The heel is a cushion of specialised fatty tissue at the back part of the foot that protects the muscles, ligaments and the heel bone (calcaneus). Heel pain is a common foot condition, seen in one out of 10 people with at least one episode in their life time. It is essential to make a correct diagnosis of the cause of heel pain to direct a person for appropriate treatment.
Heel pain can be caused by obesity, abnormal walking style, standing or walking or running on hard surfaces and wearing ill-fitting shoes. Heel pain is rarely caused by injury. The conditions that are related to heel pain include:
- Plantar fasciitis - inflammation of the ligament that connects the heel bone to the toes
- Bursitis - swelling of a bursa at the back of the heel
- Achilles tendinitis - swelling and inflammation of the Achilles tendon where it connects to the heel bone
- Calcaneus fracture - fracture of heel bone
- Haglund’s deformity - bone enlargement at the back of heel
- Tarsal Tunnel Syndrome - nerve compression at the back of the foot
- Baxter's nerve entrapment - compression of the first branch of the lateral plantar nerve
- Arthritis - degeneration and swelling of joints
The common symptom is chronic heel pain mostly during walking, jogging and running. Sharp and stabbing pain when you first stand up early in the morning and stand after sitting for long hours may also occur.
The cause of the heel pain is diagnosed with a medical history and meticulous physical examination. X-rays are always the first investigation, but other tests like ultrasound, MRI and nerve conduction studies may be required.
Treatment of heel pain is completely dependent on the cause. The conventional treatments are –
- Rest from activities that causes stress on the heel
- Applying ice packs to help pain and inflammation
- Regular exercise and foot massage
- Wearing proper shoes, heel cups, professional heel straps and night splints
Other treatments include:
- Ultrasound therapy
- Extra-corporeal shockwave therapy
- Anti-inflammatory drugs (local or oral)
Surgery may be recommended in certain cases like recalcitrant Achilles tendinitis, impinging heel spurs, retrocalcaneal bursitis, tarsal tunnel syndrome, plantar fasciitis or Baxter’s nerve entrapment, and fracture of the heel bone.