What is heel pain?
Heel pain is common and can be due to a number of conditions. The calcaneus (heel bone) is the largest bone in the foot and is the first to hit the ground when walking.
The anatomy of heel pain:
The heel bone is designed to be the first contact the foot has with the ground. The achilles tendon inserts into the back of the heel bone (calcaneus) and a very strong ligament along the bottom of the foot attaches to the bottom of the heel bone (the plantar fascia). Several small muscles also attach to the heel bone above the insertion of the plantar fascia.
Given the forces of walking that the heel bone is subjected to and the pull of all these ligaments and muscles, then it is not surprising that heel pain is so common.
The causes of heel pain:
There is no one cause of heel pain. Whole text books have been written on Disorders of the Heel. Some of the types of problems that can be seen in the heel include:
- Heel spurs – these are small bony spurs that often develop on the bottom of the heel. They do not really cause any problems. It is only mentioned here as it is a common myth that they are a problem – almost always the pain associated with heel spurs is really plantar fasciitis.
- Plantar fasciitis is the most common cause of heel pain and is due to a strain of the long ligament along the bottom of the foot. The most symptom is pain when getting out of bed first thing in the morning (‘post-static dyskinesia’)
- A number of disease processes can uncommonly cause heel pain, such as rheumatoid arthritis, ankylosing spondylitis and gout.
- Stress fractures, which is an abnormal reaction of bone to stress can occur in those that are very active (eg athletes) or have weaker bones (eg osteoporosis)
- Pain at the back of the heel could be due to a number of problems – there could be a bursitis at the back of the heel bone (sometimes called ‘Haglund’s); there could be problems with the insertion of the achilles tendon, such as tendonitis or calcification.
- A ‘stone’ bruise is sometimes considered to be a cause of heel pain – its is simply a bruise of the bone.
- Another cause of heel pain is problems in the calf muscles that refer pain to the heel (myofascial trigger points) or pain referred from the lower back via the nerves from the back to the heel.