Heel: Common Conditions & Treatments

Key Takeaways

• Plantar fasciitis and Achilles tendinitis are the most common conditions affecting the heel.

• Symptoms often include sharp or stabbing pain, especially during the first steps in the morning.

• Diagnosis typically involves a physical exam and, in some cases, imaging tests.

• Treatments range from physical therapy and medications to surgical interventions in severe cases.

• At MSK Doctors, we offer comprehensive patient-centric care for heel conditions using specialised treatment strategies. 

Heel Anatomy Overview

The heel is the back part of your foot. It has a large bone called the calcaneus that helps support your body weight when you stand and walk. Under the heel is a thick pad of fat that works like a cushion. This pad protects the deeper parts of your foot when your heel hits the ground during walking or running.

The heel bone, or calcaneus, is the largest bone in the foot and plays a critical role in weight-bearing and movement. Because of this, it is susceptible to various conditions that can cause pain (image courtesy of Wikipedia). 

Common Heel Conditions

Plantar Fasciitis

Plantar fasciitis occurs when the plantar fascia, a thick band of tissue running from the heel to the toes, becomes inflamed. This inflammation results from excessive strain - often due to overuse or improper footwear.

The pain associated with plantar fasciitis is typically sharp and most noticeable in the morning or after long periods of rest. As the day progresses, the pain may decrease but can return after prolonged standing or physical activity.

Achilles Tendinitis

Achilles tendinitis is another prevalent heel condition. It involves inflammation of the Achilles tendon, which connects the calf muscles to the heel bone. This condition is often seen in athletes and individuals who suddenly increase their physical activity.

The symptoms of Achilles tendinitis include pain and stiffness along the back of the heel, especially in the morning or after exercise. Swelling and tenderness may also be present.

Stress Fractures

Stress fractures are tiny cracks in the heel bone that result from repetitive force or overuse. They are common among athletes and individuals who engage in high-impact activities like running or jumping. 

The pain from a stress fracture often starts as a mild ache and gradually intensifies with continued activity - you must get immediate medical attention to prevent further damage. 

Initial symptoms include swelling, tenderness, and pain that worsens with activity but eases with rest. Unlike other types of heel pain, stress fractures may also cause bruising around the affected area.

Diagnosis Methods

Physical Examination

A physical examination is often the first step in diagnosing heel pain. During the exam, the healthcare provider will assess the foot's range of motion - check for swelling or tenderness, and evaluate the overall alignment and structure of the foot. 

They may ask you to walk or stand on your toes to observe how the foot functions under different conditions.

Imaging Tests

In some cases, imaging tests are necessary to confirm a diagnosis or rule out other conditions. X-rays are commonly used to detect fractures or heel spurs. However, they may not always reveal soft tissue issues like plantar fasciitis or Achilles tendinitis.

For a more detailed view, an MRI or ultrasound might be recommended. These tests provide a clearer picture of the soft tissues - helping identify inflammation, tears, or other abnormalities. 

Imaging tests are particularly useful when the cause of heel pain is unclear or when symptoms persist despite initial treatment.

Treatment Options

For Achilles Tendinitis

To manage Achilles tendinitis, rest is crucial. Avoid activities that exacerbate the pain and give the tendon time to heal. Applying ice to the affected area can help reduce inflammation and alleviate discomfort.

For Stress Fractures

To manage stress fractures, rest the foot and avoid activities that could worsen the injury. Wearing a protective boot or using crutches might be necessary to offload the pressure from the heel and promote healing. 

Medical Treatments

Medical treatments for heel pain often involve the use of medications to reduce inflammation and alleviate pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are commonly prescribed to help manage pain and swelling - making it easier to engage in rehabilitation exercises.

In other cases, corticosteroid injections may be recommended for more severe pain. These injections deliver powerful anti-inflammatory medication directly to the affected area, providing rapid relief. However, they should be used cautiously, as repeated injections can weaken tissues over time. 

