Heel pain is often relieved by wearing proper shoes, applying ice and taking nonsteroidal anti-inflammatory drugs. More severe symptoms, like a bone bruise or heel spur, may require treatment by a podiatrist.
A physical exam and medical history will help your doctor pinpoint the cause of your heel pain. Your doctor will press on (palpate) areas of your ankle, foot and calf to assess tenderness and swelling.
Plantar Fasciitis
This condition is characterized by pain in the bottom of the heel that is caused by inflammation of the plantar fascia. The plantar fascia is a fibrous band that runs from your heel to the ball of the foot and your toes. Symptoms include pain when you stand or walk, especially first thing in the morning or after sitting or sleeping for long periods of time. Pain is typically worse when you exercise, work on hard surfaces, or wear shoes with soft soles or no support.
This condition can be treated by decreasing activity, applying ice, calf stretching exercises and using shoe inserts or pads. Treatment may also involve anti-inflammatory medication, physical therapy and steroid injections (if the symptoms do not resolve). Surgery is rarely required for this condition.
Sever’s Disease
In Sever’s disease, repetitive stress from running and jumping causes irritation of the heel growth center (calcaneal apophysis) that is located at the back of the heel bone. This area is more painful in children and adolescents because the calcaneal apophysis is still growing and not fully fused to the heel bone. This irritated area is also pulled on by the Achilles tendon and this can cause pain.
The condition is typically diagnosed based on your child’s history and by doing a physical examination including the heel squeeze test. It may be necessary to take x-rays to rule out other serious foot or heel problems. Rest, ice application, and stretching can help to ease the pain. Typically, this problem will resolve when the growth plate matures and is fused to the heel bone.
Achilles Tendonitis
The Achilles tendon is the largest in the body and helps you to walk, run and stand on tiptoe. Inflammation and stiffness of the Achilles tendon causes pain. This can be mild and improve with activity or it can get progressively worse. Occasionally the Achilles can rupture (heard as a ‘pop’ in the back of your heel or calf) and this needs immediate attention.
The condition can affect anyone but is most common in runners, particularly long distance runners and those who increase their training suddenly. Other risk factors include having flat feet which adds stress to the Achilles, participating in sports that require repetitive running or jumping and being older. Treatment includes avoiding high impact activities, wearing supportive shoes, stretching and taking anti-inflammatory painkillers.
Stress Fracture
Stress fractures are small breaks in the bone that occur when repetitive force on a bone exceeds its ability to absorb shock. This is similar to the fatigue a paper clip experiences when it is repeatedly bent; eventually, the metal will break.
Symptoms include pain that gets worse with physical activity and tenderness to the touch at the affected area. This injury is more common in the lower leg and foot. The navicular bone (in the middle of the foot) is most commonly affected by stress fractures.
Treatment consists of rest, avoiding activities that increase your symptoms and using ice. Your doctor may prescribe anti-inflammatory medication or acetaminophen (Tylenol) to manage pain and encourage your recovery. Your doctor may also recommend a walking boot or brace and a period of non weight bearing to facilitate healing.
Trauma
For most heel conditions, the diagnosis depends on a physical exam and review of the person’s medical history. During the exam, the doctor will press on the heel and ankle and move the foot up and down and around to check for tenderness, swelling, bruising, deformity or other symptoms.
Injuries to the heel can range from a single event such as landing hard after a jump, or the repetitive pounding and stress of running or walking on concrete or other surfaces, flat footwear, obesity, or rheumatoid arthritis (RA). Symptoms vary depending on the injury and may include pain with weight-bearing activities, swelling of the back of the heel (calcaneal bursitis), or a feeling that something is under the heel. Treatment options for the various types of heel pain include rest, ice application, taping, immobilization, shoe modification, pain medications and physical therapy.