What are the causes of Heel pain?

Feet and Ankles, Nerve Pain, News, Physiotherapy

Heel pain can have a number of different causes. Not all heel pain is due to plantar fasciitis (inflammation) or plantar fasciosis (tissue changed). What is the cause of your heel pain? A variety of structures may give rise to heel pain and occur simultaneously; Plantar fascia -spans under the foot supporting the arch. It […]

Heel pain can have a number of different causes. Not all heel pain is due to plantar fasciitis (inflammation) or plantar fasciosis (tissue changed).

What is the cause of your heel pain?

A variety of structures may give rise to heel pain and occur simultaneously;

  • Plantar fascia -spans under the foot supporting the arch. It may be partially torn, thickened or inflammed. Commonly there is marked thickening of the tissues without swelling. (Lemont et al , 2003; Tountas and Fonasier, 1996).
  • Under the centre of the heel is a fat pad, it may be degenerated or inflamed
  • Heel bone stress 
  • Nerve entrapment or irritation – 10-15% plantar foot pain is caused by nerve pain (see below).
  • Referred pain from the spine L5/S1.
  • Trigger point pain referred from the calf, quadratus plantae, and/or toe flexors
  • Fibromatosis – benign nodules in the fascia
  • Systemic Inflammatory Arthritis – usually bilateral. Both feet can also be painful if you are really inflexible, it doesn’t have to be the worst-case scenario!

In the absence of inflammation cortisone should not be used, it may cause rupture (Lemont et al, 2003, Acevedo and Beskin, 1998, Selman 1994).

Heel spurs are not the source of symptoms (Abreu et al , 2003)

Imaging

X-Rays are not useful imaging. Ultrasound will show thickening, possible tears and hypervascularity, fibromatosis. MRI is the most comprehensive study.

Common symptoms: 

  • Morning pain.
  • Pain when walking after sitting for a while.
  • Worse with prolonged standing or walking.

What biomechanical factors are important?

  • Loss of ankle mobility or tight calves.
  • Loss of calf strength.
  • There is No association demonstrated with  a/ Arch height  b/ Leg length difference  c/ Amount of pronation (Warren and Jones 1987, Powell 1998)

Treatment – all this is available at The Physio Yoga Clinic in Crows Nest, where we have decades of experience treating heel pain.

  • Stretching:  Non-weight bearing stretching is better than weight-bearing early in treatment. Intermittent stretching throughout the day
  • It is important to be Assessed fully to find the Cause, specific to your body.
  • Night splints can help ease morning pain – as long as there are no nerve symptoms
  • Orthotics are not proven to help. A few well-controlled studies have shown this. (Lynch 1998, Martin et al 2001, Pfeffer et al, 1999). An off-the-shelf soft orthotic or silicone heel insert has been found to be more beneficial.
  • Low dye taping can help or a silicone heel cup (esp if you have central heel pain)
  • Laser – low level therapeutic medical laser (here at Physio Yoga Clinic)
  • Dry needling of trigger points and tight muscles, not under the foot!
  • Strengthen specific muscles, you will need to be tested for weakness.
  • Calf raises – technique can vary depending on your foot
  • Return to Running usually 3-6 months post-injury

Take a look at another of our blogs on Core Foot Posture Exercises.

Nerve Entrapment or Irritation

Local nerve irritation or entrapment in fascia (the container in which the nerve travels) can cause symptoms of

• Burning, sharp or shooting pain

• Night pain

• Can spread or move about

• Decreases with walking

• altered sensation – tingling, ache, line of pain, weird feelings

• Pain at rest or with driving is indicative

• Failure to respond to local treatment

Be fully assessed by A-J with 20+ years of experience in treating Heel pain.  Book Online here 

Related Resources

Core Foot Posture exercises

Do you suffer from painful or stiff feet? You may be interested in foot strengthening exercises. The foot has stabilising (core) muscles just like the pelvis and lower back. These muscles get de-trained wearing shoes all day. It  is necessary to wear shoes on concrete...

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