What causes heel pain?
You're more likely to get the condition if you're a woman, if you're overweight, or if you have a job that requires a lot of walking or standing on hard surfaces.
When you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues, you may develop heel pain. Common causes are over-use, such as doing too much exercise that involves running or jumping, or even too much walking.
You're also at risk if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches are also more prone to a painful condition under the heel called plantar fasciitis.
The best way to treat heel pain
‘Many people try to ignore the early signs of heel pain and keep on doing the activities that caused it,’ says Mr Haroon Mann, a Consultant Trauma and Orthopaedic Surgeon at Twenty-Five Harley Street day clinic. ‘If your heel hurts, make an appointment to see an orthopaedic doctor right away to determine why and get treatment.’
Conditions that cause heel pain generally fall into two main categories:
• Pain beneath the heel
• Pain beneath the heel and pain behind the heel.
Pain beneath the heel
If it hurts under your heel, you may have one or more conditions that inflame the tissues on the bottom of your foot:
Stone bruise: When you step on a hard object such as a rock or stone, you can bruise the fat pad on the underside of your heel. It may or may not look discoloured. The pain goes away gradually with rest. The condition typically starts gradually with mild pain at the heel bone. You're more likely to feel it after, rather than during exercise. The pain classically occurs right after getting up in the morning and after a period of sitting.
Plantar fasciitis, or ‘heel spur pain’, is the most common cause of pain under the heel. Most patients complain of the pain when they first get out of bed in the morning. It's usually as a result of inflammation of the tendons that lie under the heel and middle of the foot, that connect tissue from your heel bone to the base of your toes. The pain is focused under your heel and flares up when you take your first steps after resting overnight.
• Rest your feet by taking the weight off them, especially from triggers like intensive exercise or standing
• You may need to do stretching exercises
• A doctor can prescribe anti-inflammatory painkillers to reduce swelling, like ibuprofen or naproxen.
• Support your foot by wearing a heel pad in your shoe.
• Apply ice to the sore area for 20 minutes three or four times a day to relieve your symptoms.
Chronic heel pain
If you’ve tried to put up with plantar fasciitis for a long time, the frequency and intensity of the pain may increase, so you may have more pain whilst walking and sometimes at night. If you don't treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity and could develop symptoms of foot, knee, hip and back problems because of the way plantar fasciitis changes the way you walk.
A heel spur may develop, where calcium deposits form where the foot tissue connects to your heel bone. As well as the usual treatments for early heel pain, your doctor may suggest the following.
Treatment
• An X-Ray to get a better look at the bony protrusion, which can vary in size. Treatment is usually the same as for plantar fasciitis: rest until the pain subsides, do special stretching exercises and wear heel pad shoe inserts.
• A steroid injection. A specialist orthopaedic doctor will use a local anaesthetic spray on the skin before inserting the needle and a corticosteroid plus local anaesthetic, so you’ll feel very little pain with this careful technique.
• Extracorporeal Shock Wave Therapy (ESWT). This technique doesn’t require an anaesthetic, and was first used to break up kidney stones. With heel pain, pulses of energy promote the growth of new blood vessels, which speeds heeling and reduces nerve pain.
• You may need to wear a walking cast for 2-3 weeks or positional splint when you sleep.
• In some cases you might need surgery to free chronically tightened tissue.
Pain behind the heel
Pump bump can be caused by too much exercise, such as running, or as a result of wearing shoes that rub or cut into the back of the heel. Impact sports or the rigid backs of shoes or straps can irritate the heel, creating a bony enlargement, also known as Haglund’s deformity. Pain behind the heel may build slowly over time, causing the skin to thicken, get red and swell. If you develop a bump on the back of your heel it may feel tender and warm to the touch. The pain flares up when you first start an activity after resting. It often hurts too much to wear normal shoes. You may need an X-Ray to see if you also have a bone spur.
Achilles tendon pain, can be caused by wear and tear or inflammation of the main tendon that runs down the back of the leg to the heel. You may need to see a doctor for a type of therapy or localised pain relief, or in some cases surgery to remove scar tissue and strengthen the tendon.
Mr Mann practices at Twenty-five Harley Street Day Clinic Telephone 020 3883 9525, or email appointments@25harleystreet.co.uk. Visit 25harleystreet.co.uk.
