Heel pain is a pretty common reason people hit up foot specialists. It can happen in the heel area, either on the bottom of your foot or the back. Professor Carlos Maynou, who heads the foot department at Lille University Hospital and is the President of the French Association of Foot Surgery, shares some tips on how to tackle this issue.
Most of the time, heel pain (or talalgia) isn’t anything serious. But if it’s super sharp, really bad, or keeps coming back, it can seriously cramp your style.
Quick Anatomy Lesson
Your heel is made up of two bones: the calcaneus and the talus, which sit on top of each other. They’re not the most stable setup, which can lead to heel pain. Under your foot’s skin, there’s a web-like structure made of strong, stretchy tissue that runs from your heel to your toes. This is what gives your foot its arch and helps absorb shock when you walk.
Also, there’s a natural “shock absorber” made of fat in your heel. But here’s the kicker: as you get older, that fat cushion tends to wear down, which is why heel pain can pop up more often as you age.
In short, your foot is a pretty complex structure that takes a lot of pressure every time you walk or run.
What’s Heel Pain All About?
There are two main types of heel pain:
- Plantar Talalgia: This is pain in the bottom of your foot, specifically at the heel bone (calcaneus). The plantar fascia, a fibrous membrane that stretches from your heel to your toes, is usually the culprit. It helps support your foot and absorbs shock. Plantar fasciitis, which is inflammation of this fascia, is a common cause of heel pain, often due to repeated stress.
- Posterior Heel Pain: This is pain at the back of your heel, where it rubs against your shoe.
What Causes Heel Pain?
Here are some common reasons for heel pain:
- Fractures: Usually from sudden falls. They often don’t need surgery, just some time in a cast.
- Calcaneitis: Inflammation around the calcaneus, leading to pain and swelling when you walk.
- Sever’s Disease: Common in teens, especially athletes, affecting the bone cartilage in the calcaneus.
- Inflammatory Conditions: Like ankylosing spondylitis, which can cause pain in both heels and other areas.
- Skeletal Issues: Such as osteoarthritis between the talus and calcaneus.
- Heel Spurs: Bony growths on the underside of the calcaneus that can cause pain over time.
- Nerve Issues: Pain can also come from nerves in the area or the sciatic nerve.
- Foot Shape Problems: High arches or flat feet can lead to heel pain.
- Fat Pad Reduction: This can happen with age or repeated trauma.
- Tendinitis: Inflammation of the tendons in the area, like Achilles tendinitis.
Symptoms
Plantar Talalgia: People usually feel pain in the sole of the foot or heel, especially when walking, standing for a long time, or climbing stairs. It often gets better with rest. Some describe it as feeling like a nail is stuck in their heel. Many prefer wearing shoes with low heels and avoid going barefoot.
Posterior Heel Pain: This pain happens at the back of the heel when walking, putting on shoes, or playing sports. It often comes with swelling, redness, and tenderness.
There are two types of posterior heel pain:
- One is due to a mechanical conflict between the heel bone and the Achilles tendon, often seen in young women who wear rigid shoes.
- The other is related to Achilles tendon issues, common in middle-aged men, especially those who are active or have diabetes.
Diagnosis
To figure out what’s going on, doctors usually start with X-rays to check for heel spurs. An ultrasound can show if the plantar fascia is thickened, and an MRI can help assess any damage. Sometimes, blood tests are done to rule out conditions like ankylosing spondylitis.
Treatment
For Plantar Heel Pain: Most treatments are non-surgical and can take 6 to 12 months to show results. Here’s what you can do:
- Cut back on activities that stress your heel, like running or standing for long periods.
- Use shock-absorbing heel pads.
- Take non-steroidal anti-inflammatory drugs (NSAIDs) as needed.
- Wear orthotics if you have flat feet.
- Do stretching exercises for your legs.
- Shockwave therapy can help, but it might be a bit painful.
- If nothing else works after a year, surgery might be an option.
For Posterior Heel Pain: Treatment is also mostly non-surgical, focusing on pain relief with medications, wearing flexible shoes, and stretching exercises. Sometimes, surgery is needed if conservative treatments don’t help.
Some Simple Exercises
Here are a few easy exercises to help strengthen your feet and support the plantar fascia. They can help prevent heel pain, especially if you have weak foot muscles. Just remember to do them gently and regularly, and they shouldn’t hurt.
Seated Exercises:
- Pick up a tissue with your toes.
- Roll a bottle or tennis ball under your foot.
- Use a towel to gently pull your foot towards you while keeping your leg straight.
Standing Exercises:
- Stand a couple of feet from a wall, place your hands on it, and step back with one foot, keeping it straight. Hold for a minute.
- Bend your knee so it’s above your foot to stretch your Achilles tendon. Hold for a minute.
Taking care of your feet can make a big difference, so give these tips a try!