Heel pain is a common concern that can significantly impact daily activities. This discomfort often stems from heel bursitis, an inflammation of cushioning sacs in the foot. Understanding this condition and its healing strategies is important for relief.
What is Heel Bursitis
Heel bursitis occurs when a bursa, a small fluid-filled sac, becomes inflamed. These sacs act as natural cushions and lubricants, reducing friction between bones, tendons, and skin around joints. In the heel, two primary bursae are typically involved: the retrocalcaneal bursa, situated between the Achilles tendon and the heel bone, and the superficial calcaneal bursa, located between the skin and the Achilles tendon.
Inflammation of these bursae can stem from various factors. Repetitive stress from activities like running, jumping, or prolonged standing often contributes, as can sudden increases in activity intensity. Ill-fitting footwear, particularly shoes that are too tight or have stiff heel counters, can also lead to irritation.
Other causes include direct injury, bacterial infection, or underlying medical conditions such as arthritis or Haglund’s deformity. Common symptoms include pain at the back of the heel, which may worsen with movement or touch, along with swelling, tenderness, warmth, and sometimes redness. This can make walking or standing on the toes uncomfortable.
At-Home Relief Strategies
Managing heel bursitis often begins with at-home strategies to reduce inflammation and pain. Resting the affected heel is a foundational step, involving avoiding activities that aggravate the pain, such as running, jumping, or prolonged standing.
Applying ice to the inflamed area helps reduce swelling and numb painful sensations. A cold compress or ice pack, wrapped in a thin towel, should be placed on the heel for 15 to 20 minutes, three to four times daily. Elevating the foot above heart level, particularly when resting, also helps decrease swelling by encouraging fluid circulation away from the affected area.
Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, can alleviate pain and inflammation. Acetaminophen can also be used for pain relief. Choosing appropriate footwear is another home strategy. Opt for supportive, well-cushioned shoes, and avoid those with tight or stiff heels that press on the bursa. Shoe inserts or heel wedges can provide added support and reduce irritation by improving foot mechanics.
Gentle stretching exercises for the calf muscles and Achilles tendon are beneficial. Stretches like calf stretches, heel raises, or eccentric heel drops, performed without pain, can help reduce tension on the bursa. These movements improve flexibility and alleviate pressure on the inflamed bursa.
When to Consult a Healthcare Professional
While many cases of heel bursitis respond well to at-home care, certain signs indicate professional medical attention is needed. If heel pain is severe, or worsens despite consistent self-care over several days to a few weeks, a doctor’s visit is recommended. Persistent pain, even when not walking or standing, also requires evaluation.
Prompt consultation is important if you experience an inability to bear weight on the affected foot or walk normally. Signs of a potential infection, such as fever, increased redness, warmth, or the presence of pus around the heel, require immediate medical attention. Any numbness or tingling in the foot or heel, or pain that developed immediately after an injury, should also be assessed by a healthcare provider.
Professional Medical Treatments
When at-home methods are insufficient, healthcare professionals offer various medical treatments for heel bursitis. Prescription-strength anti-inflammatory medications may be prescribed to manage persistent pain and inflammation. These are typically used when over-the-counter options do not provide adequate relief.
Physical therapy focuses on specific exercises to improve flexibility and strength in the calf and foot. A physical therapist may guide patients through calf stretches, heel raises, and eccentric heel drops to reduce strain on the bursa. They might also employ modalities such as ultrasound or manual therapy to reduce inflammation and improve tissue mobility.
Corticosteroid injections involve injecting anti-inflammatory medication directly into the bursa. These injections, often performed with ultrasound guidance, can provide rapid pain relief. They offer temporary relief, but repeated injections are limited due to potential risks, including Achilles tendon degeneration. If there is significant fluid buildup, a healthcare provider might perform an aspiration to remove fluid from the bursa and relieve pressure.
In rare, persistent cases where conservative treatments fail, surgical removal of the bursa (bursectomy) may be considered. This procedure removes the inflamed bursa; sometimes, bone spurs are also removed. A new bursa typically forms in its place.
Steps to Prevent Future Occurrences
Preventing heel bursitis involves proactive measures to reduce stress on the heel. Wearing proper, supportive footwear is a key preventive step. Shoes should be well-cushioned, provide arch support, and fit correctly, avoiding tightness or stiffness that could irritate the heel. Open-backed shoes or those with an Achilles notch can help.
Gradually increasing activity levels is important, especially when starting a new exercise regimen or intensifying an existing one. Avoiding sudden jumps in mileage or intensity allows the body to adapt and reduces the risk of overuse injuries. Regular stretching and strengthening exercises for the lower legs and feet help maintain flexibility and muscle balance, reducing tension on the bursa. Maintaining a healthy weight lessens pressure on the heels, reducing bursitis risk. Avoiding prolonged pressure on the heel, such as from certain sitting positions, can help prevent recurrence.