Heel pain

Heel pain may have a number of different causes. Mild pain may be caused by wearing ill-fitting shoes or by over-exercising. Certain conditions or injuries that can also cause heel pain. These include:

• Plantar fasciitis – this is inflammation of the plantar fascia, which is the ligament that runs from the heel bone to the top of the foot. It can be caused by unusually high or low foot arches, which may result in the plantar fascia becoming overstretched.
• Heel bursitis – this is inflammation of the bursa, which is a fluid-filled sac at the back of the heel. It can be caused by pressure from ill-fitting footwear or from landing heavily on the heels.
• Achilles tendinopathy – this is caused by microscopic tears to the Achilles tendon due to excessive tension in the tendon. Over time the tendon may thicken and become weak. Achilles tendinopathy is a painful, chronic condition.
• Fractured heel.
• Ruptured Achilles tendon.
• Tarsal tunnel syndrome – this is compression of the large nerve at the back of the foot.
• Stress fracture – whereas a fracture is normally caused by trauma to the heel, a stress fracture is often the result of repetitive stress to the heel due to over-exercising or heavy manual work. It can also be due to osteoporosis.
• Osteomyelitis – this is infection of the bone or bone marrow, which may result from surgery or injury to the heel.

Symptoms may vary according to the cause and severity of the problem. You may experience:

• Sharp pain between the arch of your foot and your heel and problems lifting your toes off the floor. This can be a symptom of plantar fasciitis, particularly if you experience pain when you walk, which gets better when you rest. You may also have cramps in your calf muscle.
• Pain in the ankle and heel and when standing on tiptoes. This can be a symptom of Achilles tendonitis.
• A sudden severe pain which may leave you unable to walk and might be accompanied by a popping or snapping sound. This can be caused by a heel fracture or ruptured Achilles tendon.
• Swelling, redness and a dull aching pain. This can be a symptom of bursitis.
• Deep pain in the heel, muscle spasms and inflammation. This can be a symptom of osteomyelitis.

To diagnose heel pain, you will normally have a physical examination which may involve testing the muscles from the knee to the heel and pressing the heel to assess for cysts, stress fractures or nerve problems.

Blood tests or imaging scans may sometimes be needed to confirm a diagnosis or rule out a more serious condition.

Treatment will depend on the causes and severity of the condition. Some common treatments include:

• Anti-inflammatories to reduce swelling and pain.
• Physiotherapy exercises to stretch the tendons and strengthen the lower leg muscles, helping to stabilise the ankle and heel.
• Injections of corticosteroids to reduce pain and swelling.
• Athletic taping of the foot to provide support during sports.
• Orthotics or insoles to help correct abnormal foot structure, plus night splints to hold the Achilles tendon in a lengthened position overnight to stretch it.
• Shockwave therapy which uses sound waves to stimulate blood supply and encourage healing.
• Surgery to detach the plantar fascia from the heel bone.