Of all the reasons people visit a podiatry office—fungal nails, diabetic foot checks, bunions or hammertoes—the top concern we hear about is heel pain. Whether your pain is located at the back, front, or side of the heel, the significant discomfort it provides can keep you from enjoying physical activities, or even just accomplishing daily tasks.
Heel pain is often related to overuse injuries—or in other words, too much stress, weight, and pressure in too short a time frame with not enough time to rest and recover. There are many possible causes, but the two most common conditions by far are plantar fasciitis and Achilles tendinitis.
Plantar fasciitis is pain and inflammation in the plantar fascia, a band of tissue that runs across your sole. Its primary purpose is to support the arch, but a tight plantar fascia that’s stretched too far normally causes pain at the point where it attaches to the heel bone, typically underneath and just in front of the heel. Additionally, a tight or contracted Achilles tendon (also known as equinus) can pull on the plantar fascia from the opposite direction, potentially doubling the strain.
Your Achilles may be the strongest tendon in your body, but that doesn’t mean it’s indestructible. Achilles tendinitis usually emerges as a result of athletic overuse, particularly lots of running and jumping. Continuing to put heavy forces on tight, inflexible calves (which could be a result of genetic inheritance or lack of stretching) forces the Achilles to withstand added strain, which in turn leads to painful symptoms often located at the back of the heel.
Other Possible Causes of Heel Pain
Of course, while plantar fasciitis and Achilles tendinitis are by far the most common diagnoses, they are by no means the only ones. Other conditions that could cause heel pain include:
- Arthritis, whether by “wear and tear” (osteoarthritis), injury, or disease (such as rheumatoid arthritis).
- Achilles tendon rupture, a sudden injury in which the tendon tears or even rips completely.
- Bursitis, inflammation of a bursa fluid sac at the back of the heel.
- Foot deformities or biomechanical / gait flaws such as flat feet, high arches, overpronation, or other mechanical problems that places extra stress on the heel.
- Nerve entrapment, such as tarsal tunnel syndrome, in which nerves near the heal are pinched or compressed.
- Stress fractures, which are small cracks in bone due to overuse.
- Sever’s disease, inflammation of the exposed growth plate at the back of the heel. Affects young teens, typically active ones, during growth spurts.
Diagnosis and Treatment for Painful Heels
An accurate diagnosis is necessary to ensure successful treatment. In addition to a physical examination, we also provide technologies such as X-ray and diagnostic ultrasound to positively identify the source of your heel pain.
The good news is that many cases of heel pain, including plantar fasciitis and Achilles tendinitis, can frequently be treated successfully through the use of conservative therapies. In fact, the majority of treatment frequently happens at home, outside of physician supervision. Education is critical to our approach—we’ll help you understand the steps you need to take to overcome your discomfort.
Initial treatments often include rest, icing, stretching, and physical therapy. Pre-fabricated or custom orthotics are also frequently beneficial, particularly to correct an underlying structural defect or biomechanical problem.
More advanced treatments or procedures we may perform for various types of heel plain include platelet-rich plasma therapy (PRP), extracorporeal shockwave therapy (ESWT), or stem cell injections. These are rarely necessary but are sometimes the best option for more severe conditions, particularly as an alternative to surgery. Surgery is available as a last resort for conditions that remain painful on a daily basis, but in general we strongly urge you to exhaust all alternatives first.
When you visit North Austin Foot & Ankle Institute for your heel pain, you know you’re in good hands. From a thorough examination and diagnosis, to providing a wide variety of solid, evidence-based medical approaches, and taking the time to fully educate you and any addition caregivers on your condition and options, our goal is to provide the best possible care custom tailored to your medical, personal, and lifestyle needs. To schedule an appointment, please fill out our contact form or give us a call today at (512) 593-2949.