Heel pain may be caused by a number of different problems; for effective treatment you need to know the cause.

Why do people get heel pain?

The heel is a highly specialised part of the body designed to absorb the shock of walking and running. When walking the stresses placed on your feet can be 11/4 times your body weight and, during your lifetime, you could walk the equivalent of four times around the world. These stresses can increase to 23/4 times body weight when running. It is therefore not surprising that heel pain is a common occurrence.

Although most heel pain tends to be caused by mechanical injury, as a result of small but repetitive injuries that occur at a rate faster than the body can heal them. There are times when it can be caused by injuries to the lower back or diseases such as inflammatory joint conditions.

If I experience heel pain what should I do?

If you experience heel pain, you could follow the simple self-care measures shown in the brown box. However, if the pain persists longer than 3 weeks and it is affecting you, it may be appropriate to seek professional advice. This is necessary, as there are many types of heel pain, each with different causes and sometimes requiring quite different forms of treatment.

Who should I see if I have heel pain?

To ensure that you receive the right treatment, you need to see someone who  specialises in heel pain. Podiatrists or Chiropodists, as part of their training,  specialise in heel pain, its cause and treatment. They will also be able to determine if the pain is being caused by problems elsewhere in the body, for example back pain. To locate podiatrists in your area please see the back page of this leaflet.

What could cause heel pain?

The following are some of the more common types of heel pain. This list however, is not exhaustive but may help you appreciate the complexity of heel pain and why specialist advice can be helpful.

Plantar Fasciitis (sometimes called plantar fasciosis)

Probably the most common cause of pain in the heel results from damage to the tissue band (fascia) connecting the heel bone to the base of the toes. It tends to be painful when you take your first steps after resting and especially when getting out of bed in the morning. Most often associated with middle age, however, it can occur in all ages.

Treatment will involve special stretching exercises and, if appropriate, shoe inserts designed to alter foot function which will reduce the tension within (and thereby injury to) the plantar fascia. Soft heel cushions rarely help plantar fasciitis. Unfortunately it can be a difficult condition to treat and sometimes it may be necessary to also consider medication.

Tarsal Tunnel Syndrome

This sometimes feels like a burning sensation and at other times a tingling sensation underneath the heel and in the arch of the foot. Occasionally there can be loss of  sensation on the bottom of the foot. It 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. Special shoe inserts can reduce the pressures on the nerve and may be appropriate for certain foot types. On other occasions local injections of medication to the area where the tibial nerve is inflamed may be necessary.

Calcaneal Bursitis

An inflammation of a bursa (a fluid filled fibrous sac) under the heel bone. Typically the pain is more to the centre of the heel than that which is experienced with plantar fasciitis and significantly it worsens during the day. Medication and ultrasound can give relief but for long-term relief a shoe insert may be necessary.

Chronic Inflammation of the Heel Pad

Caused by a heavy heel strike or sometimes a reduction in the thickness of the heel pad, this can give rise to a dull ache in the heel when standing and walking that increases during the day. A soft heel cushion can help.

Stress Fracture

Can occur following injury, for example falling from a height. If this is suspected an X-ray would be required to confirm diagnosis and determine the extent of the injury and therefore treatment protocol.

Severs Disease

This condition affects young children, normally between the ages of 8 and 12. It occurs when part of the heel bone suffers a temporary loss of blood supply, and as a result the bone dies only to reform when the blood supply is later restored. It is a condition known as osteochondrosis that can occur in growing bones, and one that fortunately is self-limiting, but can be painful at the time.

Achilles Tendonosis

This can occur where the Achilles tendon is placed under more tension than it is able to cope with and so as a result small tears develop. These then become a source of further injury and gradually a swelling may develop within the tendon - this is called Achilles tendonosis (sometimes inappropriately referred to as tendonitis). Treatment will involve special exercises that strengthen the tendon and temporarily increasing the height of the heel with an insole.

Other forms of pain associated with the Achilles tendon include paratendonitis (involving tissues surrounding the tendon) and Achilles enthesis (inflammation of the insertion of the tendon to the heel). Once again differentiating between these conditions is important, as each requires slightly different treatments.

Simple self-care measures that can sometimes help with heel pain

• If the pain is associated with a particular shoe, avoid wearing those shoes for a while
• Avoid walking on hard ground
• Rest if possible, or maybe do not walk so fast
• Wear a slightly raised heel, only 6-10mm higher than normally worn
• Use a heel cushion to reduce the pressures on your heel when walking – seek advice from your Podiatrist.
• If the pain persists for more than three weeks consider seeking professional advice. It maybe more than a temporary injury.