Wednesday, November 22, 2023

Pain In The Heel And Ankle

Common Causes Of Heel Pain

Heel Pain from Plantar Fasciitis and How to Treat It

Heel pain is usually caused by any injury or infection to the heel bone or surrounding structures and tissues. It can also be caused by the nerves that service the ankle or foot.

The heel bone lies at the back of the foot beneath the ankle. Along with surrounding tissues and a small bone called the talus, the heel bone works to provide balance and side-to-side movement of the back of the foot.

The two most common causes of heel pain involve the connective tissues that link the heel to the base of the foot or bottom of the calf muscle. The conditions are called plantar fasciitis and Achilles tendonitis.

What Is Plantar Fasciitis

An inflamed plantar fascia the rubber band-like ligament that stretches from your heel to your toes is very painful. Imagine walking around with a strong ache in your heel, a tender bruise on the bottom of your foot, or a stabbing pain that hits you the moment your feet hit the ground in the morning. Now, if you already have it, imagine your pain beginning to go away or disappearing altogether this too can happen.

The normal foot has 28 bones, 33 joints and more than 100 muscles, tendons and ligaments. It does so much! The plantar fascia itself supports the arch of your foot. It absorbs pressure think of the shock absorbers of your car. It bears your weight. Pain is inevitable when the tissues are inflamed, or partially or completely torn.

The word fasciitis means inflammation of the fascia of a muscle or organ while plantar relates to the sole of the foot. Two million patients get treatment for plantar fasciitis, annually. That makes it the most common cause of heel pain. Its common especially for athletes specifically, runners. The repetitive motion of pushing off with your feet can injure the tissues.

How Are Achilles Tendon Problems Treated

Healthcare providers usually treat calcaneal tendon problems with nonsurgical treatments, including:

  • Immobilization: A boot or leg cast may help treat moderate to severe Achilles tendon problems, including partial tendon ruptures.
  • Nonsteroidal anti-inflammatory drugs : Over-the-counter medicines can help manage Achilles tendon pain.
  • Orthotics: Custom-made shoe orthotics or heel-lift orthotics can ease pain, especially if you have Achilles tendinitis or tendinosis.
  • Physical therapy: Stretches and exercises can strengthen your calf muscle.
  • RICE therapy: Rest, ice, compression and elevation can help your tendon heal.

If you completely rupture your Achilles tendon, you may need surgery as soon as possible. Your health provider makes a recommendation based on your overall health, age, medical history and seriousness of the tear. Health providers often treat partial Achilles tendon ruptures with nonsurgical treatments.

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Prevention Of Plantar Fasciitis

There are many steps you can take to help prevent plantar fasciitis.

First, try to limit the factors that increase your risk of heel pain, Steege says:

  • Maintain a healthy weight to ease the load on your heels.
  • Warm up before exercise, including calf stretches.
  • Increase running and other forms of high-impact exercise gradually.
  • Choose shoes that support your arch and cushion your heel.

Also, if youre a runner, update your running shoes regularly. I encourage runners to change their sneakers every 300 to 400 miles, or every three to four months, whichever comes sooner, Quirolgico says. Over time, the materials in your shoes wear down, which lowers their shock absorption and increases the pressure on your plantar fascia.

Tight calf muscles can also make you prone to plantar fasciitis. One of the best things you can do to prevent plantar fasciitis is to stretch out your calves regularly, Steege says. Its especially helpful to stretch them out before and/or after exercise. If stretching before exercise, do it after warming up.

If youve had plantar fasciitis in the past, consider working with a physical therapist to find out if you have any muscle weaknesses or mobility issues that could cause a recurrence. Weakness and immobility in areas such as the hip and ankle can create changes in the foot, Steege says.

Strengthening your muscles, increasing mobility, and improving endurance can help manage conditions.

Causes And Risk Factors Of Plantar Fasciitis

Heel and Ankle Pain

Plantar fasciitis occurs when the plantar fascia becomes tight from too much pressure on the tissue. That strain or damage causes inflammation, which results in your feeling pain and stiffness.

