Heel Pain
There are many causes of heel pain, but some of the most common causes include plantar fasciitis and Achilles tendinitis. The former affects the bottom of the heel, while the latter affects the back of the heel. Heel spurs can also be a culprit.
- Plantar fasciitis
- Achilles tendinitis
- Heel spurs
If you have heel pain that persists for more than a month, you should make an appointment with a foot and ankle surgeon to diagnose the cause of your pain and discuss your non-surgical and potentially surgical options to get you better.
Plantar Fasciitis
What is it?
Plantar fasciitis is a very common foot condition that involves the inflammation of the plantar fascia, a thick band of tissue that runs along the sole of your foot. This helps support the function of your entire foot and plays an important role in walking. When this band of tissue gets inflamed, typically due to age and/or overuse, it can cause heel pain and stiffness, especially when you’re getting up after periods of sitting or sleeping.
What are the causes?
The cause of plantar fasciitis could be several things, such as overuse (walking, running, and/or standing), improper shoes, being overweight, congenital issues such as high arches, low arches, etc.
What are the symptoms?
Plantar fasciitis pain can be best described as a sharp or stabbing pain in the underside of your feet.
What is the diagnosis procedure?
There are multiple potential causes of heel pain, so your foot and ankle doctor will likely complete an examination, looking at your medical history and the foot itself. Sometimes people confuse plantar fasciitis with heel spurs, so a trained medical professional can determine the cause of your heel pain and make further treatment recommendations. They will examine your foot for any tenderness and assess your range of motion. They may even evaluate your gait (how you walk) and the mechanics of your foot to identify any issues that could be contributing to the problem. In some cases, x-rays may be needed to rule out other foot conditions such as fractures or heel spurs. They can also be useful in seeing if there are any growths on your feet or bone changes associated with chronic plantar fasciitis.
What are the treatment options?
At-home treatments
Initial treatment for mild to moderate cases of plantar fasciitis initially involves staying off your feet, icing, wearing supportive shoes or special inserts, taking NSAIDs (over-the-counter anti-inflammatory medications such as ibuprofen), and/or stretching. If those at-home treatments do not work or the case is severe (as with some high-intensity athletes such as marathon runners), in-office treatments may be recommended.
Physical therapy: If at-home stretching isn’t effective, your foot and ankle surgeon may recommend in-office physical therapy sessions for you, as stretching is a highly effective form of treatment for plantar fasciitis. A physical therapist will focus on the plantar fascia and Achilles tendon and strengthen other muscles that can help stabilize your foot and ankle.
Steroid injections: While most cases of plantar fasciitis improve after a couple of months, steroid injections may be recommended if pain and inflammation persist beyond that. Steroid injections can effectively reduce inflammation in the affected area and minimize pain quickly.
Surgery: In very rare cases, surgery is required. Gastrocnemius recession or release is a surgical procedure in which the gastroc tendon (which is a part of your Achilles) is lengthened. This is used frequently when an additional condition called an equinus contracture (or tightness in the leg that prohibits you from holding your foot in a neutral 90-degree position) is found.
Achilles Tendonitis
What is it?
Achilles tendonitis is a condition caused by inflammation in the Achilles tendon, which is a large tendon that connects your heel bone to your calf muscle. It commonly occurs due to overuse, particularly in runners or athletes who do a significant amount of running in their sport. It’s often seen in middle-aged people who live an active lifestyle.
What are the causes?
Achilles tendonitis occurs from overuse, especially in runners who are running faster and/or for longer distances. This is due to the repeated strain placed on the Achilles tendon, which is used when you’re active on your feet. Achilles tendons tend to weaken as you age, so injuries are common when middle-aged people are living an active lifestyle including physical activities such as running, walking, basketball, tennis or paddleball, etc. Furthermore, common foot conditions such as flat arches or medical conditions such as high blood pressure can increase the likelihood of developing Achilles tendonitis. Wearing old or worn-out running or walking shoes can also contribute.
What are the symptoms?
Achilles tendonitis symptoms usually start as mild but can be severe over time, with ongoing activity. It is felt when you’re engaging in physical activity, typically in the back of your leg or above your heel. Stiffness or tenderness is also common, although that can improve with warmer weather and mild physical activity.
What is the diagnosis procedure?
