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Heel pain is a common complaint, especially amongst those who spend a lot of their time on their feet for work, or who are involved in repetitive impact sports. The cause of this pain can be varied and should be thoroughly investigated to ensure the right course of treatment is undertaken.
Firstly, there are two separate areas which are often termed ‘heel pain’.
- Underneath the heel – the bit we stand on.
- At the back of the heel – the Achilles region.
Pain underneath the heel may be caused by a number of injuries:
- Plantar fasciitis - Inflammation of the plantar fascia which forms the arch of the foot
- Bruised heel / heel pain (fat pad contusion) - Often caused by repetitive pounding on the heel
- Broken heel bone - a fracture of the calcaneus caused by a sudden impact.
- Calcaneal stress fracture - A fracture of the calcaneus (heel) bone, either caused by a direct trauma, or repetitive pounding resulting in a stress fracture
- Calcaneal bursitis - Inflammation of the sack of fluid which sits under the heel
- Tarsal tunnel syndrome - Entrapment of the plantar nerves as they pass round the outer ankle. Causes pain to radiate into the heel and arch of the foot
- Heel spur - A heel spur is a growth of bone under the heel which can (but doesn't always) cause pain. This may also be the cause of plantar fasciitis.
Pain at the back of the heel is often attributed to the Achilles tendon and related structures:
- Achilles Tendinopathy - is a degenerative condition of the Achilles tendon which is a common running injury and causes pain, stiffness and often a creaking feeling in the tendon
- Achilles tendon tears - a sudden onset of pain and disability.
- Achilles bursitis - sometimes also called retrocalcaneal bursitis and is difficult to distinguish from insertional tendinopathy.
- Sever’s disease - an osteochondroses similar to Osgood Schlatters disease, occurs in young athletes.
Once the cause of heel pain has been established, a suitable treatment plan should begin. Whilst reducing pain and inflammation are the first step, it is important to consider, and then correct, the cause of the injury, especially in overuse injuries such as Plantar fasciitis or tendinopathy. Common causes include:
- Tight calf muscles.
- Faulty foot biomechanics – such as overpronation or oversupination.
- Sudden increases or changes to training.
- Unsupportive footwear.
- Wearing high heels frequently.
- Without correcting the cause of the injury, the pain will more than likely return once normal activities are resumed.