Heel pain is a common foot and ankle problem. Pain may occur underneath the heel or behind it. Heel pain can make it difficult to walk and participate in daily activities. Most painful heel conditions improve without an ankle surgery, but your body needs time to recover.
However, many people try to ignore the early signs of heel pain and keep on doing the activities that caused it. When you continue to use a sore heel, it will only get worse and could become a chronic condition leading to more problems.
Plantar fasciitis is one of the most common conditions causing heel pain. The classic presentation is of sharp localized pain at the heel. This is often an overuse injury that is primarily due to a repetitive strain causing micro-tears of the plantar fascia but can occur as a result of trauma or other multifactorial causes.
Common symptoms of heel pain
Heel pain symptoms vary depending on the cause. In addition to pain, you may experience:
Bony growth on the heel
Discoloration (bruising or redness)
Pain after standing from a resting/sitting position
What causes pain behind the heel?
Several problems can cause pain to develop in the back of the heel:
The Achilles tendon is a fibrous tissue that connects the calf muscles to the heel bone and it is the body’s longest and strongest tendon. Runners and basketball players are more prone to Achilles Tendinitis. This overuse injury inflames the achilles tendon. Achilles tendonitis causes pain, swelling and stiffness in the back of the heel.
This is a painful condition that affects the bursa located between your heel bone and Achilles tendon. Bursitis occurs when fluid-filled sacs that called bursae swell. You may have a tender, bruise-like feeling in the back of the heel.
An enlargement of the bony section of the heel (where the Achilles tendon is inserted) triggers this condition. The soft tissue near the back of the heel can become irritated when there’s frequent pressure on the backs of your heels. It may be caused by wearing shoes that are too tight or stiff in the heel.
Sever’s disease (calcaneal apophysitis)
Sever’s disease is a frequent cause of heel pain in active children between 8 and 14. Kids who participate in activities that require a lot of running and jumping are more prone to this problem. The increased athletic activity irritates the growth plate in the back of the heel.
What causes pain beneath the heel?
Problems that cause severe pain underneath the heel include:
Bone bruise (contusion)
Stepping on a hard, sharp object can bruise the fat padding underneath the heel. You might not see discoloration, but your heel will feel tender when you walk. A stress fracture, as well as Sever’s disease, may cause sharp pain all along the back, side and bottom of the heel.
Plantar fasciitis refers to an inflammation of the plantar fascia, a tough connective tissue that connects the heel bone to the toes. The plantar fascia helps support the arch of the foot and has an important role in normal foot mechanics during walking. To prevent developing plantar fasciitis, supportive shoes with good insoles are often recommended.
Heel bone spurs
Chronic plantar fasciitis can cause a bony growth (heel spur) to form on the heel bone. Repetitive stress from walking, running, or jumping on hard surfaces is a common cause of heel spurs. Although some people have pain, heel spurs aren’t usually painful.
Causes of Heel Pain
Anything that puts a lot of pressure and strain on your foot for long periods can cause heel pain. The way you walk (foot mechanics) and your foot’s shape (foot structure) are also factors.
You may be more likely to develop heel pain if you:
Have a weight gain or are overweight
Have foot or ankle arthritis, flat feet or high arched feet
Run or jump a lot in sports or for exercise.
Spend a lot of time standing, especially on concrete floors.
Wear improperly fitted shoes without arch support and/or cushion.
Wear high heels frequently
Have tight calf muscles
Have rheumatoid arthritis
A physiotherapist is an expert in helping heel pain and can diagnose and identify the source and cause of foot and ankle problems.
Heel pain diagnosis is often made with a physical exam. These tools include:
A physiotherapist will observe a person's typical static postures (i.e. in sitting, standing and lying down) as well as the person's usual movement patterns in their daily life (e.g. walking and working) and in their sport. These observational findings provides vital information for the physiotherapist to identify risk factors for heel pain, the likely cause for injury or overload, and to guide subsequent assessments and tests.
2. Manual Palpation
Physically palpating (i.e. feeling) a person's area of discomfort and the regions around it would provide a physiotherapist or a physical therapist with valuable information about the texture, tightness, rigidity, temperature, and alignment of the structures. This informs the physiotherapist of the possible reason for the heel pain, the likelihood of inflammation, and whether it is localised or potentially referred from a different area.
3. Range of Motion Testing
Foot and ankle movement will be assessed when diagnosing the cause of discomfort. Often, the neighbouring joints are also assessed to identify if the heel pain is arising solely from the foot and ankle or is related to other areas in the body.
4. Joint Mobility Testing
Joint mobilisation is a skill that physiotherapists are trained in in their undergraduate degree programs. This technique will be used to assess the foot and ankle joints' movement and to test for joint stiffness and/or stability.
5. Strength Testing
Testing of strength in the foot and ankle cues the physiotherapist in on the neurological status of the person as well as to identify any issues with movement pattern or muscle function that is contributing to the heel pain.
