Heel Pain

 

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At a Glance

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What causes heel pain? 

Pain in the heel can be caused by many things. The commonest cause is plantar fasciitis but other causes include:

  • Being overweight.
  • Being on your feet for long periods (especially on hard surfaces or wearing hard-soled footwear).
  • Thinning of the fat pad of the heel.
  • Irritation of the nerves around the heel.
  • Arthritis in the ankle or heel (subtalar) joint.
  • Fracture of the heel bone (calcaneum).

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What is plantar fascitis? 

The heel absorbs the shock of your foot striking the ground during walking. It is connected to the front of the foot by a number of strong tissues with one of the strongest being the plantar fascia. In some people, this plantar fascia becomes painful and inflamed. This condition is called plantar fasciitis and usually happens where it is attached to the heel bone, although sometimes occurs in the mid-part of the foot.

There commonest cause is constant stress so it is therefore commoner in people who spend all day on their feet or are overweight. Other causes include:

  • Stiffness of the ankle or tightness of the Achilles tendon.
  • High-arched ("cavus") feet or flat feet since they are less able to absorb the stress of walking
  • After an injury to the heel.
  • Rheumatic conditions such as rheumatoid arthritis or ankylosing spondylitis since inflammation may occur where tendons attach to bone (enthesopathy), and plantar fascitis in these people is part of their general condition.

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Is the pain related to a heel spur? 

In some people, a spur forms on the heel bone near the inflamed plantar fascia attachment. Although they are commoner in people with plantar fasciitis, they are frequently found in people with no heel pain. As such, it is not believed that the heel spur is the cause of the pain and removal is rarely advocated.

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Can I do anything about heel pain myself? 

Try to avoid the things that cause heel pain to start in the first place:

  • Maintain a healthy weight.
  • Modify activities to minimise the shock to your feet from constant pounding on hard surfaces.
  • Choose footwear with some padding or shock-absorbing material in the heel.
  • If you have high-arched feet or flat feet, use a moulded insole in your shoe.
  • Exercise after any injuries to your ankle or foot to get back as much movement as possible which will reduce the stresses on your foot and your heel.

If you start to get heel pain, following the above advice may enable the natural healing process to get underway and in addition, you should consider:

  • Stretching the Achilles tendon and plantar fascia.
  • Using simple pain-killers but do take advice from your doctor or pharmacist before taking anti-inflammatory medicines as they can have troublesome side-effects in some people.
  • Wearing a splint on your ankle at night if you have early morning pain since it prevents your Achilles tendon from tightening up.

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When do I need to see a professional for advice? 

If your heel pain is affecting your normal activities and not getting better with simple self-treatment you may wish to consult your GP. By listening to your symptoms and examining your heel, they may decide to either organise further investigations such as blood tests or scans, or proceed straight to treatment.

Beyond stretching exercises and lifestyle measures, additional treatments which may be needed include:

  • Immobilisation in plaster or a walking boot. This may settle acute episodes of pain.
  • Injections. Different types of injection are available although it depends upon your surgeon regarding whether they offer them.
  • Shockwave therapy. This involves putting a high energy probe on the heel to stimulate a healing response.

It is rare to need an operation for heel pain and may only be offered for specific indications, if all simpler treatments have failed, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The type of operation varies according to the underlying diagnosis and range from releasing the tissues at the back of the calf to releasing the plantar fascia and the nerves around the heel.

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