Many of us will experience heel pain, especially when walking. This is a common complaint heard at REP Physio in Edmonton. Your symptoms may come on gradually over time, suddenly out of nowhere, or following a known trauma to the area. You may feel soreness, aching, tenderness, or other pain anywhere in the heel area, including: the back of the heel, arch, plantar fascia, achilles tendon, calf muscle, or the bottom of your heel. All of these structures and surrounding tissues work together to provide cushioning, support, and control when you walk. However, if these structures (or others) become irritated, they may cause pain in the heel from the impact experienced when walking. Altered gait pattern or limping may occur to avoid aggravating the inflamed structures, which in turn can cause other issues and pain. Since we need to walk to conduct our daily lives, it is hard to give these inflamed structures a chance to calm down. It is like poking an angry bear - the more you poke it (in this case, the more you walk/move), the more angry it will get, and it can make the pain worse.
Common causes of heel pain
Heel pain is a very common symptom that has a wide range of potential causes. It is important to determine the cause of your unique heel pain to receive proper treatment and management. Some potential causes of heel pain include:
- Achilles tendonitis - an overuse injury to the achilles tendon caused by repetitive stress.
- Plantar fasciitis
- Heel spurs
- Heel bursitis
- Fat pad syndrome
- Stress fracture
- Bone bruise
- Bursitis
- Haglund's Deformity
- Sever's Disease (calcaneal apophysitis)
Each of the above heel pain causes can present as pain in the heel bone or in other areas of the foot. We will break down these diagnoses and what they mean below. An efficient recovery from heel pain is far more likely if you understand the cause of your heel pain and how to properly manage it - so, when in doubt, book in with your trusted physical therapist or health care professional!
Achilles tendonitis
The Achilles tendon is a band of tissue tissue that connects your calf muscle to your heel bone. When your calf muscles contract, they tug on the achilles tendon which in turn pulls on the heel bone to help move the ankle joint and allows you to point your toes. Walking, running and jumping, and other activities in our day to day life require constant function of the achilles tendon. This repetitive stress can lead to inflammation of the achilles tendon, especially when the structure is not given adequate rest. Achilles tendonitis is exactly that - an overuse injury to the achilles tendon causing inflammation and pain in the region.
Signs and symptoms of achilles tendonitis may include pain on the back of the heel (heel pain is common complaint) and/or ankle, tenderness, stiffness and/or swelling of the tendon, or pain during or after activities like calf raises, walking, running and jumping. Pain may be worse in the morning (improve throughout the day), during activity or the day after, or when climbing a hill or stairs.
You may be at a greater risk of developing achilles tendonitis if you work a physically demanding job, run often, play sports - especially those requiring lots of running and jumping, or are a "weekend warrior" (play sports at a fairly competitive level infrequently without consistent exposure).
Achilles tendonitis can be a tricky injury to treat as it is difficult to refrain from using the injured tissue in day to day life. Your health care provider can assess your heel pain and diagnose achilles tendonitis through a complete assessment including both subjective history and objective measures. You can work with your health care provider to determine the proper course of treatment to manage your injury.
Plantar fasciitis and plantar fascia pain
Plantar fasciitis (PF) is one of the top causes of heel pain. It occurs when the plantar fascia becomes inflamed. Plantar fascia is a thick, fibrous band of connective tissue that runs along the bottom of your foot, from the heel bone to the base of the toes. It helps to support the arch of the foot and maintain proper gait mechanics. Plantar fasciitis pain can develop because of a sudden increase in weight bearing activity, improper footwear, hard surfaces underfoot, an increase in body weight (e.g. pregnancy), among other things.
PF pain usually starts in the arch of your foot. It can include pain in the arch or heel pain in the morning, when getting up after a period of being sedentary, with bare feet or when wearing improper footwear with minimal support. People with plantar fasciitis typically experience a painful heel on only one side, not both simultaneously. Heel discomfort may reduce throughout the day and/or with activity. Sometime to prevent heel pain due to PF, shoes with a decent heel drop (more padding on the heel, less towards the forefoot) can be helpful. You don't need high heels, but something comfortable with lots of support. Being barefoot at all times home can make this heel pain worse. Chronic plantar fasciitis can be described as PF pain that lasts greater than 6 weeks. In this case a diagnostic ultrasound may be completed to get a better idea as to the quality of the fascial tissue.
