Heel Pain
What Is Heel Pain?
Heel pain is a common orthopedic complaint that can significantly impact mobility and quality of life. The heel, the largest bones in the foot, plays a crucial role in supporting body weight during standing, walking, and running. When pain develops in this area, it can stem from numerous causes affecting bones, tendons, ligaments, or soft tissues.
The most common cause of heel pain is plantar fasciitis, characterized by inflammation and microtears of the plantar fascia—a thick band of tissue that runs across the bottom of the foot and is a continuation of the Achilles tendon. This condition typically causes sharp pain with the first steps in the morning or after periods of rest. Other frequent causes include Achilles tendinitis (inflammation of the Achilles tendon and/or paratenon, the very thin cellular layer that surrounds and nourishes the Achilles tendon), heel spurs (bony growths on the underside of the heel bone from chronic inflammation or trauma, often associated with plantar fasciitis), and stress fractures (small hairline cracks in the foot bones caused by repetitive stress or overuse).
Additional causes of heel pain include bursitis (inflammation of the fluid-filled sac that cushions the heel bone), tarsal tunnel syndrome (compression of the tibial nerve as it passes through the tarsal tunnel on the inside of the ankle, similar to carpal tunnel syndrome but affecting the foot), rheumatoid arthritis (an autoimmune disorder causing joint inflammation and pain), gout (a type of arthritis caused by crystallization of uric acid in joints), and calcaneal apophysitis or Sever's disease (a common cause of heel pain in children caused by inflammation of the growth plate in the heel bone).
Symptoms vary depending on the underlying cause but typically include pain that worsens with activity, swelling, stiffness, difficulty bearing weight, and in some cases, numbness, tingling, redness, or warmth. Seeking medical advice is important if heel pain persists for more than four to six weeks despite rest and home remedies, if the pain is severe and interferes with daily activities, if there is swelling, redness or warmth in the heel, or if you experience fever, chills, numbness, or tingling along with the heel pain.
Nonsurgical Treatments
Most cases of heel pain can be effectively managed without surgery. Our doctors offer a comprehensive range of nonsurgical treatments to relieve pain, reduce inflammation, and restore function.
Lifestyle Modifications
Rest is crucial for healing—avoiding activities that exacerbate the pain, such as running or prolonged standing, allows inflamed tissues to recover. Ice application for 15 to 20 minutes several times daily helps reduce inflammation. Maintaining a healthy weight reduces stress on the heels. Proper footwear with adequate arch support and cushioning is essential. Physical activity modifications may be necessary as well as shifting to low-impact exercises like swimming or cycling during recovery.
Medications & Injections
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can help reduce both pain and inflammation. Compound topical medications, including CBD topical creams, offer a good alternative to systemic medications for some patients. In severe cases, corticosteroid injections may be administered to reduce inflammation and provide pain relief. These injections can be particularly effective when other conservative measures have not provided adequate relief.
Physical & Occupational Therapy
Physical therapy is crucial for heel pain treatment. A physical therapist can teach proper stretching techniques for the calf muscles and plantar fascia to improve flexibility and reduce tension. Guided exercises help strengthen surrounding muscles and improve biomechanics. Therapists develop personalized home exercise programs tailored to each patient's specific condition. Professional guidance ensures stretches are performed appropriately to avoid further injury. Specific techniques to improve mobility and gait mechanics are also incorporated into therapy plans.
Supportive & Assistive Devices
Custom or over-the-counter orthotic shoe inserts can provide mechanical support and cushioning to alleviate pressure on the heel. Night splints may be worn while sleeping to gently stretch the plantar fascia and Achilles tendon, helping to reduce morning pain. Compression with elastic bandages can help control swelling. Extracorporeal shockwave therapy (ESWT) is a noninvasive treatment that uses focused shockwaves to stimulate healing and reduce pain in chronic cases.
Surgical Treatments
Surgery for heel pain is rare and typically considered only after conservative treatments have failed to provide relief after several months. The right surgical approach depends on the underlying cause of the heel pain and the specific structures involved.
Plantar Fascia Release
For severe, recalcitrant plantar fasciitis that does not respond to conservative treatment, a plantar fascia release may be performed. This procedure involves partially cutting the plantar fascia to relieve tension and reduce inflammation. The surgery can often be performed through a small incision, allowing for faster recovery than traditional open procedures.
Heel Spur Removal
When heel spurs cause persistent pain and do not respond to conservative treatments, surgical removal of the bony growth may be necessary. This procedure is typically performed in conjunction with plantar fascia release to address both the spur and the underlying inflammation causing symptoms.
Gastrocnemius Recession (Calf Lengthening)
For patients with tight calf muscles contributing to heel pain, an endoscopic gastrocnemius recession may be recommended. This procedure lengthens the calf muscle, reducing tension on the Achilles tendon and plantar fascia. By releasing tightness in the gastrocnemius muscle, this surgery can improve ankle flexibility and reduce stress on the heel structures. The endoscopic approach uses small incisions and specialized instruments, resulting in less scarring and faster recovery.
Following any heel surgery, recovery typically involves a period of immobilization, followed by gradual return to weight-bearing and physical therapy to restore strength and flexibility. Most patients experience significant improvement in pain and function after surgical treatment when conservative measures have been exhausted.