Heel Pain: Causes & Treatment Options

Key Highlights:

• Heel pain is a common foot and ankle issue, most often caused by plantar fasciitis and Achilles tendinitis.
• Physiotherapy plays a crucial role in managing heel pain and addressing underlying conditions, with surgery needed only in extreme cases.
• Your physiotherapist may treat your condition with a mix of key modalities, manual therapy, shockwave therapy, stretching & strengthening exercises, and custom orthotics.
• Home care also plays a role in managing heel pain and may include pain relievers, stretches and exercise, and wearing proper footwear.

Introduction

Heel pain is a fairly common foot and ankle problem that affects many people at some point in their lives. With symptoms ranging from mild discomfort to severe pain, living with heel pain can have a significant impact on your ability to walk and to participate in various daily activities. The good news, however, is that most cases of heel pain can be effectively managed with non-invasive, physiotherapy related treatments, modalities and supports. In fact, surgery is rarely necessary for addressing heel pain and is usually reserved for severe cases that don’t respond to more conservative treatments. If you’re struggling with heel pain, here’s what you need to know about the symptoms, causes and available treatment options.

Understanding Heel Pain and Heel Discomfort

As the term suggests, heel pain refers to feelings of pain or discomfort felt in the heel area of the foot and ankle. It’s a common and universal experience and affecting people of any age and activity level, at some point in their life.

Heel pain symptoms can manifest in various ways, depending on the underlying cause, and may include pain or tenderness in the bottom of your foot, back of your heel, or underneath your heel bone. Some people may experience a sharp, stabbing pain in their heel when taking their first steps in the morning or after a period of rest. Others may notice a dull ache or throbbing sensation that worsens with activity, especially after walking or standing for long periods. In some cases, swelling, redness, or warmth may also be present in the affected area.

What Causes Heel Pain?

Heel pain can have several root causes or contributing factors. Plantar fasciitis is, by far, the most common cause of heel pain, however, Achilles tendinitis is also a common cause. Other contributing factors include flat feet, high arches, and prolonged exposure to hard surfaces.

Plantar Fasciitis: The Most Common Culprit

Plantar fasciitis is the most common cause of heel pain and accounts for approximately 80% of all cases. It occurs when the plantar fascia, a thick band of tissue that supports the arch of the foot, becomes inflamed or irritated. This inflammation can be caused by repetitive strain, excessive pressure on the feet, or small tears in the plantar fascia.

The pain associated with plantar fasciitis is typically felt in the bottom of the heel and can radiate towards the arch of the foot. It’s often described as a sharp, stabbing pain that’s most noticeable when taking your first steps in the morning or after an extended period of rest. Risk factors for developing plantar fasciitis include age, obesity, occupations that require prolonged standing or walking, and certain foot mechanics, such as flat feet or high arches.

Achilles Tendinitis and Its Impact on the Heel

Another common cause of heel pain is Achilles tendinitis, which occurs when your Achilles tendon becomes inflamed. The Achilles tendon is a strong fibrous tissue that connects your calf muscle to your heel bone. It’s responsible for the movement of your foot and ankle and can be subjected to repetitive stress and overuse.

Achilles tendinitis is often characterized by pain and tenderness in the back of the heel, just above the insertion of the Achilles tendon. This pain may get worse with activity, such as running or jumping, and may be accompanied by swelling and stiffness in the area. Factors that can contribute to the development of Achilles tendinitis include tight calf muscles, a sudden increase in physical activity, improper footwear, and biomechanical issues.

Other Factors Leading to Heel Pain

In addition to plantar fasciitis and Achilles tendinitis, there are other factors that can contribute to heel pain. If you have flat feet or high arches, you may be more prone to developing heel pain due to the altered biomechanics and increased stress on your heel and the surrounding structures. Prolonged exposure to hard surfaces, such as concrete or tile floors, can also contribute to heel pain. A lack of cushioning and shock absorption can lead to increased pressure on your heel, causing discomfort and inflammation.

Professional Treatment Options for Heel Pain

When it comes to professional treatment options, physiotherapy is typically the first choice for addressing heel pain. Physiotherapy techniques may include a combination of various key modalities, manual therapy, shockwave therapy, stretching & strengthening exercises, gait analysis, orthotics, taping and bracing. For extreme cases or those not responding to non-invasive physiotherapy treatments, surgery may be necessary.

Physiotherapy Techniques for Pain Relief and Healing

Physiotherapy plays a crucial role in managing heel pain and addressing underlying conditions. Through a combination of modalities, therapies, and treatments, your physiotherapist can help to reduce your pain & inflammation, promote healing and restore your functionality.

• Key Modalities: Physiotherapists use various modalities to manage pain and promote healing. Ice therapy decreases swelling and numbs acute pain, TENS therapy (Transcutaneous Electrical Nerve Stimulation) temporarily interferes with pain signals being sent to your brain, and ultrasound therapy reduces inflammation and promotes tissue healing. Meanwhile, heat therapy relaxes your muscles and improves your blood circulation, which aids in your overall recovery process.
• Manual Therapy: Manual therapy techniques can be very effective for addressing heel pain. Soft tissue massage helps reduce muscle tension and improves blood flow, while myofascial release alleviates tightness in the fascia and surrounding tissues, and joint mobilization enhances joint function and reduces pain.
• Extracorporeal Shockwave Therapy: Shockwave therapy is a non-invasive treatment that uses high-energy sound waves to promote tissue repair and alleviate discomfort. It’s particularly effective for chronic heel pain conditions like plantar fasciitis.
• Stretching and Strengthening Exercises: A key component of any physiotherapy treatment plan for heel pain is stretching and strengthening exercises. Calf stretches can relieve tension on your Achilles tendon and plantar fascia, while other specific stretches can target the plantar fascia itself. Strengthening exercises for your toe, foot and ankle muscles improve heel support and stability, helping to prevent future pain.
• Gait Analysis and Correction: Your physiotherapist may also conduct a gait analysis to assess and correct your walking or running mechanics to reduce stress on your heel. Biomechanical corrections can address issues like overpronation or flat feet, helping to distribute pressure more evenly and minimize pain.

