The fatty tissue that makes up your heel may seem pretty idle, but it has a vital role to play. It dictates the structure of your foot,
manages weight distribution and balances your gait. So, if you’re experiencing heel pain it can make a big difference to how you go
about your day.
Unlike other foot and ankle issues, heel pain can be caused by a wide range of different conditions or injuries. In this article,
we’ll give you more info on the different causes of heel pain and potential treatments. Giving you a better understanding of what
might be contributing to your heel pain and the power to do something about it.
So, what causes your heel pain? There are two core groups of causes: internal and external. This relates to whether
the ‘problem’ is something on the surface of your skin (a dermatological issue) or whether it is something related to your
muscles, tendons, ligaments, joints, bones, nerves or blood vessels. Below we have a description of each cause, and these should help you to
self diagnose to some degree, but it’s always best to get a professional assessment from a registered practitioner or podiatrist.
Internal
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Plantar fasciosis or commonly known as Plantar fasciitis is
a degeneration of the tendon-like band of fasciae that connects the heel bone to the toes. This will often feel like a sharp
‘stabbing’ pain in and around the heel, and it commonly produces sharp pain in the morning that fades to a dull ache throughout
the day. Tight calf muscles or reduced ankle joint range of motion is associated with this condition as bands of the plantar fascia
and the Achilles tendon are connected.
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Heel spurs are a bony calcium deposit that develops on the underside of the heel. Heel spurs are commonly associated with
plantar fasciosis as the body attempts to repair the degenerating tendon at the site where the tendon is attached to the heel bone. This
process occurs over several months, producing sharp pain in the morning and fading to a dull ache throughout the day. Following any
treatment, the morning pain associated with both plantar fasciosis and heel spurs is always the last to resolve.
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A stress fracture is a stress reaction in the heel bone that worsens over time. A stress fracture will
often feel tender when weight bearing or when pressure is placed on the heel.
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Sever’s disease is a swelling and irritation of the growth plate in the heel. This is experienced by children
commonly between the ages of 8-12 years of age. Sever’s disease often presents itself as redness and swelling, making the back of the
heel tender and tight.
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Achilles tendinopathy is a degeneration of the Achilles tendon which connects the calf to the heel. Initially, it will
deliver a mild aching pain however it can develop into swelling and tenderness. Often associated with high impact exercise or sports.
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Flat feet can be hereditary or develop over time, characterized by having no arch in the foot. The arch plays a vital role
in supporting the foot and its surrounding tendons and ligaments. So, with flat feet the pain can centralise in the heel with the tendons
and ligaments attached to the heel taking a more supportive role.
External
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Corns and calluses are patches of skin that are hardened as a result of friction or pressure. Typically, in a circular or
conical shape. Corns and calluses can cause localised heel pain if left untreated.
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Cracked heels are what you see on all the treatment cream adverts. Our skin is the largest organ and is responsible for
protecting our internal organs from the outside world. One way the skin protects us is by thickening itself, a condition is commonly known
as callous. Callous develops from excessive plantar pressure, commonly from increased weight. Much like the desert floor cracking from
drought, our skin can dry out and crack from medications, conditions like hypothyroidism or exposing our feet to the environment by walking
barefoot or in footwear that offer little support. Cracked heels can feel uncomfortable, painful and even develop an infection as the crack
becomes a portal of entry for bacteria on the outside world.
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Plantar warts are hard growths that appear on the bottom of our feet. These are caused by HPV (human papillomavirus) and
become painful in areas of pressure.
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Blisters are an area of skin covered by a raised, fluid-filled ‘bubble’. Usually the result of ill-fitting
shoes or excessive friction of the heel. They can increase in size and become very painful over time.
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Pompholyx is a condition that is linked to seasonal allergies or stress in which itchy pustules appear on the skin around
the heel. When the pustules dry out they become painful.
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An athlete’s foot is a fungal infection that usually starts around the toes. Often caused by not changing your
footwear or socks after sweating. This condition can cause the skin to crack which results in a stinging or burning sensation around the
heel.
How to fix your heel pain?
Just like the causes, we’re going to split the treatments into external and internal. This will allow you to explore the different
options you have to solve your heel pain. Helping you to decide whether you can manage them yourself or you need help from a health
practitioner.
Internal
As you can see above, the majority of internal pain is caused by soft tissue or bone injury. These issues usually require some physical
therapy or a more hands-on approach. Some common treatments may include:
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RICE protocol. Rest, ice, compression, and elevation. This is a standard first aid protocol that is useful in the acute
phase for reducing inflammation in the first 72 hours of injury. This is not useful after this period and does nothing for addressing the
cause. If your pain continues, seek advice from a health professional like a podiatrist.
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Podiatry. Working with a professional for treatment that is based on your needs. Get in touch with our Brisbane
podiatrist clinic for more information on this.
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Modified exercise program. Building an exercise program that doesn't aggravate symptoms but helps to strengthen weak
muscles related to the injury and maintaining physical activity to help you achieve your goals. The last thing you want to do is stop.
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Shockwave therapy. A non-invasive therapy that uses audio waves to stimulate a healing process of the targeted
tissue.
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Dry needling. Using a very fine needle to break apart knots (aka trigger points) within muscles cause an inflammatory and
healing response.
- Foot mobilisation therapy to improve the mobility of the ankle and joints of the feet.
- Foot and ankle strapping to support the feet during the healing phase.
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Supportive footwear with support and cushion in the right places. The cushion is a double edge sword. Evidence has shown
that full cushion shoes make our feet and legs work harder which can make an injury worse. When the cushion is in the right spot it can
improve things for our conditions. No one shoe will fix all that's why professional advice is recommended. Podiatrists are footwear nerds
and know what's best for you.
However, if you are experiencing any issues it’s always best to consult a podiatrist who will be able to advise you on the best
treatment for your internal heel pain.
External
Some of the external sources can be rectified at home or with one-off treatments, but the majority require
Ongoing maintenance unless the root cause of the issue is resolved. Here are a selection of treatments to manage or rectify your externally
sourced heel pain:
- Mechanical debridement.
- Dermal foot balm. Ultra-moisturising balm to treat dry skin.
- Changing shoes and socks regularly
- Letting your feet ‘breathe’ after exercise or sweating.
- Foot and ankle strapping
- Swift therapy. Focused microwave therapy that rapidly heats the tissue. Used to treat warts and verrucas.
- In clinic chemical treatments. Using powerful chemicals in targeted areas to remove warts, corns or verrucas.
- Cryotherapy. Targeted freeze therapy is used to treat warts
- Surgical wart removal
- Over the counter remedies: this could be for athletes' feet or warts (home freezing or reduction creams).
- Using a pumice stone on callused area: for corns and calluses
- An exercise program to improve mobility
- Remove causes of friction for blisters and calluses
- Keep burst blisters in an antiseptic area
Again, if your symptoms are becoming increasingly severe or painful please consult a podiatrist to get further advice.
We hope this article has given you some insight into the reasons your heels hurt and how to fix them. For more information on causes of heel
and other types of foot pain, check out our blog. Or, if you’d like to book an appointment with one of our podiatrists, get in touch
with us today.
Book your appointment with our podiatry team online
here
or call us on (07) 3356 3579.
