Our feet literally support everything we do, day in and day out. The foot is a complex structure and due to repetitive stress, age, or other risk factors, problems can develop that cause heel pain. Common causes of heel pain include plantar fasciitis, Achilles tendonitis, and other issues such as neuropathy.
If you or your child suffers from heel pain, it can be frustrating at best and debilitating at worst, and limiting to your daily activities. Working with a podiatrist can provide solutions to reduce or eliminate the pain so you can move through life with more ease.
Getting an accurate diagnosis is the first step.
Diagnosing Heel Pain
“The first thing I look at is the age of the patient,” said Dr. Jeff Boggs, Podiatrist at WWMG. Heel pain is common among tweens – children from about 9-13 years old. When a child experiences heel pain, it’s almost always growing pains (also called Sever’s disease). Sometimes during a growth spurt, the heel bone grows faster than surrounding tissues, which causes painful inflammation.
Heel pain in kids “is self-limiting; it eventually goes away once that growth plate closes,” said Boggs. In the meantime, stretching, icing, arch support and heel lifts can help ease discomfort.
Heel pain is almost as easy to diagnose for adults. Pain located on the bottom of the foot that originates in the heel nearly always indicates plantar fasciitis. When the pain is located on the back of the heel, the problem is likely caused by Achilles tendonitis or a bone spur.
What causes plantar fasciitis?
The number one problem that causes heel pain is plantar fasciitis. It is the result of low grade repetitive stress, usually an accumulation of microtears to the connective tissue (fascia) on the bottom of the foot.
“Plantar fasciitis is by far the most common thing we see in our practice,” said Boggs. It results from inflamed connective tissue and causes a sharp stabbing pain in the bottom of the heel.
Plantar fasciitis is typically seen in people who work on their feet all day. Those who stand in one place, such as at a cash register, are especially at risk, since prolonged standing strains the fascia.
Less commonly, plantar fasciitis is the result of overexertion or trauma. Some people are biomechanically at risk of plantar fasciitis due to:
- extremely high or flat arches
- tight tendons that affect range of motion, or
- because they experience more overall inflammation, as in patients with rheumatoid arthritis.
Treatment for plantar fasciitis
“Plantar fasciitis is fairly easy to treat, especially if caught early,” said Boggs. “A lot of people notice foot pain, decide to wear better shoes, ice the area, and stretch. They kind of self-treat it” so it never gets to the point where they need a podiatrist’s help.
But if the pain becomes chronic, or severe enough to cause a limp, or starts early in the day before you’ve spent time on your feet, it’s time to see a skilled podiatrist who can help.
A podiatrist will teach you how to stretch and advise what type of shoes can help you. You may also need to use over-the-counter arch supports and avoid going barefoot.
Sometimes, custom inserts may be prescribed, or the doctor may recommend steroid injections. In some chronic cases, ruptured fascia could result in abnormal scarring that requires foot surgery (which WWMG’s Podiatrists can perform if needed).
“Physical therapy can also be a good option for people with plantar fasciitis, because it may not be just the plantar fascia that’s the problem. Weakness or tightness in the legs, or abnormal range of motion, can contribute to plantar fasciitis,” said Boggs.
If a patient has severe pain or is failing to respond to initial treatment for plantar fasciitis, an MRI can be useful to evaluate for additional problems.
What causes issues in the Achilles tendon?
When pain is felt at the back of the heel, it is likely an issue with the Achilles tendon. Achilles tendonitis is inflammation of the Achilles tendon where it attaches onto the calcaneus, or heel bone.
“Usually by the time I see these patients they have developed a significant spur within the Achilles tendon, and this has become chronically inflamed,” says Boggs. “The pain can be debilitating,” said Boggs.
Although it shares many of the same potential causes as plantar fasciitis, Achilles tendonitis tends to occur in different populations. It is most commonly a result of injury from overexertion or a sudden increase in activity.
It becomes more common as people grow older because the tendon weakens with age. Additional risk factors for Achilles problems include:
- High arches
- Tight tendons, and
Wearing supportive shoes, especially during exercise, and stretching well before activities, can reduce one’s risk of developing Achilles tendonitis.
Treatment for Achilles problems
“We can do conservative treatments such as heel lifts, icing, and immobilization,” for Achilles tendonitis, said Boggs. But reoccurrence is common, and when bone spurs form, “It’s more of a surgical fix,” he warns. About 50% of Achilles cases commonly result in surgery.
Other issues that cause heel pain
Among the less common causes of foot pain is Baxter’s neuropathy. This condition is caused by compression of the nerve where the heel meets the arch. In contrast to plantar fasciitis, Baxter’s neuropathy is usually a result of structural issues rather than activity, and requires different medical treatment.
Broken Heel Bone
A broken heel bone, also called a calcaneal stress fracture, results from severe accidents and often requires surgery.
Warts and Corns
When warts or corns form on the bottom of the foot, “It’s like walking on a pebble,” says Boggs. Fortunately, these skin lesions are not hard to remove.
Some people who don’t like to wear socks can get cracks in the calloused skin of their heels. “These can be extremely painful and they’re difficult to treat,” said Boggs. Wearing socks and using softening creams can eventually reduce the thickness of skin and help the fissures heal.
Wearing High Heels
“High heels are really hard on your feet and ankles. We don’t see it as much anymore, but folks who wear heels exclusively can get chronic tightness in the Achilles and calf muscles that make walking in flat shoes painful,” said Boggs. Regular stretching can help counter the tightness and muscle strain caused by wearing heels.
Preventive measures to keep your heels healthy
Choose shoes that are good for your feet
Wearing good shoes with socks is important for anyone to maintain foot health. If you have flat feet or very high arches, it is particularly important to pay attention to your shoe choices.
“No more $2 flip flops,” said Boggs. These days there is no shortage of variety in healthy shoe styles, including running shoes, light hikers, and even “recovery sandals” that provide adequate support and cushioning. A podiatrist can recommend shoe choices that are appropriate for your foot condition.
Stretch your legs and calves
Boggs also recommends stretching every day. “People always do stretches with the knee straight, but they don’t do the one with the knee bent,” he shared. “When you’re stretching your calves, you need to do both.”
Even with good shoes and regular stretching, heel problems and pain can sometimes develop. When your daily activities are limited by heel pain, it’s time to seek help.
Where to get help for heel pain
If you’ve started having heel pain recently, or you have recurring foot pain, contact a WWMG Podiatrist for a comprehensive evaluation. It’s our goal to help you (literally) get back on your feet and return to an active lifestyle.