Heel pain is one of the most common foot problems, but not all heel pain is plantar fasciitis.
Pain underneath the heel, at the back of the heel and around the sides of the heel can have different causes. Plantar fascia problems, Achilles tendon disorders, nerve irritation, stress injuries and problems around the joints of the hindfoot can all produce heel pain.
The first step is therefore to understand where the pain is coming from and why it has developed.
Pain under the heel is commonly associated with plantar fasciitis, particularly when it is worse with the first few steps after getting out of bed or after sitting for a period of time.
However, persistent heel pain can have other causes and may need further assessment.
Pain behind the heel may arise from problems involving the Achilles tendon, the area where the tendon attaches to the heel bone, or the structures around it.
Some patients also develop a prominent area at the back of the heel that becomes uncomfortable in shoes.
Sudden heel pain following an injury should be assessed differently from gradually developing heel pain.
Depending on the mechanism and examination, an X-ray or other imaging may be required to exclude a fracture or significant tendon injury.
Some common causes include:
Diagnosis usually begins with a detailed history and clinical examination.
I look at:
Most patients with common causes of heel pain can initially be treated without surgery.
Depending on the diagnosis, treatment may include:
Treatment should be directed at the underlying cause rather than simply trying to suppress the pain.
That is why a clear diagnosis comes first. The right plan for plantar fasciitis is different from the right plan for an Achilles problem or a stress injury.
Surgery is generally reserved for selected patients whose symptoms remain significant despite an appropriate period of non-operative treatment and when the diagnosis is clear.
The type of procedure depends entirely on the cause of the heel pain.
Consider an assessment if:
No. Plantar fasciitis is common, but several other conditions can cause heel pain.
Not necessarily. A heel spur may be an incidental finding and does not automatically explain the pain.
Many common causes can be managed successfully without surgery, depending on the diagnosis.
Usually not. The appropriate activity level depends on the cause and severity of your symptoms. Complete rest is not always necessary.
If the pain persists, interferes with normal activities, follows an injury or is associated with swelling, numbness or other concerning symptoms, assessment is appropriate.
Persistent heel pain is easier to treat when the underlying problem is correctly identified.
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Dr. S.K. narayan Dash
Cardiology Surgeon
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