Understanding Chronic Heel Pain
Chronic pain generally refers to pain that is ongoing and has lasted longer than three months. Chronic heel pain refers to pain generating from the cushion of fatty tissue located at the back part of the foot below the ankle.
How Is Chronic Heel Pain Diagnosed?
Some episodes of pain can be managed themselves, but if you have had long-term pain, you will need to get a diagnosis from a healthcare professional, such as a general doctor, physical therapist or a foot specialist, known as a podiatrist. Podiatrists were previously known as chiropodists but essentially do the same job. They are qualified to diagnose and treat a variety of foot and leg problems.
They will examine the foot and leg area, take your general medical history, ask you to explain the type of pain, how long it has been going on for, and when and where the pain mostly occurs. They will determine the best course of treatment for you or refer you for further tests or x-rays.
The symptoms for heel pain vary depending on the cause of the injury but may involve:
- A sharp or stabbing pain
- A dull ache
- Tingling or burning
- Inability to stand on the foot or put pressure on it
- Hard lumps or swelling in the foot and/or leg area
Pain can be felt below or under the heel, or under the arch of the foot and may be worse after long periods of inactivity, such as sitting or sleeping, and after prolonged exercise or standing.
If you are unable to walk, move the foot or have swelling in the leg or foot, you must seek urgent medical advice as it may be caused by a break or a fracture, particularly if you have noticed a crack or popping sound beforehand.
What’s the Cause?
Chronic heel pain can be caused by a variety of factors and medical conditions, so it is vital that you seek advice for pain and ongoing issues, particularly those which you have experienced for a long period of time.
Heel pain is usually caused by inflammation or an injury to the muscles, tendons, nerves and sometimes the bones. This may be identified as one of the following conditions:
- Plantar fasciitis
- Heel bursitis
- Tendonosis or tendinitis
- Tarsal tunnel syndrome
- Heel bumps or spurs
- Sever’s disease (in pre-teen children)
The most common condition that causes heel pain in adults is plantar fasciitis. This can also be referred to as heel spur syndrome if a spur is present. The condition causes pain because the plantar fascia (the connecting tissue from the toes to the heel) becomes irritated and inflamed.
Children who suffer from heel pain may experience Sever’s disease. This affects children from 8 years old to pre-teen, especially males. They may have overexerted the area through exercise or have experienced sudden growth spurts.
Heel pain may be due to an existing deformity. Very occasionally, but rarely, pain can be caused by a cyst or tumor. It can also be caused by something as simple as badly fitted shoes.
What Are the Risk Factors?
Some people are more at risk of heel pain than others. Those who may be more likely to suffer are:
- Adults who have reached middle age (over 40s)
- Pregnant women
- Children in the pre-teen age bracket
- Adults and children who wear ill-fitting footwear
- People who are overweight, particularly if they have a BMI (body mass index) that determines they are in the obese category
- People in occupations where they stand for long periods of time
- People who exercise a lot, particularly on hard surfaces
- Those who already suffer from lower back problems
- People suffering from other diseases, such as arthritis and diabetes
As some of these risk factors are avoidable, it is vital to get medical advice so that you can make lifestyle changes to reduce the pain.
Treatments and Pain Management for Chronic Heel Pain
Treatments and pain management for chronic heel pain will be dependent on your medical diagnosis:
- Keeping the foot elevated for periods of time
- Strapping or splinting the foot and lower leg
- Wearing well supported and fitted shoes
- Adding padded heel grips, inner soles, wedges or specially made inserts in your footwear
- Using a heated pad or wrap on the area
- Using an ice pack
- Using alternative hot and cold compresses
- A cortisone steroid injection
- Heatwave therapy
- Reducing exercise that involves intensive or repetitive movements
- Physical therapy treatments and exercises
- Using a massage ball under the heel or arch in your foot
- Practicing yoga or joint stretching and relaxation exercises with medical approval
Breaks, fractures and deformities will usually involve an operation with an immobilizing boot or splint to wear afterwards.
Medication can be in the form of a mild over-the-counter pain killer such as acetaminophen/paracetamol and non-steroidal anti-inflammatory drugs (NSAIDS), like aspirin or ibuprofen. Others may need a stronger prescribed medication containing opioids or nerve blockers.