Orthotics and Other Supports for Heal Pain

Your physiotherapist may also recommend supports including custom orthotics, taping and bracing to help manage symptoms, support recovery and prevent future occurrences.

• Custom Made Orthotics: Custom orthotics are tailored shoe inserts that provide support and cushioning for your feet to address specific biomechanical issues contributing to your heel pain. By improving your alignment and distributing pressure evenly, orthotics alleviate stress on your heel, reduce pain, and prevent further injury. They provide long-term relief and enhanced foot functioning. They can also be particularly effective if you have flat feet or high arches, as these conditions can increase your risk of developing heel pain.
• Taping and Night Splints: Kinesiology tape can also be used to support your plantar fascia and reduce pain. Additionally, night splints can be used to keep your plantar fascia stretched overnight, alleviating morning pain and stiffness by maintaining an optimal position while you sleep.

Surgery: An Advanced Treatment Option

Surgery for heel pain is only considered when more conservative, non-invasive treatments fail to provide relief. Conditions like chronic plantar fasciitis, heel spurs, or nerve entrapment may require a surgical intervention to remove damaged tissue, release tight structures, or decompress nerves. A thorough evaluation by a medical specialist will determine whether surgery is required in your case.

Home Care for Heel Pain

Home care can also play an important role in managing your heel pain. Taking over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can provide temporary relief. Stretching exercises, such as calf stretches and plantar fascia stretches, can help improve flexibility and relieve tension in the muscles and tissues of your foot. Wearing supportive shoes with good arch support and cushioning can also help alleviate heel pain.

Medications for Managing Pain and Inflammation

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help with managing the pain and inflammation associated with heel pain and can help to promote healing. They work by reducing the production of prostaglandins, which are responsible for inflammation and pain.

Stretches and Exercises for Heel Pain Relief

Stretches and exercises can be an effective way to alleviate heel pain and promote healing at home. Stretching your calf muscles can help relieve tension and reduce strain on your heel. One simple exercise for stretching your calf muscles is the standing calf raise. Start by standing facing a wall, with one foot behind the other. Keep your front knee bent and your back leg straight, with your foot on the ground. Pull your hips forward toward the wall until you feel a stretch in the calf of your lower leg. Hold the stretch for 30 seconds and repeat several times on each leg.

Stretching your plantar fascia, the band of tissue that runs along the bottom of your foot, can also help relieve heel pain. One effective stretch is the towel stretch. Sit on the floor with your legs straight out in front of you. Place a towel around the ball of your foot and gently pull back on the towel, stretching the arch of your foot. Hold the stretch for 30 seconds and repeat several times on each foot.

In addition to stretching, exercises that strengthen the muscles of your foot and ankle can help provide support and stability to your heel. These exercises may include toe curls, ankle rolls, and heel raises. It’s important to start these exercises gradually and speak with your physiotherapist if you experience any pain or discomfort.

Proper Footwear and Preventing Heel Pain

Wearing proper footwear is essential for preventing heel pain. Supportive shoes with good arch support and cushioning can help distribute pressure evenly and reduce the strain on your heel. Look for shoes that provide ample support and stability, especially if you engage in activities that put a lot of stress on your feet, such as running or jumping. It’s best to avoid shoes with high heels, as they put your heel in an unnatural position and increase your risk of developing heel pain.

Conclusion

Heel pain can be a painful and debilitating experience. However, it’s also a very treatable once you understand the root cause of your condition. By working with a physical therapist employing various therapies and treatments, you can yourself on the path to recovery. Fortunately, the need for surgery is relatively rare and for extreme cases. Completing home stretches and wearing appropriate footwear can also help with managing your symptoms and supporting your recovery.

If you or someone you know is struggling with heel pain, we can help. Contact us today and let us show you why, at Physiomed…Healthier Starts Here.

Frequently Asked Questions About Heel Pain:

What are some common causes of heel pain?

Common causes of heel pain include conditions such as plantar fasciitis, Achilles tendinitis, bone spurs, flat feet, and high arches. Plantar fasciitis is by far the most common cause and occurs when your plantar fascia becomes inflamed. Achilles tendinitis occurs when your Achilles tendon becomes inflamed. Bone spurs can develop as a result of chronic plantar fasciitis. Flat feet or high arches can increase your risk of developing heel pain.

When should I seek medical attention for persistent heel pain?

If you’re experiencing persistent heel pain that doesn’t improve with rest and self-care, it’s important to seek professional support. Chronic heel pain may be a sign of an underlying condition that professional support. A chiropodist or other healthcare professional can conduct a detailed physical exam, evaluate your symptoms, and recommend appropriate treatment options. Severe discomfort, difficulty walking, or any signs of complications are also reasons to seek professional attention.

How long does it take to recover from heel pain?

The recovery time for heel pain can vary depending on your underlying condition and other personal factors. With rest, physiotherapy, and home care, most cases will improve within a few weeks to a few months. Of course, the healing process may take longer for some, especially if the underlying condition is severe or chronic. It’s always best to consult with your healthcare professional for an accurate assessment of your specific situation.