What is it?

The heel is a specialised part of the body designed to absorb the impact of your body weight when walking, running or undertaking any other form of physical exertion or weight bearing exercise.  When pain does develop, it can be very disabling, making every step a problem which in turn affects your overall posture

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There are various types of heel pain and the more common ones include:

• Heel spurs (plantar fasciitis)

• Heel bursitis (subcalcaneal bursitis)

• Heel bumps
   

What causes the problem?

Heel pain is a common occurrence and in most cases the pain is caused by some form of mechanical injury caused by small repetitive injuries that occur at a rate faster than the body can heal them. 

Heel pain can also be caused by lower back problems or inflammatory joint conditions.

The following types of heel pain are not exhaustive but may help you appreciate the complexity of heel pain and why specialist advice can be helpful.

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Heel spurs (plantar fasciitis or fasciosis):

This is the most common caused by inflammation to the fascia ‘band’ (similar to a ligament) which connects the heel bone to the base of the toes. This condition can be caused in various ways including extensive running/walking/standing for long periods of time, especially when you are not used to it as well as a sedentary lifestyle.  In particular, a change of surface (eg. road to track), poor shoe support, being overweight, overuse or sudden stretching of your sole as well as a tight Achilles tendon can lead to this condition.

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Heel bursitis (subcalcaneal bursitis):

This is an inflammation of a bursa (a fluid filled fibrous sac) under the heel bone where the pain is typically more in the centre of the heel than that experienced with plantar fasciitis (heel spur) and significantly worsens during the day. This condition can be caused following a fall from a height on to the heel

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Heel bumps:

These are firm bumps on the back of the heel.

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Tarsal tunnel syndrome:

This can feel like a burning or tingling sensation under the heel within the arch of the foot with occasional loss of sensation on the bottom of the foot.  This is caused by compression of the tibial nerve as it passes the inside of the ankle and tapping of the nerve will stimulate the symptoms known as Tinel’s sign. 

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Chronic inflammation of the heel pad:

This is caused by a heavy heel strike or sometimes a reduction in the thickness of the heel pad which can give rise to a dull ache in the heel which increases during the day.

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Stress fracture:

Often caused following injuries such as falling from a height or landing on an uneven surface.

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Severs disease (calcaneal apophysitis, and osteochondrosis):

This condition affects young children, usually between the ages of 8-12 and occurs when part of the heel bone suffers a temporary loss of blood supply.  The bone dies only to reform when the blood supply is later restored and is also known as osteochondrosis where this condition occurs in active growing bones.

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Achilles Tendonosis:

This condition occurs when the Achilles tendon is placed under more pressure than it can cope with and small tears develop along with inflammation and in some cases can lead to tendon rupture.  These tears become a source of further injury which can lead to swelling within the tendon, hence the name ‘tendonosis’ (sometimes referred to in error as ‘tendonitis’).

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Is it serious?

Heel pain is a common condition and in most cases will diminish following some routine self-care measures but if the pain persists longer than three weeks, it is best to seek professional advice from someone who specialises in heel pain, such as a podiatrist or chiropodist.  This is necessary as there are many types of heel pain, each with their own different causes and separate forms of treatment. 

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Who gets it?

Heel pain can affect everyone, whatever your age, but those more commonly affected include those in middle age (over 40’s age group) as well as athletes.

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How do I know I have it?

With heel spurs, there are no visible features on the heel but a deep localised painful spot found in or around the middle of the sole of the heel and is usually worse on standing after long periods of rest, particularly first thing in the morning. Although the name implies a spur of bone sticking out of the heel bone (heel spur syndrome), around 10% of the population have heel spurs without any pain whatsoever.

With bursitis, pain can be felt at the back of the heel when the ankle joint is moved and there may be a swelling on both sides of the Achilles tendon. Or you may feel pain deep inside the heel when it makes contact with the ground.

With heel bumps, these are usually caused by excessive shoe rubbing in the heel area.

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How do I prevent it?

Follow the self-care measures below in the first instance.

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What are the treatments?

If you experience heel pain, some simple self-care measures include:

• Avoid wearing ill-fitting or uncomfortable shoes

• Wear shoes with good heel cushioning and effective arch support

• Avoid walking or exercising on hard ground

• Rest regularly and try not to walk or run too fast

• Wear a raised heel (no more than 6-10 mm higher than normal)

• Losing weight if you are overweight

 

More specialist treatments include:

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Heel spurs (plantar fasciitis or fasciosis):

Treatment can take many forms from resting your foot as much as possible, stretching exercises and deep heat therapy to steroid injections and even medication or surgery to release the tight tissue ‘band’. In some cases, padding and strapping is applied to alter the direction of stretch of the ligament to alleviate symptoms in the short-term.  However, for the long-term, special insoles (orthoses) are prescribed to help the feet to function more effectively and help to make any possible recurrence less likely.

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Heel bursitis (calcaneal bursitis):

Medication and ultrasound can give relief but for the long-term, a shoe insert may be necessary. In addition, attention to the cause of any rubbing and appropriate padding and strapping will allow inflammation to settle.

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Heel bumps:

Adjustments to footwear is usually enough to make them comfortable, although a leather heel counter and wearing boots may help.  In more serious, recurring cases, surgery may be necessary.

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Tarsal tunnel syndrome: 

Special shoe inserts can reduce the pressures on the nerve and may be appropriate for certain foot types whereas, on other occasions, local injections of medication to the area where the tibial nerve is inflamed may be necessary.

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Chronic inflammation of the heel pad:

A soft heel cushion can help this condition.

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Stress fracture: 

If this is suspected, an X-ray is required to confirm final diagnosis and to determine the extent of the injury and a follow-on treatment plan.

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Severs disease (osteochondrosis):

This condition is temporary and self-limiting but can be painful at the time.

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Achilles Tendonosis:

Treatment involves special exercises that strengthen the tendon and increasing the height of the heel with an insole on a temporary basis.

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When should I see a podiatrist about it?

If you experience any foot care issues which do not resolve themselves naturally or through routine foot care within three weeks, it is recommended to seek the help of a healthcare professional such as your GP to refer you to your local NHS trust for free treatment but if you do not qualify for this, or need urgent attention, you should contact a private podiatrist.

To talk to a podiatrist (also known as a chiropodist) about the options available regarding treatment, you can contact an NHS podiatrist or a private practice podiatrist.  In both cases, always ensure that any practitioners you visit are registered with the Health Professionals Council (HPC) and describe themselves as a podiatrist (or chiropodist).

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