Heel pain can be caused by a variety of medical issues. Trauma, overuse, or other factors can lead to problems such as stone bruises, heel spurs, Achilles tendinitis, or retrocalcaneal bursitis. The most common cause of heel pain is plantar fasciitis—an inflammation of the tissue bands that connect the heel to the bones of the forefoot.
Treatment for heel pain varies with the cause but can range from rest or different shoes to physical therapy or surgery.
Plantar fasciitis is an inflammation of the plantar fascia, a ligament that runs along the bottom of the foot from the heel to the base of the toes. This ligament normally supports the arch of the foot, functioning as a shock absorber, but if after repeated stretching it tears, inflammation and severe heel pain result. Plantar fasciitis is the most frequent cause of heel pain and a common reason for the development of outgrowths of bone, called heel spurs, as well.
Patients with plantar fasciitis have sharp pain in the heel that may extend to the arch of the foot or to the back of the leg during walking. The pain is usually worst in the morning when the patient first steps down on the affected foot. It may subside somewhat and then recur when the patient rises to a standing position after sitting or lying down.
Risk factors for developing plantar fasciitis and heel spurs include overuse during exercise, standing or walking for many hours a day, having naturally tight calf muscles, wearing shoes with high heels, having flat feet or having very high arches. Runners, ballet dancers and individuals who stand a great deal are more prone to develop this condition, as are those who habitually wear shoes with inadequate support or who are overweight. Arthritis, more likely to occur in older individuals, may also be a factor in the development of plantar fasciitis. Most often, the condition occurs in patients between 40 and 60 years of age.
Usual treatments for plantar fasciitis include over-the-counter pain medications, physical therapy, orthotics and corticosteroid injections at the site. In some situations, night splints that stretch the calf and arch during sleep may be prescribed. In severe cases, where the condition does not respond to more conservative treatments, shock wave therapy to the area or surgery may be necessary.
Plantar Fascia Tear
A tear, or rupture, of the plantar fascia ligament is typically characterized by acute pain in the heel and arch of the foot. Inflammation and bruising may also develop. The tear can occur due to trauma, such as a fall or jump from a high place, or from intense movement during a sports activity.
The pain caused by a plantar fascia tear is often like that of plantar fasciitis, but the patient typically experiences a "pop" in the foot and sudden pain during the event that resulted in the tear. In contrast, plantar fasciitis generally progresses slowly over time.
Treatment of a plantar fascia tear may include use of a cast or boot to keep the foot immobilized, anti-inflammatory and pain-relief medications and corticosteroid injections. A chronic or very large tear might require surgery to repair the ligament and prevent complications from developing.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome, also known as posterior tibial neuralgia, is a disorder of the foot that may result in significant pain. The tarsal tunnel, the canal that runs between the inner ankle and the band of ligaments that stretch across the foot, houses several vital arteries, nerves and tendons, which provide flexibility to the foot. Since the walls of this tunnel consist of either bone or tough fibrous material through which these blood vessels, tendons and nerves must pass, the inflexibility of the walls may create a problem.
In tarsal tunnel syndrome, abnormal pressure is exerted on the tibial nerve, the nerve that provides sensation to the bottom of the foot, pushing the nerve painfully against the rigid wall of the tarsal tunnel. This can happen for a variety of reasons when any tissue in the area becomes inflamed and enlarged, causing symptoms ranging from tingling to numbness. As the tunnel narrows, the pain may worsen.
There are a variety of treatments for mild to moderate tarsal tunnel syndrome, which may include:
- Resting the foot
- Wearing well-fitted shoes
- Wearing orthotics for support and to limit excess motion
- Receiving corticosteroid or anesthetic injections
- Taking nonsteroidal anti-inflammatory drugs (NSAIDs)
- Wearing compression stockings or a cast to restrict movement
- Taking vitamin B supplements
- Doing foot exercises
When these treatments do not provide relief, surgery may be considered to relieve pressure on the tibial nerve. During such a procedure, an incision is made into the ankle to relieve pressure on the tibial nerve. Benign tumors, cysts and scar tissue, if present, may be removed at the same time to increase the space in the tibial tunnel.