Understanding Different Heel Pain Injuries
Heel injuries can be sudden onset (acute) or can come on gradually over time. The most common causes of heel pain including pain under the heel are Plantar Fasciitis and Bruised Heel whilst pain at the back of the heel in children is often Sever's disease. Select from the injuries below or if you do not know what your injury is then click on any of the symptoms below to view injuries with that particular symptom.
What is plantar fasciitis? Probably the most common cause of heel pain. Symptoms come on gradually and are often worse first thing in the morning. The plantar fascia is the tissue under the foot which forms the arch. Treatment includes rest, reducing pain and inflammation and stretching exercises.
A bruised heel, also known and Policeman's Heel is a contusion or bruising to the tissues under the heel causing pain. Treatment includes rest and protecting the area with padding or taping as well as identifying potential causes and rectifying them.
Sever's disease is mainly a cause of heel pain in kids affecting active children aged 8 to 15 years old. Pain at the back of the heel from overuse that if managed correctly, is something the young athlete should grow out of. Rest is an essential part of treatment along with ice or cold therapy and managing training loads.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is a painful condition of the foot caused by pressure on the posterior tibial nerve as it passes along a passage called the tarsal tunnel just below the bony bit on the inside of the ankle causing a burning pain in the foot along with pins and needles and pain radiating in the arch of the foot.
Calcaneal Stress Fracture
A stress fracture of the calcaneus is a hairline fracture of the big heel bone and is usually caused by overuse. It is common in soldiers who march long distances and road runners. Treatment involves resting for 6 to 8 weeks followed by a gradual return to full training and fitness.
Lateral Plantar Nerve Entrapment
Lateral plantar nerve entrapment causes pain radiating to the inner, lower heel and inner ankle area.
Heel pain symptoms
Below is the list of injuries which have that particular symptom.
Pain under the heel - the two most common causes are plantar fasciitis and bruised heel. Both are over use injuries and come on gradually. With plantar fasciitis the pain is worse in the morning and may radiate into the foot. A bruised heel gets worse with use and is more likely to be localised under the heel.
Back of heel pain - pain at the back of the heel in young athletes is likely to be Sever's disease. Insertional achilles tendonitis and achillies bursitis are more common in older athletes, particularly runners.
Gradual onset heel pain occurs over a period of time. Athletes may not be able to pinpoint the exact time of injury and can have continued to train with niggling discomfort. These injuries are most likely from overuse with plantar fasciitis and bruised heel being the most common although a stress fracture of the calcaneus should be considered.
Foot arch pain - pain under the arch of the foot can be caused by a number of injuries. Gradual onset is most commonly plantar fasciitis although nerve entrapments and stress fractures can also result in arch pain. Sudden onset can be a strain or tear of the foot arch.
Heel pain in the morning - this is a common symptom of heel pain linked to the plantar fascia or arch ligament. Over night the fascia tightens up causing pain at the insertion of the heel. As the tissues warm up the pain goes often to return later.
Swollen heel - a small localised swelling at the back of the foot may be achilles bursitis. If the swelling is sudden onset as a result of trauma or a fall then fractures should be considered. Seek medical attention as soon as possible.
When should I see a doctor?
When should you see a doctor with your foot pain? Often people do not want to bother their GP or A & E department but if you have any of the following symptoms you should seek further medical assistance.
- Severe pain, especially on walking
- Severe swelling (oedema)
- Altered sensation in the foot – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anaesthesia) in the foot.
- Unable to complete normal daily activities after the initial 72 hours.
Further medical assistance can be sought through either your local GP or a private clinician such as a podiatrist, physiotherapist, sports therapist, osteopath or chiropractor. If you have followed the P.R.I.C.E. principles (see below) and are still unable to walk after 72 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment.
Secondly, if you have applied for P.R.I.C.E. principles and still have weakness that lasts a long time (more than 2 weeks) or have ongoing discomfort in your foot or heel, you are highly recommended to seek advice from a specialist expert - such as a podiatrist or physiotherapist, osteopath, or chiropractor - who can provide you with advice and an appropriate and effective recovery and rehabilitation program.