The calcaneus, more commonly known as the heel, is the largest structure in the foot. It plays a major role in your daily functioning, so any pain that arises in this area can severely compromise your quality of life. Heel pain can have various causes. That's why it's important to identify your symptoms, understand what they could mean, and seek the appropriate treatment. The following are eight common causes of heel pain and what you can do to treat each one.
Achilles Tendonitis
Ankle and Ligaments by Nino Liverani is licensed with Unsplash License
Achilles tendonitis is an overuse injury of the Achilles tendon, which attaches to the calcaneus. Pain above the heel is a common symptom associated with this injury, as is tenderness and stiffness. Men are more susceptible to the condition. Other risk factors include:
- Advanced age.
- Flat arches.
- Frequent running, particularly in cold weather or with insufficient footwear.
- Hypertension and psoriasis.
- Obesity.
- Use of fluoroquinolones, a type of antibiotic.
You may find that self-care treatments, such as over-the-counter pain medicines, effectively relieve your symptoms. See a podiatrist for persistent or worsening pain, as they can prescribe stronger medication or physical therapy. In some cases, surgical repair of the Achilles tendon may be necessary.
Bone Spurs
Bone spurs are calcium deposits that develop along the edges of bony structures. When they arise on the underside of the calcaneus, they're known as heel spurs. These usually result from tension on the plantar fascia, repetitive tearing of the membrane that covers the calcaneus, or other strains in that area. Pain may occur if inflammation accompanies the spur formation.
Common risk factors associated with heel spurs are:
- Advanced age.
- Diabetes.
- Extended periods of standing.
- Frequent running on hard surfaces.
- High arches or flat feet.
- Gait abnormalities.
- Ill-fitting footwear.
- Obesity.
In some cases, the pain associated with heel spurs may self-resolve with non-steroidal anti-inflammatory drugs (NSAIDs) and rest. If it persists after a month, consider seeing a podiatrist, who may recommend treatments such as:
- Changes in footwear.
- Night splinting.
- Shoe inserts or orthotics.
- Stretching exercises and physical therapy.
Symptoms lasting longer than nine months may indicate that surgery is needed to remove the spur or release the plantar fascia.
Bruising
A bruised heel can refer to either a fat pad contusion or a bruise of the calcaneus itself. Common acute causes are:
- Forceful impact against the heel, such as from an attack.
- Landing on the heel from a great height.
- Misstepping on a firm object, such as a stone.
Chronic causes include:
- Frequent running on hard surfaces.
- Insufficient footwear.
- Poor foot mechanics.
- Repetitive stress or impact.
Additionally, obesity, atrophy of the fat pad, flat feet, and excessive pronation of the foot can increase an individual's susceptibility to heel bruises. Treatment is usually conservative, and the most common treatments include immobilization, rest, ice, elevation, NSAIDs, and orthotics.
Bursitis
Bursitis is an inflammation of the bursa, a fluid-filled sac that helps to cushion and mitigate friction in the areas between bones and soft tissues. Bursitis in the heel can affect both the Achilles tendon and calcaneus, resulting in pain, tenderness over the affected area, swelling, and a limited range of motion in your ankle. Acute injury, repetitive strain, infection, and various chronic conditions — arthritis, diabetes or gout, and thyroid disease — are all common causes.
You can treat heel bursitis at home with rest, ice, NSAIDs, and a change of footwear. Should those fail, your physician may prescribe custom orthotics or physical therapy. Worsening pain may merit injections of corticosteroids. Surgery to remove is typically a last resort.
Fracture
A calcaneal fracture is a break in the heel bone. It typically results from a severe direct impact to the bone, such as during a motor vehicle accident or from a fall. In the event of a fracture, the calcaneus may widen and shorten. You would experience severe pain, swelling, bruising, and deformity. Your mobility, range of motion, and weight-bearing would be compromised as well. Treatments for calcaneal fractures include six to eight weeks of immobilization and surgical intervention.
Haglund's Deformity
Haglund's deformity is a bony enlargement that develops on the back of the heel, where the Achilles tendon attaches to the calcaneus. The most common cause is repetitive abrasion of the Achilles tendon against the rigid backs of footwear. Symptoms include:
- A visible bump over the affected area.
- Redness and swelling in the affected area.
- Pain where the Achilles attaches to the calcaneus.
High-arched feet, a tight Achilles tendon, and a supinated gait pattern are common risk factors.
Haglund's deformity is typically responsive to conservative treatment in the form of rest, ice, compression, NSAIDs, orthotics, and physical therapy. In severe cases, the patient may undergo surgery to remove the enlargement.
Plantar Fasciitis
Plantar fasciitis is inflammation of the plantar fascia, the ligament that connects the calcaneus to the base of the toes. It's usually due to repeated stress on the fascia, which produces microtears that worsen and inflame. The primary symptom is stabbing pain in the heel. The pain may improve with activity but worsen with prolonged standing. Here are some common risk factors:
- Age between 40 and 60.
- High heel-stress activities, such as dance and long-distance running.
- Flat feet.
- Gait abnormalities.
- High arches.
- Obesity.
- Occupations that require long periods of standing.
Plantar fasciitis tends to resolve after several months of conservative treatment, which may include ice, stretching, NSAIDs, and activity modification. Physical therapy, night splinting, and ambulatory aids may also be helpful. Should symptoms persist in spite of conservative treatment, you may explore escalated options such as:
- Plasma injections.
- Steroid injections.
- Surgery.
Sever's Disease
Sever's disease is a condition that mostly affects growing children. Its cause is the pulling of the Achilles tendon on the calcaneal apophysis. Repetitive stress in this area results in pain and inflammation, which is exacerbated by physical activity and growth spurts. Typical treatments include:
- NSAIDs.
- Calf stretches.
- Ice.
- Rest.
- Supportive footwear.
Warning Signs To Look Out For
In addition to non-resolving pain, the following symptoms may be warning signs of a more severe condition that demands medical attention:
- Severe pain.
- Sudden-onset pain.
- Swelling or redness about the heel.
- Inability to ambulate secondary to pain.
Get Your Custom Heel Pain Treatment Plan
If you're experiencing heel pain, we at Gurnee Podiatry & Sports Medicine Associates can help. Dr. Lisa M. Schoene is both a sports medicine specialist and a certified athletic trainer whose podiatry practice traces back to the early 1990s. She has helped professional and semi-professional athletes literally get back on their feet, and she remains a top-tier source of podiatric care in the Chicago area. Use our contact page to make an appointment or call us at 847-263-6073. We look forward to helping you.