Physical Therapy

A physical therapist can design a personalised exercise program to improve flexibility, strength, and balance. These exercises target the muscles and tendons around the heel, promoting healing and preventing future injuries.

Therapists may also use techniques like ultrasound therapy or manual manipulation to enhance recovery. 

Surgical Interventions

Most cases of heel pain can be managed with conservative treatments, surgery may be necessary for severe or persistent cases. Surgical interventions aim to correct structural issues, remove bone spurs, or repair damaged tissues.

Common procedures include plantar fascia release, where part of the plantar fascia is cut to relieve tension, and tendon repair - which involves stitching torn tendons back together. 

Home Remedies

Rest and Ice

Resting your heel is one of the most effective ways to reduce pain and promote healing. By minimising activities that put stress on the heel, you allow the inflammation to subside. 

Ice therapy is a simple yet powerful tool in managing heel pain. Applying ice packs to the affected area for 15-20 minutes several times a day can significantly reduce swelling and numb the pain. Wrap the ice pack in a towel to protect your skin from frostbite.

Stretching Exercises

Incorporating stretching exercises into your daily routine can greatly improve flexibility and reduce tension in the foot and calf muscles. 

Simple exercises such as calf stretches, toe curls, and towel stretches can target the Plantar fascia and Achilles tendon - promoting better movement and relieving pain.

To perform a calf stretch:

1. Stand facing a wall with one foot forward and the other back. 

2. Keeping your back leg straight and heel on the ground, 

3. Bend your front knee and lean towards the wall until you feel a stretch in the calf of your back leg. 

4. Hold for 15-30 seconds and repeat several times on each leg.

Footwear Adjustments

Shoes with proper arch support and cushioning can reduce the stress on your heel and provide the necessary support for your foot's natural structure. 

When selecting shoes, look for features such as:

• A cushioned heel 

• Firm arch support

• A flexible sole

Avoid high heels and shoes with minimal support, as they can exacerbate heel pain and lead to further complications.

Consider replacing worn-out shoes and opting for orthotic inserts if needed. These inserts can provide additional support and alignment - especially for those with flat feet or high arches.

Your Path to Heel Pain Relief

At MSK Doctors, we understand how debilitating heel conditions can be to your daily life and activities. Our specialised team offers comprehensive diagnostic and treatment solutions for all heel conditions, from plantar fasciitis to stress fractures. 

Using our state-of-the-art musculoskeletal MAI-Motion AI platform, we gain valuable insights into your movement patterns to create personalised treatment plans that address the root cause of your pain, not just the symptoms. 

Our approach combines conservative treatments, advanced therapies, and surgical options when necessary, all delivered by leading orthopaedic consultants. 

With our patient-centric approach, you'll also receive education about your condition and preventive strategies to maintain long-term heel health. 

Don't let heel pain limit your mobility or quality of life any longer – take the first step toward recovery by booking your consultation today with MSK Doctors. 

Frequently Asked Questions (FAQ)

How can I tell if my heel pain is plantar fasciitis or something else? 

Plantar fasciitis causes sharp heel pain in the morning that improves with activity. If you have significant swelling, bruising, or a different pain pattern, it may be another condition.

How long does it typically take to recover from heel pain? 

Most mild cases improve within 2-6 weeks with proper self-care. Severe cases may take 3-6 months, depending on the condition and treatment adherence.

Can I continue exercising with heel pain? 

Yes, but modify activities that cause pain. Switch to low-impact exercises like swimming or cycling instead of running or jumping activities.

What should I look for in footwear to prevent heel pain? 

Look for good arch support, cushioned heels, and flexible soles. Shoes should fit properly with adequate toe room and snug heel support.

Why should I choose MSK Doctors for my heel pain treatment? 

MSK Doctors offers direct access to musculoskeletal specialists without GP referrals and uses advanced diagnostic technology.