From the Guidelines
Heel pain is most commonly caused by plantar fasciitis, Achilles tendinitis, stress fractures, heel spurs, bursitis, and nerve compression, with the exact cause often determined by a combination of clinical evaluation and imaging studies, such as radiographs, which are usually the first imaging study performed in the evaluation of chronic foot pain 1.
Causes of Heel Pain
The causes of heel pain can be varied and include:
- Plantar fasciitis, which is inflammation of the band of tissue connecting the heel bone to the toes
- Achilles tendinitis, which is inflammation of the tendon that connects the calf muscles to the heel bone
- Stress fractures, which are small cracks in the bone
- Heel spurs, which are bony growths on the underside of the heel bone
- Bursitis, which is inflammation of the fluid-filled sacs that cushion the joints
- Nerve compression, which can cause pain and numbness in the heel
Diagnosis and Treatment
For treatment, start with rest, ice application for 15-20 minutes several times daily, and over-the-counter pain relievers like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily) 1. Supportive footwear with cushioned heels and arch support is essential, and custom orthotics may help distribute pressure evenly. Gentle stretching exercises for the calf muscles and plantar fascia can provide relief, particularly before getting out of bed. Most heel pain improves within weeks with these conservative measures. If pain persists beyond 2-3 weeks, worsens, or is accompanied by swelling or inability to bear weight, medical evaluation is necessary as more targeted treatments like physical therapy, night splints, steroid injections, or rarely, surgery might be needed.
Imaging Studies
Radiographs are usually the first imaging study performed in the evaluation of chronic foot pain, and are useful to distinguish among different causes of chronic foot pain, including plantar fasciitis, stress fractures, and tarsal coalitions 1. Ultrasound may be performed when there is a high clinical suspicion of pathologic conditions of the Achilles tendon, plantar fascia, and other conditions such as tarsal tunnel syndrome, Morton’s neuroma, plantar plate tears, and intermetatarsal bursitis.
Prevention
Heel pain often results from repetitive stress, improper footwear, sudden increases in activity, or structural foot problems that alter normal walking mechanics. Prevention measures include wearing supportive footwear, stretching regularly, and avoiding sudden increases in activity 1.
From the Research
Causes of Heel Pain
The causes of heel pain are varied and can be attributed to several factors, including:
- Mechanical factors, which are the most common etiology of heel pain 2
- Plantar fasciitis, which is the most common cause of heel pain in adults 3, 4, 5
- Heel spur, which can occur with or without plantar fasciitis 3
- Sever's disease, heel bump, Achilles tendinopathy, heel neuritis, and heel bursitis, which are other common causes of heel pain 2
- Rheumatic inflammatory diseases, such as spondyloarthritis, which can cause heel pain due to inflammation at the bone insertion of tendon, ligament, bursa, or fascia 6
- Biomechanical imbalance, resulting in tension along the plantar fascia 5
- Neurologic, traumatic, or systemic origins, which can also contribute to heel pain 5
Common Symptoms and Diagnosis
Common symptoms of heel pain include:
- Pain on standing after a prolonged non-weight-bearing period 3
- Localized tenderness on the medial plantar calcaneal region 3
- Pain along the plantar fascia with or without the presence of a bony heel spur 3 Diagnosis is typically based on clinical examination, including history and physical examination 2, 4, 5, and may involve routine imaging studies to rule out other pathologies or confirm chronic or recalcitrant plantar fasciitis 3