From the Guidelines
Heel pain is most commonly caused by plantar fasciitis, which is inflammation of the band of tissue connecting the heel bone to the toes, as well as other conditions such as Achilles tendinitis, stress fractures, heel spurs, bursitis, and nerve irritation. The causes of heel pain can be multifactorial, including overuse, improper footwear, sudden weight gain, and foot structure problems like flat feet or high arches 1.
Common Causes of Heel Pain
- Plantar fasciitis
- Achilles tendinitis
- Stress fractures
- Heel spurs
- Bursitis
- Nerve irritation
Risk Factors
- Overuse
- Improper footwear
- Sudden weight gain
- Foot structure problems (like flat feet or high arches)
According to the most recent and highest quality study available, the American College of Foot and Ankle Surgeons divides heel pain into plantar heel pain, usually related to pathology of the plantar fascia, and posterior heel pain, usually related to pathology of the Achilles tendon, with treatment options varying from nonoperative treatments to surgical procedures 1.
Treatment Options
- Rest
- Ice application for 15-20 minutes several times daily
- Over-the-counter pain relievers like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily)
- Stretching exercises for the calf and plantar fascia
- Wearing supportive shoes with cushioned heels and using heel cups or custom orthotics
It is essential to note that most heel pain improves within weeks with conservative measures, but if pain persists beyond a few weeks, worsens, or is accompanied by swelling or inability to bear weight, medical evaluation is necessary to consider more advanced treatments like physical therapy, steroid injections, or rarely, surgery 1.
From the Research
Heel Pain Causes
Heel pain is a common condition that can be caused by various factors. Some of the main causes of heel pain include:
- Plantar fasciitis, a self-limiting condition that affects more than 1 million persons per year 2
- Obesity, excessive foot pronation, excessive running, and prolonged standing, which are risk factors for developing plantar fasciitis 2
- Sedentary and athletic populations are also affected by plantar fasciitis 2
Symptoms of Heel Pain
The symptoms of heel pain can vary, but common symptoms include:
- Heel pain with the first steps in the morning or after prolonged sitting 2
- Sharp pain with palpation of the medial plantar calcaneal region 2
- Discomfort in the proximal plantar fascia can be elicited by passive ankle/first toe dorsiflexion 2
Treatment Options for Heel Pain
There are various treatment options available for heel pain, including:
- Conservative treatments such as rest, activity modification, ice massage, oral analgesics, and stretching techniques 2
- Physician-prescribed treatments such as physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections 2
- Corticosteroid injection, which is frequently used for plantar heel pain, although there is limited high-quality evidence to support this treatment 3
- Combination of corticosteroid injection and controlled training, which is recommended as first line treatment in patients with plantar fasciitis 4