There are over 40 different types of heel pain and although plantar fasciitis has been said to account for up to 80% of heel pain. This is not an exhaustive list but it is to give you an idea of the many structures in the heel and how they can all get problems. This guide is not designed for you to self-diagnose but to give you an idea of the possible causes. I cannot stress enough that the best idea is to get a proper assessment and diagnosis from a podiatrist, especially if you have tried some of the self-help treatments and they haven’t worked.
- Plantar fasciopathy. Pain worst on first standing, often improves initially but then will worsen with activity. Pain under the middle of the heel.
- Achilles Tendinopathy. Pain worst on first standing, often improves initially but then will worsen with activity. The main difference is the location of the pain. You will feel this at the back of the heel and up into you calf.
- Posterior Tibial tendonitis. Pain around the inside of the foot or ankle sometimes into the heel but usually pain is felt at a distinct point at the front of the heel almost into the arch. Pain worst on first standing, often improves initially but then will worsen with activity there may be associated redness and swelling and you may notice the foot becomes flatter.
- Calcaneal apophysitis/ Severs. This affects children and is an inflammation of the growth plate in the calcaneus (Heel Bone) it is characterised by pain that worsens on activity and often is described as feeling bruised. It is painful when the area is squeezed.
- Calcaneal Stress or Avulsion Fractures. Pain that occurs and intensifies during normal activities. It may or may not be associated with trauma or an increase in activity. There may be some swelling and it will typically be tender to the touch.
- Calcaneal fracture. Will result from a trauma often after sudden impact, for instance falling off a ladder. Sudden onset, bruising, extreme pain and swelling and inability to put the heel to the floor
- Bruised Heel
- Haglunds deformity or retrocalcaneal exostosis. This is a bony prominence at the back of the shoes, often caused by chronic irritation from shoes rubbing the back of the heel. This can develop a bursa over the top of it which can cause difficulty with shoe fitting, pain, swelling and redness.
- Septic or InflammatoryArthritis. A red hot painful joint with no history of trauma may indicate this, especially if other joints are also affected.
- Osteoarthritis of the subtalar joint.
- Fat pad atrophy. As we age the fatty padding under our feet gets thinner, this can cause pain and discomfort under the heel when standing for long periods.
- Baxter’s nerve entrapment. This is entrapment or inflammation of the lateral plantar nerve in the heel (Baxter’s nerve). Baxter claims as much as 20% of heel pain is caused by entrapment of the first branch of the lateral plantar nerve. You may also complain of laterally radiating pain.
- Tarsal tunnel syndrome. Entrapment or inflammation of the posterior tibial nerve as it passes through the tarsal tunnel around the inside of the ankle. Similar to carpal tunnel syndrome I the wrist.
- Corn or callous in the skin
- Cellulitis Infection of the skin. This is very painful, red and hot and you may feel generally unwell with flu like symptoms.
- Tarsal Coalitions. This is an abnormal connection that can develop between the bones in the rear of the foot (the tarsal bones). This can be composed of bone, cartilage or fibrous tissue, and can cause a reduction in motion and pain.
- Tumour. This is thankfully very rare but can occur. It is characterised by increasing pain with no relieving factors and pain even at night getting steadily worse.
Often it is not just one thing that is causing pain. You may have plantar fasciitis with some bone oedema and fat pad atrophy and because of the inflammation in the area you also have Baxter’s nerve entrapment as well. This is why it is so important to go and see a podiatrist to be properly assessed to work out exactly what is causing your heel pain so we can work out a really effective treatment plan for you.
What to expect when you come to see us
We will take a thorough history. We will ask all sorts of seemingly random questions about your general health, previous problems, your lifestyle and activities and the kind you footwear you regularly wear. We will try to find out everything we can about your painful symptoms. When and how it started, things that make it better and worse and any other problems you may also be suffering from. Once we have done that we will have a good look at your foot while you are seated, moving it around assessing the joint ranges of movement, how flexible or stiff you are and looking at how your foot works. Often we will then take a closer look at you standing and walking so we can thoroughly assess how your feet and legs look when static and also dynamically. This all helps for us to build a picture of how your body functions and your individual biomechanics so that we can then work out exactly what it is that is hurting so we can then work out why it’s hurting. Once we’ve done that, we can come up with a bespoke plan for you on how to fix the problem.
From that plan you may need to change your footwear, we may give you exercises to do and sometimes we may recommend orthoses to change the way your foot interacts with the ground to alter your dynamics to help relieve your painful symptoms.
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