Heel pain. It seems so simple, at least on the surface. But when you look a little more closely, you start to realize just how complicated this common symptom can truly be.
You can take our word for it. We’ve been looking closely at heel pain for many years—thousands of cases, in fact. It’s the most common reason our patients come in seeking our help.
And yet, no two cases are ever exactly the same.
What’s causing your pain? We’ll need to examine your heels at our office to be sure, but let’s take a closer look at some of the most common factors.
Why Heels Hurt: The Bigger Picture
We’ll start broad, with some of the major structural, situational, and lifestyle triggers. In other words, we’re not even touching diagnoses yet. (More on those later.)
Regardless of the specific type and severity of heel pain you have, it’s very likely at least one (and usually more than one) of these underlying factors is involved to at least some degree.
- Bad shoes. It’s not at all an exaggeration to say that most people have at least one pair of footwear in regular rotation that doesn’t actually fit. Of course, even if your shoes are the right size, they might not be appropriate for your activity (for example, the wrong type of athletic shoe), or they might be worn out, or they were just bad to begin with (i.e., poor cushioning and support by design). For any of these reasons, heels may become fatigued or injured. Check out our previous blog, “Are Your Shoes Causing Your Heel Pain?” for more info.
- Overuse. Our ancestors didn’t have to contend with all the hard and flat surfaces we have today, and unfortunately our feet haven’t always kept up. Overuse can come in many forms. Perhaps you spend all day working on your feet. Perhaps you run or play high-impact sports. In such situations, heels can start to wear down under repetitive strain, especially if you aren’t giving them enough time to rest.
- Foot and leg mechanics. No two pairs of feet or legs are exactly the same. Unfortunately, that also means that not all feet and legs are equally good at distributing weight and pressure in a healthy way. Inherited or acquired abnormalities such as flat feet, overpronation, leg length discrepancies, tight calf muscles, and more can magnify the forces acting on heels beyond the normal range.
- Obesity. Nearly 1 in 3 Idahoan adults are obese. And the truth is that the heavier you are, the more force you place on your heels with every single step you take. In fact, one pound of body weight can be equivalent to 3-4 added pounds of force as far as your heels are concerned. That adds up quickly.
- Age. No, getting older doesn’t cause heel pain (and you should never accept heel pain as an inevitable part of aging), but it does increase the risk. Even if you keep up with your conditioning, you’ll gradually lose muscle tone and tendon flexibility. The fat pad under your heel will start thinning, too. As these things happen, your margin for error when it comes to preventing heel pain starts to shrink.
Why Heels Hurt: Specific Diagnoses
When it comes to diagnosing the problem—and by extension, pairing you with an appropriate treatment method—it’s not enough to simply understand the underlying causes. We need to know what structure specifically has been injured, and how badly.
There are many possible conditions that can produce heel pain as a major symptom. Some of the most common include:
- Plantar fasciitis. This refers to inflammation and/or tearing in the plantar fascia ligament, typically at the underside of the heel. The most distinctive symptom is sharp pain when rising from a lengthy rest.
- Heel spurs. Heel spurs usually form slowly over time due to chronic plantar fasciitis. They usually don’t cause pain on their own, and treating the plantar fasciitis will eliminate the problem. However, occasionally the spurs themselves can cause discomfort.
- Achilles tendinitis/tendinosis. These terms are often used to refer to various forms of inflammation, tearing, or degeneration in the Achilles tendon, which connects the calf muscles to the heel bone. As you might imagine, pain tends to be along the back of the heel.
- Achilles bursitis. This is inflammation of the bursa sac meant to provide cushioning between the Achilles tendon and the heel bone. Due to its location, symptoms of Achilles bursitis are very hard to distinguish from Achilles tendinitis without a professional evaluation.
- Sever’s disease. If the person experiencing heel pain is a child or adolescent, there’s a good chance they have Sever’s disease. At this age, the growth plate of the heel bone—which is softer and easier to irritate than mature bone—is particularly exposed.
- Haglund’s deformity. Chronic irritation along the back of the heel can eventually lead to the formation of an enlarged, bony bump. It’s common among people who regularly wear shoes with hard, unforgiving backs, including pumps, skates, and certain types of work boots.
- Nerve pain. In some cases, heel pain may be the result of a nerve that has become compressed or pinched and is sending faulty signals to the brain. One common example is tarsal tunnel syndrome, which involves a nerve getting trapped in the ankle. It’s very similar to carpal tunnel syndrome, a somewhat more familiar condition that affects the hands and wrists.
This is by no means an exhaustive list. Other possibilities include bone tumors and infections, stress fractures, rheumatoid arthritis, and others.
So What Should You Do?
We don’t want to overwhelm you with information, so we’ll keep it very simple:
- No matter what’s causing your heel pain, you should always get it checked out by a pro.
- We will take all the necessary steps to properly diagnose your condition—a physical examination, any necessary diagnostic tests, and as much time as you need to discuss your symptoms and experience.
- The vast majority of heel pain cases (95 percent) can be treated non-surgically, especially by a practitioner who has kept up-to-date with new treatment technologies and protocols.
To that end, you are in very good hands at Canyon Foot + Ankle. In our previous blog, we described at length some of the advanced options available at our practice, including laser therapy, 3D digital foot scanning for custom orthotics, and more.
Suffice it to say, whether your heel pain is minor or severe, and whatever may have caused it, and however long you have had it, there is a great chance we can help you beat it.