As tension in the plantar fascia increases, tiny tears form in the tissue. The more tension and tearing that occur in the plantar fascia, the more inflammation and irritation there will be. Its this buildup of tension and tearing that cause the pain and stiffness associated with plantar fasciitis.

Men and women between ages 40 and 60 are most likely to experience the condition, though its slightly more common among women, according to a June 2019 article in American Family Physician.

It has a higher incidence among athletes particularly runners. It is sometimes referred to as runners heel. A retrospective study of running injuries found that 7.8 percent of the injuries were plantar fasciitis, and the condition ranked as one of the five most common running injuries.

Plantar fasciitis usually develops over time, rather than being triggered by any one specific injury. There are a number of risk factors that can increase your risk for plantar fasciitis, including:

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What Are The Parts Of The Achilles Tendon

Strong collagen fibers make up the Achilles tendon. As with other tendons, a layer of paratenon cells surround each layer of the Achilles. The paratenon layer provides blood flow to the tendon and lubricates its movement.

Healthcare providers often classify parts of the Achilles as the:

  • Noninsertional Achilles tendon: The parts of the Achilles that are higher up the calf, including the midtendon and preinsertional tendon.
  • Midtendon: The part of the Achilles at the narrowest part of the ankle, visible as a cordlike structure at the back of the lower calf or upper ankle.
  • Preinsertional Achilles tendon: The part of the tendon just above the heel.
  • Insertional Achilles tendon: The point where the Achilles tendon attaches to the heel bone.

Bursae, small sacs of fluid, cushion your Achilles tendon at its insertion point into your heel. The bursae arent part of the Achilles itself, but injuries to the tendon often affect them.

What Are The Common Causes Of Heel And Ankle Pain

Heel and ankle pain are common, and in most cases are caused by some form of small injury or repetitive stress that occurs faster than the body can heal. Here are just a few conditions and symptoms that could be causing pain:

Plantar fasciitis

Pain under the heel when taking first steps after waking or after a period of not moving. You may also have difficulty raising your toes off the floor and there are no visible features.

Achilles tendonitis

Tenderness and aching at the back of the leg or above the heel. You may experience pain in the calf when standing on tiptoes or going up stairs


A dull, achy pain at the back of the heel.

This is not a diagnostic tool. See your healthcare professional if needed.

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The Number 1 Cause Of Adult Heel Pain: Plantar Fasciitis

Plantar fasciitis is the most common source of heel pain in adults. It is caused by inflammation of the plantar fascia, the ligament that runs along the bottom of your foot and connects the toes to the heel.

The plantar fascia supports the arch of your foot and helps absorb the shock of impact when you walk or run. When you place too much tension on this tissue, it stretches and may become inflamed or even tear or rupture.

Heel Pain In Children: Severs Disease

About Heel Pain

Severs Disease, otherwise known as Calcaneal Apophysitis is an inflammation of the growth plate in the heel of growing children, typically adolescents. The condition presents as pain in the heel and is caused by repetitive stress to the heel and is thus particularly common in active children.

Severs Disease or Calcaneal Apophysitis is caused due to overuse of the tendons and bone in the heel. This is usually due to repetitive heel movement as seen while playing sports. In growing children, excessive weight bearing on the heel causes excessive traction as the bones and tendons are still developing and are still soft. Children who over-pronate are more vulnerable to this condition. It affects both the heels in 50% of the patients.

Learn more about this condition on our Severs Disease page.

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Heel Pain Is Never Normal

Heel or foot pain is never normal and should not be ignored. It could be something as simple as an overuse injury but it may also be the symptom of a condition requiring medical treatment, such as a stress fracture or ruptured tendon. Its important to consult with a heel pain podiatrist who has experience treating heel pain.

