x-rays, but if suspected, treatment is to protect to avoid complications. The bone remodels until it is strong again and when the pain is gone, decreasing the likelihood of recurrence is key.
No condition is 100% preventable. It is hard to keep track of all we have to do and to be honest our feet do not get the attention they need. In the instance of stress fractures, wearing supportive and protective shoes, ensuring nutritional health (vitamin D and calcium) and custom orthotics to assist in a more even distribution of weight during your activities.
A neoplasm is simply a new or abnormal growth of tissue. This could be bone, fat, cysts, scar tissue. Neoplasms can be linked to cancer, though this is rare in the foot. At your first visit to evaluate for heel pain, x-rays are an important first step in determining whether this is part of the issue. The character and timing of pain with neoplasms is variable, depending upon what type of lesion may be present.
Tendinitis and myositis can also be causes of heel pain. If pain is most noted to the back of the heel bone, this is where the Achilles tendon attaches to the heel bone. Many patients have tight calf muscles and this undue strain on the Achilles tendon can cause inflammation and pain. Pain at the attachment point of the achilles tendon is called insertional achilles tendinitis. There is often pain when you press on the area and if you are up and down stairs throughout the day, this condition will really get your attention. The achilles tendon is the strongest tendon in the body. It is the main tendon responsible for pushing off the ground when walking, running and jumping. Myositis describes a condition where there is inflammation and subsequent pain in a muscle. Whether you realize it or not, there are many small muscles that attach to the bottom of the heel bone. These muscles help to stabilize the foot while walking. You can experience inflammation and pain from these muscles being overworked.
Nerve entrapments can be a tricky cause of heel pain. Nerves branch off of the spinal cord, just like the trunk of a tree. There are branches off of branches as the nerves traverse toward the toes in your feet. At any point along their course, a nerve can experience pressure which can cause pain to the area and also can cause pain anywhere going forward from there. Pain that is from a nerve when there is a higher up compression or irritation is called referred pain. This means that you may have pain in your heel that is from a nerve being compressed near the ankle or even in the back. Nerve pain can express itself as anything from an itching or buzzing sensation, to sharp stabbing pains – or even numbness. Because it can present many ways and be present so near to other anatomical structures, this can sometimes be difficult to identify.
Arthritis by definition is inflammation of a joint. Generally speaking, arthritis can be caused by mechanics and wear-and-tear or from some form of systemic abnormality. Wear-and-tear arthritis is also called osteoarthritis. This can be from a traumatic injury to or near a joint which starts a degenerative process that progresses over years. It can also be due to overuse. Our feet have several joints that may be overly stressed and the location of arthritis is determined by foot structure. The bottom and back of the heel where most people experience heel pain do not articulate with any other bone. There is no joint on the bottom or back of the heel specifically. Therefore heel pain from arthritis can be referred pain or it can be due to a different type of arthritis. Systemic arthritides such as psoriatic arthritis and rheumatoid arthritis can result in pain in the heel. Interestingly enough, some people experience pain in the achilles tendon due to crystal arthropathy or gout.
The most common cause of adult heel pain is Plantar fasciitis. You have likely heard of this condition. Perhaps you know someone who has experienced this dreaded condition. It can be challenging to get rid of, but there are many treatments available. Plantar fasciitis is pain and inflammation of a ligament on the bottom of the foot called the plantar fascia. This ligament runs from the heel bone all the way to the ball of the foot. Pain from plantar fasciitis is most often seen at the attachment point on the heel because this is where the most strain occurs. Plantar fasciitis may present with a subsequent spur on the bottom or back of the heel. The development of plantar fasciitis is typically a combination of tight plantar fascia and calves in combination with inappropriate support of the foot structure.
The characteristics of plantar fasciitis can vary slightly from one patient to the next. For most, plantar fasciitis will come about suddenly in the morning as you are getting out of bed. You may find yourself reaching for the bed or nearby nightstand or wall to stabilize yourself on the way to the bathroom to get ready. “What in the world happened” might cross your mind and you are trying to retrace your steps for what you did the day before and why this all of a sudden is so intensely painful. You aren’t likely to find a reason as this condition builds up and finally hits a tipping point where the inflammation in the plantar fascia becomes symptomatic. As you shower and get ready for the day, you realize you can stand on your foot more reliably and are cautiously relieved that you can get on with your day. Later on, you are at work sitting at a desk or sitting in your car driving and you get up after an hour or so and BAM! That similar stabbing pain starts again. Again you are reaching for something and now your anxiety gets a little higher. What is wrong?
Post-static dyskinesia is a key symptom of plantar fasciitis. Post-static refers to the time after you haven’t been up and about/moving. Dyskinesia refers to the difficulty and abnormality of getting moving again. This is worst usually in the morning after prolonged time off of your feet. So why does this happen? What led to this point is typically time on your feet day after day. Maybe you started a new job and you have been doing more. Little by little, strain develops on the plantar fascia which results in the start of an inflammatory reaction in the body as it tries to toughen up the ligament in preparation of your next walk. In some cases, you went on vacation and wore flipflops or unsupportive shoes on the daily but did the same if not more activity than when you are moving through the daily grind. The extra strain again causes the start of an inflammatory reaction. In the most frustrating circumstances, you have no idea what you did differently that would have brought this on. Yet here we are.
Treatment of plantar fasciitis is multifactorial because the cause is multifactorial. The component that is most typically treated is the inflammation. Reason being that the inflammation is what directly causes pain. Some patients are treated at their first visit with a steroid injection or prescription for anti-inflammatories. If this is the only treatment, in most cases the pain will return again.
The other critical component of plantar fasciitis are the mechanical contributions. The physical stress and strain is the root cause of inflammation, so treatment for this is of the utmost importance. Breaking down the mechanical contributions, generally we consider two main things: flexibility and support. This is why stretching, stretching splints, physical therapy, optimal shoes and custom orthotics are mainstays of treatment for plantar fasciitis. In most cases this condition is treated conservatively, though surgery is an option for some patients.
Don’t wait to call!
If you are suffering from heel pain, don’t ignore the pain, call for an evaluation! Improvement is based in large part on how long the condition has been there. The sooner you treat it, the better!
Dr. Lauren Doyle practices out of our Elmhurst, IL location.