With an intricate system of 28 bones connected by numerous joints, muscles, tendons and ligaments, the foot is one of the most complex parts of your body. Every day your feet bear your weight and withstand the shocks of overuse and abuse, repetitive actions, extreme situations, trauma, disease and the natural wear-and-tear of aging. Due to these many potential causes of heel pain, the heel is always at risk for injury or trauma.
Heel pain originates from a variety of conditions including acute trauma, such as a broken heel from a fall or automobile accident or an overuse injury from regular exercise like running or rollerblading. Heel pain also comes from systemic diseases like diabetes, nerve disorders or degenerative osteoarthritis. Mild to severe heel pain can also originate from simple, everyday habits such as walking or jogging in worn-out athletic shoes that have no support. As a result, symptoms of heel pain can vary widely and are not always easy to diagnose.
Some causes of heel pain are:
- Achilles tendon injury – The largest tendon in the human body and the one most often injured, your Achilles tendon connects your calf muscle to your heel bone. Achilles tendon injuries are common sports injuries caused by overuse of the tendon and calf muscles and can lead to tendonitis (inflammation of the tendon) or a ruptured or torn tendon that requires surgery. Achilles tendon injuries are a common cause of heel pain.
- Plantar fasciitis – Plantar fasciitis is an overuse injury of the plantar (sole surface) of your foot and results in inflammation of the fascia, a tough, fibrous band of tissue that connects your heel bone to the base of your toes. Plantar fasciitis is commonly thought to be caused by a heel spur, but research has proven that to be untrue. Rest, icing and exercises that help stretch the fascia are very effective in relieving the pain.
- Heel spurs – Spurs are hooks of bone that form at the back of the foot. The American Academy of Orthopaedic Surgeons (AAOS) reports that one out of 10 people has heel spurs, but only one out of 20 people with heel spurs has symptoms of heel pain.
- Stone bruise – When you step on a hard object like a rock or stone, you can bruise the fat pad on the underside of your heel. It may or may not look discolored, and the pain goes away gradually with rest.
- Retrocalcaneal bursitis – Heel pain symptoms that occur behind the heel can result from inflammation in the area where the Achilles tendon inserts into the heel bone. This is often caused by running too much or wearing shoes that rub or cut into the back of the heel.
- Heel fractures – Fractures of the heel bone (calcaneus) often happen during high-energy collisions such as a motor vehicle crash or a fall from a height.
- Osteoarthritis of the heel – Known as wear-and-tear arthritis, osteoarthritis can cause painful inflammation of one or more of the 30-plus joints in your foot, including the subtalar or talocalcaneal joint that connects the talus bone to the heel bone. The talus bone is a small bone between the heel bone and the lower leg bones (tibia and fibula). Nearly half of people in their 60s and 70s have arthritis in their feet and/or ankle that do not yet cause symptoms of foot pain.
- Rheumatoid arthritis of the foot and ankle – Rheumatoid arthritis is a chronic autoimmune disease that causes inflammation of the joints in any part of your body. Ninety percent of people with this disease eventually develop symptoms of foot and ankle pain.
- Diabetic foot – People with diabetes can experience multiple problems and complications of the disease in their feet as a result of high blood sugar levels. The condition, known as diabetic foot, is the result of nerve damage and circulation problems caused by diabetes.
- Peripheral vascular disease – Also known as hardening of the arteries, this common circulatory problem is the result of narrowed blood vessels and reduced blood flow to your legs and feet.
Common symptoms of heel pain that occurs under the heel and behind the heel include:
- Severe heel pain as a result of plantar fasciitis, especially when standing after resting.
- Pain, bruising, swelling, heel deformity and inability to put weight on your heel or walk, as a result of a fracture. Minor fractures can be treated non-surgically, but severe ones may need surgery.
- Burning and aching pain while resting, especially at night, and redness and sores that do not heal, as a result of peripheral vascular disease.
- Inflammation of the joints of your foot and ankle, and in severe cases, deformity, can be symptoms of rheumatoid arthritis.
- Thickened, reddened and swollen skin as a result of retrocalcaneal bursitis. Rest, exercises, icing, anti-inflammatory medications and heel inserts can alleviate the pain.
Treatment options depend on the specific cause of heel pain. Due to the foot's intricate system of bones, joints, ligaments and tendons, it is best to consult an orthopaedic or podiatric specialist for an accurate diagnosis and comprehensive plan for successfully treating the underlying cause.