Heel pain

• feet that flatten and roll inward when walking or running
• shoes with poor arch support
• stiff-soled shoes
• quick turns that put stress on the ligaments
• too much distance running

Bursitis (inflammation of the back of the heel) can be caused by landing hard or awkwardly on the heel, or by pressure from shoes.

Achilles tendinitis , which occurs when the calf muscles repeatedly contract suddenly or with much force, can be caused by:

• shortening of and lack of flexibility in the calf muscle
• shoes with inadequate stability or shock absorption
• sudden inward or outward turning of the heel when hitting the ground
• running on hard surfaces, such as concrete

Common Causes:

• plantar fasciitis
• bursitis
• Achilles tendinitis
• bony spur

Note: There may be other causes of heel pain. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for heel pain, occurring alone or in combination with other problems.

Home Care:
For plantar fasciitis (if the pain on the bottom of the foot is about 1 to 2 inches from the back edge of the heel), rest as much as possible for at least a week; over-the-counter analgesics can be used for pain. Wear proper-fitting shoes. Avoid shoes with excessively low heels. A heel cup, felt pads in the heel area, or an orthotic device may help. The most important thing to do is refrain from the activity that caused the problem and allow the injury to heal. Be patient; this problem can take a year or more to go away.

For bursitis (if the pain and swelling is just above the back of the heel or on the bottom of the heel near the back edge), rest for at least a week and take over-the-counter analgesics for pain and inflammation. New shoes or stretching of the old shoes to avoid rubbing against the heel is recommended. Pressure from the bump may be relieved by applying moleskin to the affected area.

For Achilles tendinitis (if the pain and tenderness is in the Achilles tendon, usually about 2 to 3 inches above the bottom edge of the heel), avoid exercise and apply ice twice a day to the tendon. Take over-the-counter analgesics for a week to relieve pain and reduce inflammation. Following a week or more of rest, proper stretching is the most important treatment.

Call Your Healthcare Provider If:

• pain is getting worse despite home treatment, or if there is little progress after a month.

What to Expect:
The medical history will be obtained and a physical examination performed.

Medical history questions documenting heel pain in detail may include:

• time pattern
  • Is this the first time that you have had this type of heel pain?
  • When did the pain begin?
  • If the pain is long term, at what age did pain begin?
  • How long does each episode of pain last?

• associated complaints
  • Is there enlargement of the bone?

• location
  • Is the pain in the joint?
  • Is it in the back of the heel (posterior)?
  • Is the pain on the bottom of the foot about 1 to 2 inches from the back edge of the heel?
  • Is the pain just above the back of the heel or on the bottom of the heel near the back edge?
  • Is the pain only on one side (unilateral)?
  • Is it in the tendon at the back of the heel (Achilles tendon)?

• quality
  • Is the pain dull and aching or sharp and stabbing?

• aggravating factors
  • Is it worse after you exercise ?
  • Is it worse when you are standing?
  • Have you had a fall recently?
  • Have you twisted your foot recently?
  • Are you a runner?
    • How far do you run?
    • How often do you run?
    • Where do you run?

  • Do you walk or stand on your feet often?
  • What kind of shoes do you wear?

• other
  • What other symptoms are present?
  • Is the heel swollen?

The physical examination will include a detailed examination of the foot and leg. Diagnostic tests that may be performed include a foot X-ray ( extremity X-ray ) focusing on the heel.

Intervention:
If either plantar fasciitis or bursitis is diagnosed and if shoe changes and the use of orthotics have not been successful, then cortisone injections may be tried. Surgery is a last resort and is seldom necessary.

If Achilles tendinitis is diagnosed, an oral anti-inflammatory medicine may be prescribed. Heel lifts may be used. In particularly unresponsive cases, a walking cast may be tried. Surgery is usually unnecessary.

After seeing your health care provider:
If a diagnosis was made by your health care provider related to heel pain, you may want to note that diagnosis in your personal medical record.