What Are The Symptoms Of Plantar Fasciitis

Both a dull pain and a stabbing pain have been reported by patients with plantar fasciitis. The symptoms of plantar fasciitis include:

  • Pain on the bottom of the heel, or nearby.
  • Increased pain after exercise .
  • Pain in the arch of the foot.
  • Pain that is worse in the morning or when you stand after sitting for a long time.
  • A swollen heel.
  • Pain that continues for months.
  • A tight Achilles tendon. Your Achilles tendon connects your calf muscles to your heel.

Read Also: Medical Term For Top Of Foot

But Why Am I Still In Pain

There are so many potential reasons why your back pain is lasting so long. But the most important thing we want to say is don’t look to the internet or your friends and relatives for a diagnosis. So many people online and in our social circles like to offer unsolicited medical advice. But, in most cases, it isn’t credible sometimes even dangerous, and it’s usually based on their experience, not your specific set of symptoms and medical history.

Youre probably jumping to conclusions yourself about the source of your Foot or Ankle Pain especially if it isn’t something obvious like an injury. But, then, you’re blaming yourself for that time, you wore improper footwear and walked across town or went too hard too soon. Or maybe its just your age, right? Perhaps you’re too old for running?

But the actual cause could just be tight fascia that developed gradually over time due to overuse and lack of stretching and mobility exercises. So we help you find the root cause so you can stop guessing.

Are you still wondering why your foot and ankle pain is lasting so long?

What Are The Treatment Options For Outer Heel Pain


Regardless of what is causing your outer foot pain, the RICE method is an easy way to start getting some relief at home.

  • Rest your foot try to keep your weight off it as much as is practical
  • Ice your foot with an ice pack wrapped in a towel, for 20 minutes at a time, a few times a day
  • Compress your foot by wearing an elastic bandage with comfortable pressure. Be mindful to not wrap too tightly or you may cause further injury!

Elevate your foot above your heart to reduce swelling .

Individual treatment of outer heel pain will largely depend on the condition that is causing the pain symptoms and the patients individual circumstances. Once your sports podiatrist has determined the cause of your pain, an appropriate treatment plan can be commenced. To begin with, often the treatment is aimed at reducing the load on the heel, so that the irritated structures can settle and begin to heal. Once your pain starts to subside, you will most likely be prescribed with appropriate exercises for your lower limb muscles and improve your balance and range of motion in the ankle.

Some of the other common treatments used for outer heel pain, depending on the causative condition, may include:

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Video: Exercises To Reduce Heel Pain

This video demonstrates exercises that can help reduce heel pain.

The exercises in this video are suitable for most people. They are general exercises only and are not aimed at treating any specific cause of pain or condition.

Get advice from a GP or health professional before trying it, especially if:

  • you have any concerns about your health
  • you are not sure if the exercises are suitable
  • you have any pre-existing health problems or injuries, or any current symptoms

Stop the exercise immediately and get medical help if you feel any pain or feel unwell.

Medial Malleolar Stress Fracture

The medial malleolus is the bony bit on the inside of the ankle. A stress fracture of the medial malleolus can occur but is very rare2.

  • It causes pain on the inside of the ankle which is exacerbated by activity, especially running and jumping activities.
  • You will have specific point tenderness over the medial malleolus where the fracture is located.
  • You may also be swelling, but not in all cases.
  • If the stress fracture is in the early stages it may not show up on X-ray but a bone scan, CT scan, or MRI can confirm the diagnosis.

More on Medial malleolar stress fracture

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Research And Statistics: How Common Is Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain in adults, with about 10 percent of the population experiencing it in their lifetime.

Researchers keep looking to improve minimally invasive treatments for plantar fasciitis when symptoms dont improve from rest, icing, and physical therapy. Although a corticosteroid injection is the most common treatment in these cases, newer treatment options may be just as effective, with a lower risk of complications.

A 2019 review of studies for the treatment of plantar fasciitis reveals that autologous platelet-rich plasma therapy , which uses injections of a patients own platelets to speed healing, may be safer and more effective than corticosteroid injections. 30155-4/fulltext” rel=”nofollow”> 24)

The same review found that dry needling, a treatment that involves inserting thin needles through the skin to stimulate muscle tissue in specific areas to relieve tightness and pain , also shows promising results with minimal side effects, but more research is needed.

