When someone comes into my office complaining of heel pain, the first thing that has to be determined is the underlying cause of the heel pain. Today I will briefly discuss the numerous reasons your heel can hurt. In the near future, each of these conditions will be discussed in greater detail. The types of questions you'll be asked if you're being evaluated for heel pain include:
- Where on your heel are you having pain?
- How long have you been experiencing these symptoms?
- What activities make your symptoms worse?
- What activities help relieve your pain?
- Did you suffer an injury to the heel that was associated with the onset of your symptoms?
- What things have you tried on your own to relieve your pain? Have any of these treatments helped?
- Have you seen another doctor for this problem? If so, when, and what was done at that visit?
- Are there any particular times of the day when your symptoms are worse?
- What kind of work do you do? Are you required to stand or walk all day?
- What kind of shoes do you normally wear?
Once these questions are answered, your feet will be carefully examined. In addition, x-rays will most likely be taken, and in many cases, a diagnostic ultrasound will be performed. X-rays help determine problems with the bone, while the diagnostic ultrasound is helpful in determining soft tissue causes of your symptoms.
Some of the more common causes of heel pain are as follows:
- Plantar fasciitis - this is by far the most common cause of heel pain. Patients with plantar fasciitis typically report that their pain is greatest in the morning when they first get out of bed, then report gradual worsening of pain when they are standing or walking for prolonged periods of time throughout the day.
- Rupture of the plantar fascia - a rupture of the plantar fascia is a painful event associated usually with a specific injury.
- Fracture of the heel bone (calcaneus) - Major injuries aside, stress fractures of the calcaneus can occur without the history of an injury.
- Nerve entrapment - the lateral plantar nerve can become entrapped between other structures in the foot, often causing a burning, tingling sensation.
- Tarsal tunnel syndrome - this is caused by compression of the major nerve to the foot in the area of the ankle
- Atrophy of the fat pad, or loss of natural cushioning beneath the heel bone - this lack of cushioning can be especially painful when patients walk barefoot.
- Calluses, especially when associated with cracking of the skin - fissuring or cracking in the skin around the heels can be very painful. It is of special concern to diabetics or others who may be prone to foot ulcerations and infections.
- Poor circulation - a lack of circulation to the foot can cause at times extreme pain due to not enough oxygen reaching the tissues. Pain from poor circulation often is present when one is walking short distances, and is relieved by rest. More serious cases may experience pain while lying down in bed at night.
- Arthritis (including osteoarthritis, rheumatoid arthritis, gout, and many others)
- Bursitis - this usually affects the back of the heel, at the attachment of the achilles tendon into the heel bone
- Achilles tendinitis - The largest tendon of the body can become inflamed from overuse, and cause pain in the back of the heel
- Bone spurs - bone spurs are common on both the bottom and back of the heel. However, it is usually only the spurs on the back of the heel that causes pain.
- Sciatica - Pressure on the sciatic nerve in the lower back can cause pain along the entire length of the nerve, including in the heel.
- Calcaneal apophysitis - this affects mainly younger, overweight or extremely active boys from the ages of 6 to 10.
Once your doctor determines the cause of your heel pain, steps can be taken to start a treatment plan that can get you back to feeling great!
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