Heel pain is a common complaint. While plantar fasciitis is a recognized cause, many other conditions can lead to similar discomfort. Identifying the specific source of heel pain is important for effective treatment. This article explores causes of heel pain beyond plantar fasciitis, including their characteristics, diagnosis, and treatment approaches.
Understanding Heel Pain Beyond Plantar Fasciitis
Heel pain can stem from various structures around the heel bone and its surrounding soft tissues. A calcaneal stress fracture is a tiny crack in the heel bone, often from repetitive stress or impact, especially in athletes. Unlike acute fractures, stress fractures develop gradually, causing pain that worsens with activity and improves with rest.
Fat pad atrophy is another condition where the fatty cushion beneath the heel thins out. This reduces the heel’s shock-absorbing capacity, leading to pain when walking or standing, particularly on hard surfaces. The heel may feel bruised or tender without visible discoloration.
Nerve entrapment, such as tarsal tunnel syndrome, can also cause heel pain. This occurs when the posterior tibial nerve, which runs through a narrow space on the inside of the ankle, becomes compressed. Symptoms include sharp pain, tingling, or numbness along the inside of the ankle, heel, arch, or into the toes or calf.
Bursitis, an inflammation of fluid-filled sacs called bursae, can affect the heel in different locations. Retrocalcaneal bursitis involves the bursa between the Achilles tendon and the heel bone, causing pain, swelling, and tenderness at the back of the heel. Subcutaneous calcaneal bursitis affects the bursa between the skin and the Achilles tendon, presenting with pain, swelling, and redness on the back of the heel, often aggravated by tight shoes.
Insertional Achilles tendinopathy refers to degeneration or inflammation of the Achilles tendon where it attaches to the heel bone. This condition causes pain and stiffness at the back of the heel, often worse in the morning or after rest, and can be accompanied by swelling. Haglund’s deformity, sometimes called “pump bump,” is a bony enlargement on the back of the heel bone that can irritate the Achilles tendon and retrocalcaneal bursa, leading to pain, swelling, and a noticeable bump. Systemic conditions like certain types of arthritis, such as rheumatoid arthritis or gout, can also manifest as heel pain due to inflammation affecting the joints and soft tissues in the foot.
Diagnosing the Specific Cause
Diagnosis begins with a detailed patient history to understand the pain’s onset, location, and factors that worsen or alleviate it. Information about activities, footwear, and previous injuries provides valuable clues. This discussion helps narrow down potential causes and differentiate between conditions.
A thorough physical examination follows. The clinician inspects the heel for swelling, redness, or visible deformities like a bony bump. They palpate specific areas to pinpoint the exact location of tenderness, which helps distinguish between different bursitis types or tendinopathy. Range of motion tests and specific maneuvers can assess nerve involvement or tendon integrity.
Diagnostic imaging supports confirming a diagnosis or ruling out other conditions. X-rays can identify stress fractures, bone spurs, or Haglund’s deformity. While X-rays primarily show bone, magnetic resonance imaging (MRI) provides detailed images of soft tissues. MRI is useful for evaluating stress fractures not visible on X-ray, nerve entrapment, or the extent of tendon damage. Ultrasound can visualize soft tissue issues like tendinopathy or bursitis.
Treatment Options
Treatment for heel pain not related to plantar fasciitis often begins with conservative measures. Rest and activity modification are important, involving reducing or temporarily stopping activities that aggravate the pain. Applying ice packs to the affected area can help decrease pain and inflammation.
Appropriate footwear with good support and cushioning can reduce stress on the heel. Custom orthotics or over-the-counter shoe inserts may also be recommended to provide additional support and evenly distribute pressure. Physical therapy is frequently prescribed, including specific exercises to stretch tight muscles and tendons or strengthen weak ones. For nerve entrapment, nerve glides might be beneficial, while strengthening exercises can support tendinopathy recovery.
Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and reduce inflammation. In some cases, injections may be considered. Corticosteroid injections can reduce inflammation in conditions like bursitis, though they are generally used cautiously for tendinopathy due to potential risks. Surgical intervention is a last resort, reserved for conditions that do not respond to extensive conservative management.
When to Consult a Healthcare Professional
While mild heel pain can sometimes resolve with home care, certain signs indicate the need for professional medical evaluation. Seek medical attention if heel pain is severe or prevents normal activities. Persistent pain that does not improve after a few weeks of rest and home treatments also warrants a doctor’s visit.
Worsening pain, inability to bear weight on the affected foot, or sudden severe pain, especially after an injury, are important red flags. If heel pain is accompanied by swelling, redness, warmth, or tingling and numbness in the foot, consult a healthcare professional promptly. Self-diagnosis can be challenging; a professional evaluation ensures an accurate diagnosis and appropriate treatment plan.