Heel pain can be the result of a biomechanical imbalance, bruise, overuse injury or underlying systemic medical problem. When the pain occurs on one side, it may necessitate the use of crutches to rest the area. Treatment may also include anti-inflammatory medication, physical therapy, stretching, strengthening or surgical intervention. However, treatment protocols will depend on an accurate diagnosis to ensure that the correct modalities are used.
Plantar Fasciitis
This is a result of too much activity or because the arch of the foot does not get enough support in the shoes. Overuse during running or jumping can inflame the band of tissue that connects the heel bone to the base of the toes on the underside of the foot, according to the American Academy of Orthopedic Surgeons. When the plantar fascia is inflamed, the pain is usually centered under the heel. It may be mild at first but will continue to get worse until rest and treatment is initiated.
Stone Bruise
A stone bruise happens to the foot when it strikes a rock or stone or other hard object. According to the American Academy of Orthopedic Surgeons, these injuries will heel gradually with rest. The bruise occurs over the fat pad on the underside of the heel and does not affect the bone. Even though it may be bruised, the heel may not discolor.
Tarsal Tunnel Syndrome
This syndrome is caused by compression of the tibial nerve as it runs from the ankle to the foot. The nerve travels through a limited space bound by a fibrous bony structure. Tendons, muscles, arteries and veins also use the entry into the foot. When compression happens, the individual will experience a burning sensation at the heel. Physicians may order nerve conduction studies to evaluate and confirm the diagnosis.
Calcaneal Stress Fracture
Acute pain in the heel can result from a stress fracture in the heel that closely resembles the pain of plantar fasciitis. However, according to American Family Physicians, the history may reveal a recent abrupt increase in activity or running distance. Pain will be felt on standing and walking but can be elicited when the physician places pressure on the sides of the heel. Activity should be limited, and patients should wear supportive athletic shoes for three weeks. If the pain has not subsided by then, the physician may recommend a removable cast boot.
Sever’s Disease
This is a condition that occurs in children when there is an injury to the growth plate in the heel of the foot. Because the heel grows faster than other bones of the body, it reaches full size first. According to Family Doctor, during this time the muscles and tendons tighten and the heel becomes less flexible. The tight tendons put pressure on the back of the heel and can cause an injury to the heel. It is most common in physically active girls ages 8 to 10 and physically active boys ages 10 to 12 years.
Achilles Tendinitis
The Achilles tendon inserts into the heel bone and connects the calf muscle to the heel. Running or jumping too much, as well as wearing shoes that rub or cut into the back of the heel, can cause pain. Poorly fitting shoes will cause the skin over the heel to thicken, redden and swell. Sometimes a red bump will develop that is tender and warm to the touch. If left untreated, the Achilles tendon can rupture, necessitating surgery to repair it.