Another review found that acupuncture may help reduce plantar fasciitis pain in the short term with few side effects. However, more research is needed to determine if its effective in the long term.

Currently, trials are planned that will compare the effectiveness of dry needling versus various types of acupuncture for the treatment of plantar fasciitis.

The Keys To Successful Treatment For Heel Pain & Plantar Fasciitis

Back of the heel pain (Bone, Tendon & Bursa)

Footwear: Wearing shoes that allow your feet to be in their natural position is the most important treatment for plantar fasciitis. Shoe characteristics that are required are low heel height, wide toe box and have adequate support are most appropriate for this foot problem.

Stretching & Strengthening Exercises: Calf and plantar fascial exercises are imperative in treating the pain of plantar fasciitis. They are easy to do, your Foot and Ankle Clinic Podiatrist will talk you through accurately how best to do these exercises.

Taping techniques: There are a range of taping techniques which can unload the stress through the plantar fascia. This can be very useful at reducing pain levels and allow normal activity levels again.

Heel Cushions: Silicone or foam heel cushions commonly available from pharmacies do nothing to actually cure this condition and at best provide temporary comfort. On the other hand, hard and flat walking surfaces are certainly not favourable.

Compression: Almost all joint, tendon and associated condition benefit from compression to prevent excessive inflammatory oedema. The Foot and Ankle Clinic has a range of compression socks and garments that are clinical proven to relieve symptoms of heel pain and plantar fasciitis.

Alternative options such as Prolotherapy, cortisone injections, anti-inflammatories, paddings, dry needling and refexology also have their place and great potential to reduce plantar fascial pain.

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The Two Most Likely Causes Of Heel Pain In Adults Are Plantar Fasciitis And Achilles Tendinitis

But these arent the only causes of adult heel pain. Since these are the most common causes , we want to focus on them first, but the full list of 12 can be found below .

This article has been written in collaboration with foot and heel pain doctors, Dr. Mikkel Jarman and Dr. Brent Weintrub. The information has been derived from both clinical studies and inhouse patient statistics, the content is credible and verified, but still should only serve as information only and not an official diagnosis. For an official diagnosis we always recomend seeing a podiatrist or foot specialists that truly understands the intricacies of the bones, ligaments, muscles, and other tissues of the foot and ankle to accurately diagnose the cause of your heel pain.

Having said that, if you are suffering from heel pain, or just want to learn more about it, we still highly recommend this page as an up-to-date and accurate source of information. Lets jump in !

Where Is Your Achilles Tendon

The Achilles tendon starts in the middle of your calf and extends down to your heel. It connects your calf muscles in the back of your lower leg to the heel bone in your foot.

The gastrocnemius muscle has two heads that crisscross the knee joint. This muscle flexes your knee and ankle. The soleus muscle flexes your foot to point your toes downward.

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What Can I Do To Relieve My Foot And Ankle Pain

Soft tissue takes time to heal, but there are a number of things you can do to help speed up the process:

  • Exercises help to relieve pain by loosening up the soft tissues in your feet. Tightness in the Achilles tendon can often have a knock-on effect on the plantar fascia, so these areas are particularly important to target. Read on for a list of suggested exercises to ease your pain
  • Resting your feet wherever possible by not running, walking or standing for too long can help to avoid any more inflammation
  • Wearing comfortable shoes with good arch support will also reduce the strain on your feet
  • Painkillers such as paracetamol and ibuprofen can help to control the pain. Ibuprofen is also an anti-inflammatory meaning it will help to relieve any swelling. Taking these as tablets or using anti-inflammatory creams can both be helpful. Remember to not take more than the recommended dose
  • Ice packs pressed against the bottom of the foot can help to reduce swelling. Do not apply ice directly to the skin instead, try wrapping the pack in a tea towel

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