6. Neurological Testing
If pain, tingling and numbness are present in the foot and ankle, the physiotherapist will consider varicosities and possible soft tissue masses in the region of the tarsal tunnel pressing on the nerve. Tarsal tunnel syndrome is a compression neuropathy and painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel. There will be aching or sharp pain around the medial part of the foot and ankle, often radiating along the medial or the lateral part of the foot, or towards the plantar fascia insertion.
7. Gait Analysis
A physiotherapist can analyze the biomechanical faults in a person's walking pattern and identify impairments through observation. An unusual gait or walking pattern can cause an uneven weight distribution that is harder on the feet.
8. Red Flag Testing
Red flags are symptoms and alert signs that indicate serious underlying pathology and conditions. A professional physiotherapist is trained to identify them through common subjective complaints, medical history as well as through special tests.
9. Medical Imaging
Imaging tests are not necessary in the diagnosis of heel pain, but in cases where red flags (such as a stress fracture) are suspected, blood or imaging tests can help to confirm diagnoses and guide potential surgical management(s).
Heel pain/foot pain can be treated with medical interventions such as the use of analgesics, surgical interventions (as recommended by your foot and ankle surgeons), or with conservative management like physiotherapy/physical therapy.
The treatment of heel pain depends entirely on the cause of the problem. Therefore, it is important that you understand the cause of your symptoms before embarking on a treatment programme.
If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice from your foot and ankle surgeons before beginning any treatment plan. Not all of the treatment options listed are appropriate for every condition.
Corticosteroid injections can ease pain and swelling and may help plantar fasciitis and bursitis. Steroid injections can reduce acute or chronic inflammation enough to stimulate healing of tissues and promote better growth of new cells.
Custom-made shoe inserts (orthotics) or heel pads can take pressure off the heel. Some people find relief by wearing a night splint, especially if they get morning pain. A night splint holds the plantar fascia and achilles tendon in a stretch position during sleep and its one of the most effective ways to reduce pain from plantar fasciitis. You don't have to go to a doctor for night splints as you can easily get them from any drugstore. You may also need to switch to more supportive shoes for everyday wear and exercise.
Nonsteroidal anti-inflammatory drugs (NSAIDs) combined with an ice pack can help to ease pain and swelling.
Your physiotherapist can show you how to do stretching exercises for your tight calf muscle (located on your lower leg) to ease heel pain. There are two types of stretches to target the calf muscles. Keeping the knee bent or leg straight while stretching will target the soleus or gastrocnemius muscles respectively. If you feel any pain in the front knee during the stretch, please get a healthcare professional to review this exercise with you.
Taping can be done either to facilitate mobility or to stabilize joints and limit movement. Plantar fasciitis taping is usually done with zinc oxide tape. This is a type of cotton athletic tape that’s more rigid than others. Plantar fasciitis results from too much strain on your plantar fascia. Taping can reduce the amount of stretching and moving the ligament when you’re on your feet. This will prevent further damage, reduce heel pain and give your plantar fascia a chance to heal.
This is an important aspect of treatment for almost all orthopaedic conditions. Our physiotherapists can treat heel pain with a combination of manual therapy, use of modalities and exercises. They can also provide health tips to prevent heel pain or foot pain.
If you are unsure of the cause of your symptoms, you should seek medical attention. You should see your foot and ankle surgeons for further advice when:
You have an injury that causes deformity around the joint
Your heel pain occurs at night and does not improve despite long periods of rest
You have heel pain and/or foot problems that persists beyond a few weeks
There are signs of an infection, including fever, redness, warmth and swelling of the ankle joint
You are unable to relieve pain with anti inflammatory medicine, physiotherapy/physical therapy or other treatments
How can Balance Core Relieve Heel Pain?
At Balance Core, we strive for excellence in providing an accurate diagnosis and managing pain with effective treatment(s). We believe in ensuring a systematic review of a person’s posture, body alignment, movement patterns and habits to identify the root cause of problems.
Our physiotherapists/physical therapists follow a clinical practice guideline and are highly trained in manual palpation and observation to identify the sources of discomfort. This helps our clients to minimise their symptoms in a few sessions and to empower them to manage their conditions with a targeted treatment program.
We use a combination of manual therapy, adjunct modalities such as dry needling, taping, ultrasound therapy and TECAR therapy, as well as exercises to help our clients and patients to achieve their goals.
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Frequently Asked Questions
Your physiotherapist will perform a thorough assessment to evaluate the problem and identify the problem’s root cause. A detailed explanation will be given so that you can fully understand your issues and the outline of subsequent physiotherapy treatment plans.
Thereafter, a treatment involving muscle release, specific muscle activation or joint mobilization, etc. will be rendered to provide symptomatic pain relief and address underlying root problems.