My heel hurts, what is causing it?

Symptoms:
Intermittent burning pain on the heel of my right foot. There’s no obvious trigger and it lasts a few minutes. The heel sometimes feels very tight, usually after I’ve been inactive for a while.

Duration:
It used to just be the tightness and has happened for the last two or three years but the last year or so has been more the the burning pain

History:
I thought originally this was Achilles tendinitis from running but I stretch well and even when I’m not running it is no better.  I often go months without running but it doesn’t make a difference.

“Sorry to hear about the aching in your heel

Hopefully you will be able to work out what is happening from the information below. Is the pain at the top of the heel bone (at the insertion of your achilles) or is it under the heel bone? Which side of the heel is the most painful?

Typical problems are:

Heel spur (small overgrowth of bone on bottom of heel) – This normally creates sharp hot searing pain on weight bearing especially during excessive heel contact.  Sometimes you can actually feel a hard object in the centre of your heel (not dissimilar to the princess and the pea).  Treatment is orthotics, careful choice of footwear, minimise barefoot activity and spur removal surgery when it is really bad.  Request an X ray of your heel from your GP to rule this condition out.

Plantar-fasciitis – inflamed fascia/ligament connecting your heel to your toes. This typically becomes inflamed on the inside border at the base of your heel giving initially sharp pain especially after rest periods, normally easing with a little activity and typically increases to a deep aching/burning pain with increased activity.  The condition is classically triggered by tight calves and  too much exuberance during walking/running with insufficient fitness or warm up.  It is a typical holiday condition – girls jumping into flip flops from high heeled office shoes and then doing much more walking than normal giving an unwelcome persistent pain than  for them bizarrely resolves when they put their high heeled shoes back on but returns when they use their flip flops.  Treatment is stretching, deep tissue massage, orthotics, careful choice of footwear and minimising barefoot activity for as long as required until the pain gradually subsides.

Inflamed fat pad – fat pad syndrome is akin to deeply bruising your heel after jumping and landing hard on your heel.  Often it is impossible to weight bear on you heel at all. Treatment is rest, taping and sometimes orthotics to support the fat pad and reduce the stress on it. This condition typically self resolves with proper rest but the above treatments make it resolve more quickly.

Also try NSAIDS (non steroidal anti-inflammatiories) and use well cushioned running shoes for normal activity. Avoid very low heeled shoes or barefoot walking.

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