Heel Pain

Why do my heels hurt and what can I do about it?

Heel pain is a common foot problem. Pain usually occurs under the heel or just behind it, where the Achilles tendon connects to the heel bone. Sometimes it can affect the side of the heel.

Pain that occurs under the heel is known as plantar fasciitis. This is the most common cause of heel pain.

Pain behind the heel is Achilles tendinitis. Pain can also affect the inner or outer side of the heel and foot.

Fast Facts about heel pain

  • Heel pain is usually felt either under the heel or just behind it.
  • Pain typically starts gradually, with no injury to the affected area. It is often triggered by wearing a flat shoe.
  • In most cases the pain is under the foot, towards the front of the heel.
  • Home care such as rest, ice, proper-fitting footwear and foot supports are often enough to ease heel pain.

Common causes include:

Plantar fasciitis, or inflammation of the plantar fascia: The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot.

This type of pain often happens because of the way the foot is made, for example, if the arches are especially high or low.

When the plantar fascia is stretched too far, its soft tissue fibers become inflamed. This usually happens where it attaches to the heel bone, but sometimes it affects the middle of the foot. Pain is felt under the foot, especially after long periods of rest. Calf-muscle cramps may occur if the Achilles tendon tightens too.

Heel bursitis: Inflammation can occur at the back of the heel, in the bursa, a fibrous sac full of fluid. It can result from landing awkwardly or hard on the heels or from pressure from footwear. Pain may be felt deep inside the heel or at the back of the heel. Sometimes, the Achilles tendon may swell. As the day progresses, the pain usually gets worse.

Heel bumps: Also known as pump bumps, these are common in teenagers. The heel bone is not yet fully mature, and it rubs excessively, resulting in the formation of too much bone. It is often caused by having a flat foot. It can be caused by starting to wear high heels before the bone is fully mature.

Tarsal tunnel syndrome: A large nerve in the back of the foot becomes pinched or entrapped (compressed). This is a type of compression neuropathy that can occur either in the ankle or foot.

Chronic inflammation of the heel pad: This is caused either by the heel pad becoming too thin, or through heavy footsteps.

Achilles tendinosis: This is also known as degenerative tendinopathy, tendonitis, tendinosis, and tendinopathy. It is a chronic condition associated with the progressive degeneration of the Achilles tendon.

Sometimes the Achilles tendon does not function properly because of multiple, minor microscopic tears of the tendon, which cannot heal and repair themselves correctly. As the Achilles tendon receives more tension than it can cope with, microscopic tears develop. Eventually, the tendon thickens, weakens, and becomes painful.

Other causes of heel pain include:

  • Achilles tendon rupture, where the tendon is torn
  • a plantar fascia tear
  • calcaneal stress fracture
  • calcaneal cysts
  • soft tissue mass
  • short flexor tendon tear
  • systemic arthritis (lupus, rheumatoid arthritis, psoriatic arthritis)
  • bone bruise
  • poor posture when walking or running
  • bone cyst, a solitary fluid-filled cyst in a bone
  • gout, when levels of uric acid in the blood rise until urate crystals start to build up around the joints, causing inflammation and severe pain

Home remedies

Home care can help get rid of heel pain that is not severe.

This includes:

Rest: Avoid running or standing for long periods, walking on hard surfaces, and any activities that may stress the heels.

Ice: Place an ice-pack wrapped in cloth on the affected area for about 15 minutes, but not directly onto the skin.

Footwear: Shoes that fit well and provide good support are crucial, especially for athletes.

Foot supports: Wedges and heel cups can help relieve symptoms.

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