Heel pain is a common complaint, especially among those who spend a lot of their time on their feet for work, or who are involved in repetitive impact sports. The cause of this pain can be varied and should be thoroughly investigated to ensure the right course of treatment is ensured.

Firstly, there are two separate areas which are often termed 'heel pain.'

  1. Underneath the heel – the bit we stand on.
  2. At the back of the heel – the Achilles region.

Pain underneath the heel may be caused by a number of injuries. By far the most common is Plantar Fasciitis. This is an infection and degeneration of the fascia which attaches to the heel bone and runs along the arch of the foot. Symptoms include pain under the heel, usually towards the inside and sometimes also along the arch. It is often at its worst first thing in the morning or after long periods of rest.

Other causes of pain under the heel include a bruised heel which usually occurs after a fall or repetitive impact to the fat pad which cushions the heel bone.

A heel spur should also not be overlooked. These are often confused with plantar fasciitis and can cause the condition, however both can exist independently. A heel spur is a bony growth underneath the heel which may be symptom free or may cause pain under the heel.

Pain at the back of the heel is often attributed to the Achilles tendon and related structures. Achilles tendinopathy is a degenerative condition of the Achilles tendon which attaches the calf muscles to the heel bone. It is a common running injury and causes pain, stiffness and often a creaking feeling in the tendon. It also is often worse in the mornings.

Other causes of pain in this region include Achilles tendon tears which have a more sudden onset than a tendinopathy which tends to develop gradually. Achilles bursitis is inflammation of the sack of fluid which sits between the tendon and heel bone. Again this is usually an overuse injury and can be difficult to distinguish from a tendinopathy.

In young athletes with pain at the back of the heel, Sever's disease should have considered. This is an osteochondroses similar to Osgood Schlatters disease of the knee. It occurs around the time of sudden growth spurts due to the pull of the tendon on the growth area at the back of the heel. Younger bones are still reliably soft and so the pull of the Achilles on this area often results in micro-fractures and the development of a lump at the back of the heel.

Once the cause of heel pain has been established, a suitable treatment plan should begin. Whilst reducing pain and inflammation are the first step, it is important to consider, and then correct, the cause of the injury, especially in overuse injuries such as PF or tendinopathy. Common causes include:

  • Tight calf muscles.
  • Faulty foot biomechanics – such as overpronation or oversupination.
  • Sudden increases or changes to training.
  • Unsupportive footwear.
  • Wearing high heels frequently.

Without correcting the cause of the injury, the pain will more than likely return once normal activities are resumed.