Heel pain

Answer 1

Alternative Names

Pain - heel

Common Causes

Most frequently heel pain is not the result of any single injury, such as a fall or twist, but rather the result of repetitive or excessive heel pounding.

Plantar fasciitis is inflammation of the thick connective tissue on the sole of your foot that attaches to your heel. The pain is usually felt at the bottom of your heel and is often worse in the morning because of stiffness that occurs overnight. The following increase your risk of developing this painful problem:

• Shoes with poor arch support or soft soles
• Quick turns that put stress on your foot
• Tight calf muscles
• Repetitive pounding on your feet from long-distance running, especially running downhill or on uneven surfaces
• Pronation -- landing on the outside of your foot and rolling inward when walking or running; to know if you pronate, check the soles of your shoes to see if they are worn along the outer edge

Bone spurs in the heel can accompany plantar fasciitis, but are generally not the source of the pain. If you treat the plantar fasciitis appropriately, the bone spur is likely to no longer bother you.

Heel bursitis(inflammation of the back of the heel) can be caused by landing hard or awkwardly on the heel, or by pressure from shoes.

Achilles tendinitis is inflammation of the large tendon that connects your calf muscle to your heel. This can be caused by:

• Running, especially on hard surfaces like concrete
• Tightness and lack of flexibility in your calf muscles
• Shoes with inadequate stability or shock absorption
• Sudden inward or outward turning of your heel when hitting the ground

Home Care

• Rest as much as possible for at least a week.
• Apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes, more often in the first couple of days.
• Take acetaminophen for pain or ibuprofen for pain and inflammation.
• Wear proper-fitting shoes.
• A heel cup, felt pads in the heel area, or an orthotic device may help.
• Night splints can stretch the injured fascia and allow it to heal.

Additional steps:

• Apply moleskin to avoid pressure if you have bursitis.
• See a physical therapist to learn stretching and strengthening exercises. These help prevent plantar fasciitis or Achilles tendinitis from returning.

Call your health care provider if

• Your pain is getting worse despite home treatment
• There is little progress after 2 to 3 weeks of home treatment
• Your pain is sudden and severe
• You have redness or swelling of your heel or you cannot bear weight

What to expect at your health care provider's office

Your doctor will take your medical history and perform a physical examination, including a full exam of your feet and legs.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• Have you had this type of heel pain before? If so, what was the diagnosis and what caused the problem?
• When did this episode of pain begin?
• Do you have pain upon your first steps in the morning or after your first steps after rest?
• Where exactly is your pain?
• Is the pain dull and aching or sharp and stabbing?
• Is it worse after you exercise?
• Is it worse when you are standing?
• Do you have any swelling or redness of your heel?
• Have you had a fall or have you twisted your foot recently?
• Are you a runner? How far do you run? How often do you run? On what type of surface do you run?
• Do you walk or stand on your feet for long periods of time?
• What kind of shoes do you wear?
• Do you have any other symptoms?

Diagnostic tests that may be performed include a foot x-ray, focusing on the heel.

If either plantar fasciitis or bursitis is diagnosed and if shoe changes and the use of orthotics have not been successful, cortisone injections may be tried. Surgery is a last resort and is seldom necessary.

If Achilles tendinitis is diagnosed, anti-inflammatory medicine may be prescribed. Heel lifts may be used. Stretching can be helpful. In particularly unresponsive cases, a walking cast or boot may be helpful. Surgery is usually not necessary.

Prevention

To prevent plantar fasciitis and Achilles tendinitis, maintain flexible and strong muscles in your calves, ankles, and feet. Always stretch and warm-up prior to athletic activities.

Wear comfortable, properly fitting shoes with good arch support and cushioning. If you pronate, look for athletic shoes with an antipronation device. If orthotics are prescribed by your provider, wear them in all of your shoes, not just while exercising.

References

Schroeder BM; American College of Foot and Ankle Surgeons. Diagnosis and treatment of heel pain. Am Fam Physician. 2002;65(8):1686-1688.

American College of Radiology (ACR), Expert Panel on Musculoskeletal Imaging. Chronic Foot Pain. Reston, VA: American College of Radiology; 2002.

Donley BG, Moore T, Sferra J, Gozdanovic J, Smith R. The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study. Foot Ankle Int. 2007;28:20-23.

Aldridge T. Diagnosing heel pain in adults. Am Fam Physician. 2004;70:332-338.

Ho K, Abu-Laban RB. Ankle and foot. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006:chap 55.

Answer 2

Alternative Names

Pain - heel

Common Causes

Heel pain is often the result of overuse of the foot. It is rarely caused by a single injury such as a fall or twist.

Heel pain may include swelling or tenderness. It may be caused by:

• Running, especially on hard surfaces like concrete, or too often
• Tightness in your calf muscles or the Achilles tendon
• Shoes with poor support or shock absorption
• Sudden inward or outward turning of your heel
• Landing hard or awkwardly on the heel

Conditions related to heel pain include:

• Achilles tendinitis, inflammation of the large tendon that connects your calf muscle to your heel.
• Bursitis, inflammation of the back of the heel
• Bone spurs in the heel
• Plantar fasciitis, swelling of the thick band of tissue on the bottom of your foot

Home Care

The following steps may help relieve your heel pain:

• Rest as much as possible for at least a week.
• Apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes, more often in the first couple of days.
• Take acetaminophen or ibuprofen for pain and inflammation.
• Wear proper-fitting shoes.
• A heel cup, felt pads in the heel area, or shoe insert.

Other treatments depend on the cause of your heel pain.

Call your health care provider if

Call your doctor if your heel pain does not get better after 2 - 3 weeks of home treatments. Also call if:

• Your pain is getting worse despite home treatment
• Your pain is sudden and severe
• You have redness or swelling of your heel
• You cannot put weight on your foot

What to expect at your health care provider's office

Your doctor will perform a physical exam and ask questions about your medical history and symptoms, such as:

• Have you had this type of heel pain before?
• When did your pain begin?
• Do you have pain upon your first steps in the morning or after your first steps after rest?
• Is the pain dull and aching or sharp and stabbing?
• Is it worse after exercise?
• Is it worse when standing?
• Did you fall or twist your ankle recently?
• Are you a runner? If so, how far and how often do you run?
• Do you walk or stand for long periods of time?
• What kind of shoes do you wear?
• Do you have any other symptoms?

Your doctor may order a foot x-ray. Treatment depends on the cause of your foot pain. You may need to see a physical therapist to learn exercises to stretch and strengthen your foot. Your doctor may recommend a night splint to help stretch your foot.

Prevention

Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising.

Wear comfortable, properly fitting shoes with good arch support and cushioning.

References

Wapner KL, Parekh SG. Heel pain. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:section F.

Abu-Laban RV, Ho K. Ankle and foot. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 55.

Reviewed By

Review Date: 02/19/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.