Heel spur
A heel spur is a bony growth on the bottom of your heel, often localized where your plantar fascia inserts on the heel bone. A bone spur may develop in response to stress on the area (e.g. from plantar fasciitis). Heel spurs may also develop from other stresses such as a gait disorder. Heel spurs generally cannot be cured and treatment is usually aimed at treating the primary condition responsible for the growth (e.g. plantar fasciitis). Some conservative treatment options may include: rest, ice, topical or oral anti-inflammatory medication and proper supportive, cushioned footwear or shoe inserts. Fortunately, foot and ankle surgeons rarely remove heel spurs. The reason is that the presence of a heel spur, does not necessarily mean you will have pain. Said differently, people with and without heel spurs can have pain in the same area.
Heel bursitis
Heel bursitis is the painful condition whereby the bursa - a fluid-filled sac - between your achilles tendon and calcaneus becomes inflamed and irritated. Bursa sacs are responsible for reducing friction between bones, muscles, tendons, and skin. Irritated and inflamed bursa sacs cause pain in the region and cannot properly act as a cushion or lubricant. This condition will make repetitive movements of the ankle and actions like walking, running and jumping quite painful.
Signs and symptoms include: pain, swelling and tenderness, warmth, change in skin color in the heel region. Although it is a common condition, you have a higher likelihood of developing bursitis of the heel if you overuse your ankles without an acclimation period - e.g. you suddenly start walking, running, or jumping more than before - or if you are an athlete in a sport that requires repetitive foot/ankle motions.
How to treat heel pain
Heel pain typically improves with non-surgical treatments over time. Treatment can be case-specific, but may include efforts to reduce pain and inflammation, increase strength and mobility, and reducing strain on the foot and heel. Some options include:
- Rest - Resting the injured area gives your body time to heal and can reduce your pain levels. This does not necessarily mean you avoid movement all together, but that you avoid, or modify, the activities that are stressing the injured tissues or aggravating your symptoms.
- Exercises - Movements to help stretch and/or strengthen the muscles, tendons and ligaments in the foot and lower leg may help reduce irritation and pain in the heel.
- Pain Relievers - Pharmacological intervention and other modalities can help with pain and swelling management. Your health care provider may recommend modalities such as heat, ice, NSAIDs (non-steroidal anti-inflammatory drugs), topical anti-inflammatory medication, or other options.
- Orthotic Devices - Some conditions of the heel may benefit from devices such as over-the-counter or custom shoe inserts (orthotics). Some pain may improve by using a night splint, especially if symptoms are worst in the morning.
- Physical Therapy - Physical Therapists are trained to help you treat your pain and injuries. They use many different techniques including manual therapy, soft tissue massage, modalities (e.g. shockwave therapy, dry needling, acupuncture, etc.) coupled with home programs to help you treat heel pain at home through exercises and stretches.
- Lifestyle Changes - changing certain things in your day-to-day life can help reduce heel pain. Some examples include wearing supportive shoes, managing your weight, reducing aggravating activities, or gradually becoming more active.
Stretching exercises for heel pain relief
A simple way to help some reasons for heel pain include simple stretches. Whether you stretch your foot or your calf (or anywhere really), if the stretch feels good, then do it. In some cases however, strething may not be appropriate (chronic tendon dysfunction for example). Again, if you're experiencing pain, or are unsure about what to do, contact the physiotherapists at REP Physio in Edmonton.
Physical therapy for heel pain
The approach at REP Physio for common foot problems is to begin with a thorough, one on one assessment. At REP Physio, we take the time that is necessary to understand not only your injury, but also how it fits in with your lifestyle and approach. We call this complete care management. This allows us to tailor goals and timeles specific to your unique, individual needs. What you will not get at REP Physio is heat and a TENS machine, or passive care. We only provide evidence based, active care. Following a thorough subjective history, we will complete a detailed biomechanical exam and record baseline measures as appropriate so we can objectively track your progress and response to our interventions.
Using orthotics to support heel pain
In some scenarios a custom orthotic may be recommended for certain types of heel pain. Unlike some clinic, our orthotics are not made by physiotherapists. Rather, clients of REP Physio have their orthotics made by our certified pedorthist, as creating custom foot orthotics is all they do. That way you are getting the right type of provider for the right type of care. Our certified pedorthist can also determine if ill-fitting shoes are a potential cause of your heel pain and direct you towards the right shoes to help with your problem
Come get an assessment
You don't have to accept heel pain when walking. Come see one of our experienced physiotherapists at REP physio today and put some pep back in your step. At REP Physio, we pride ourselves on having an extensive knowledge of heel conditions. We will get to the root problem that is causing the pain in your heel. For more information on heel pain, check out our other heel pain blog.