When diagnosing Achilles tendonitis, your physician will do a physical examination and ask you questions related to your pain. They will feel for tenderness in and around your heel and Achilles tendon especially when you’re standing on your toes. While X-rays can help diagnose bone-related problems, it typically isn’t needed to diagnose Achilles tendonitis. If your doctor suspects a tear in your Achilles tendon, he or she may recommend an MRI scan which can help with further diagnosis.
What are the treatment options?
For a mild to moderate case of Achilles tendonitis, your doctor will typically recommend resting and avoiding physical activity to minimize the strain on your Achilles tendon. Ice and over-the-counter anti-inflammatory pain relievers such as ibuprofen or naproxen can help, although you should talk with your doctor about the right treatment plan for you.
Insoles or a properly fitted pair of running/walking or cross-training shoes are strongly recommended, as they can help prevent further irritation of your Achilles tendon. Tight-fitting or high-heeled shoes should be avoided until your tendonitis is healed.
If the case is severe, your doctor may recommend physical therapy to provide you with specific stretches to strengthen your calf muscles and improve your flexibility. They can also give you corticosteroid injections although these are a short-term solution and not advisable long-term.
Lastly, if these courses of treatment fail, surgery can be recommended if the tendon is damaged beyond the point of healing without medical intervention. Achilles tendons can rupture [link to Achilles tendon rupture surgery page] as well, in which case surgical intervention is necessary. Surgical treatments aim to repair the tendon and remove damaged tissue, reinforcing the tendon with grafts where necessary. Chronic Achilles tendon disorders may also require surgery. [link to Surgery for chronic Achilles tendon disorders]
If you suspect you have a case of Achilles tendonitis, you shouldn’t hesitate to contact a foot and ankle surgeon to help put your mind at ease about the diagnosis and provide you with treatment options.
Heel Spurs
What is it?
A heel spur is a bony growth that develops on the bottom of your heel. This is a calcium deposit that grows out from your bone. These are commonly associated with plantar fasciitis, because it typically forms where the plantar fascia is on the bottom of the foot, although it is important to point out that not everyone who has plantar fasciitis has a heel spur, and not all heel spurs will cause pain.
When the plantar fascia is injured, whether due to inflammation or minor tears in the tissue, the body responds by trying to repair the tissue. Over time, these calcium deposits can build up forming a heel spur.
What are the causes?
Heel spurs are commonly caused by stress on the plantar fascia, due to causes that contribute to plantar fasciitis. [link to plantar fasciitis]
What are the symptoms?
Symptoms can vary from person to person and are largely dependent on how and why the person developed the heel spur to begin with. Sometimes people have heel spurs and don’t notice them, and sometimes they can be tremendously painful. Typically the first symptom that is noticed is pain in the heel from weight-bearing exercises. It may start as a dull ache and increase in intensity with use and/or over time. Often those with heel spurs will notice an increase in pain in the mornings when they’re waking up and starting to walk around for the day. This is due to the plantar fascia tightening up overnight without use, then using the plantar fascia when you start walking around again can aggravate the tissue.
Pain with physical activity that involves the heel is often present, as is tenderness and potentially swelling in the affected area. You may find that it is difficult to wear certain shoes, especially tight-fitting or ill-fitting shoes, due to the pain experienced when wearing them.
What is the diagnosis procedure?
A physician can diagnose a heel spur through physical examination, understanding your medical history and the symptoms you’re experiencing, and/or imaging. The most common imaging used to diagnose a heel spur is X-rays, which can reveal any inconsistencies or abnormalities within the bones of your foot. Ultrasounds may also be used to identify plantar fasciitis or other areas of inflammation. Although rare, MRIs can be used to capture more detailed images of suspected tissue damage. All these images can assist your doctor in further diagnosing the issue.
What are the treatment options?
Treatment options vary depending on the severity of the heel spur but typically focus on relieving pain and inflammation as well as addressing any underlying causes. The treatment plan is generally similar to other heel pain conditions. Resting and taking a break from physical activities that cause pain is generally where your doctor will start. Icing and NSAIDs (over-the-counter anti-inflammatory medications) will also help relieve inflammation. Your doctor may also give you stretching exercises or refer you to physical therapy for a more structured regimen. Changing your shoes to a more supportive running/walking or cross-training shoe and adding insoles to help cushion your heel may be advised. Steroid injections may be a short-term solution to alleviating inflammation and pain quickly. In rare cases in which symptoms do not resolve over continued treatment, surgery may be recommended. These could include releasing the plantar fascia or a heel spur resection in which the protruding bone particle is removed.