My heel hurts, what is causing it?

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.

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

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.  Heel spurs are easy to find and identify in clinic and also easy to offload with adaptation to your existing insoles from your sports shoes.

Hauglands Deformity – This is a bony outgrowth observed at the back of your heel where it meets your achilles that causes irritation within shoes especially with a rigid heel counter (back of heel).  Typically golf. shoes and stiff walking or sport shoes are the worst offenders.  This condition is often related to poor foot alignment (plano-valgus foot posture – flat foot) but often affects individuals with an unstable high arch foot (Cavo-planus).  Within clinic, adaptations can be made to your shoes to accommodate for this deformity and prescribed orthotic insoles can help minimise foot instability that triggers the overwork of your foot.  Bone grows with pressure/impact so it is important to remove mechanical irritation from your shoes and make space for your heel deformity.

Plantar-fasciitis – See fuller answer on this one on other post. 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.

Severs Disease – Young adolescents 10-14 complaining of widespread heel pain typically after 15-20min of sport.  This is typically found in children undertaking a significant amount of sport but with  bones that are not quite strong enough to cope with the demands.  Regulating sport participation is vital, simple cushioned heel inserts or prescription orthotic insoles  can be very beneficial.  Regular dynamic stretching of legs and building stability and balance.  Try to stand and balance on one leg … Do you wobble?

Tibialis Posterior (Tib Post) Dysfunction – Individuals with unstable feet can often become aware of pain on the inside border of the heel just below and behind the inside ankle bone.  This is the tendon of the main muscle that acts as a spring to stabilise the collapse of your arch especially in jumping and sport.  If hyou have Flat-foot posture this means that the tendon of this muscle is under constant load but when impact and load exceeds its capacity the tendon becomes very bruised and tender and walking becomes very painful.  Your Tib post is supported by your buttocks and you can assess the function of your tib post by standing on one leg and observing how much your knee rotates and your foot collapses and lifts as your try to retain balance.  This is treated in clinic with initially, modifications to your current inlays in your shoes with hip exercise to support and offload your tib post and also with prescribed orthotic insoles to maximise the offloading to this tendon.  With correct treatment the pain quickly subsides and function restores, but with no treatment this eventually becomes much worse.

Peroneii Tendonitis – These are muscles on the outside of your leg that control the outwards rolling of your ankle and heel bone.  The tendon of these muscles passes close to the heel and when overloaded can become quite bruised and tender just to the outer side of your heel bone.  Strengthing, taping and local muscular release are extremely beneficial in addressing this tricky problem.  Oddly, this problem occurs frequently in individuals with flat feet whose feet collapse inwards (not outwards) resulting in the peroneii having nothing to do and becoming very lazy and ultimately weak.  Correcting Foot posture, giving firm stable foundations and building strength are essential in managing this.

Also, Individuals with extremely high arched feet will be aware that their feet typically roll outwards in an uncontrollable manner overstraining these same muscles.  Restricting and controlling this excessive movement is essential and is done using clnic tape and prescribed orthotic insoles designed to accommodate and correct the unique issues that a high arched foot brings but then building strength and balance on top of new foundations is vital.

Also try NSAIDS (non steroidal anti-inflammatiories), or Ice and heat, also make sure you  warm up carefully before activity and use well cushioned running shoes for normal activity. Avoid very low heeled shoes or barefoot walking.

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