Foot Pain in Heel Bone [Causes, Symptoms & Best Treatment!]
Do you have foot pain in the heel bone? We have you covered with the best causes, symptoms and treatment! Get it 100% better FAST!
- One of the top causes of heel pain is plantar fasciitis. This is damage to a ligament that holds your heel to your toes.
- Another root cause of heel pain has flat feet.
- There are also photos of heel spurs that can occur to the bottom of your heel (plantar fascia insertion) and the back of your heel (Achilles tendon insertion).
- Baxter’s nerve entrapment can also happen at the bottom of the heel.
- An underlying cause is an overpronated flatfoot or an over a supinated high arched foot.
- A plantar fibroma is a thick nodule that can occur within your plantar fascia ligament and contribute to plantar fasciitis.
- This can lead to the formation of a heel stress fracture( AKA calcaneus stress fracture.)
Please click on the gallery for a guided tour through heel pain conditions!
The #1 Cause is Plantar Fasciitis:
- Foot pain in the heel bone can be usually due to the development of a heel spur.
- A heel spur should essentially be treated as if though it were plantar fasciitis.
- Plantar fasciitis is the most common cause of heel pain seen by foot and ankle surgeons.
- Massive pain that inhibits you from standing
- About 15% of the population suffer from plantar fasciitis.
- This is usually an overuse injury at the origin of the plantar fascia caused by excessive stress to the foot or biomechanical abnormalities of the foot.
- The plantar fascia stretches from your heel (calcaneus) to the joints of all your toes (Metatarsal phalangeal joints)
- The plantar fascia consists of 3 bands: medial, central, and lateral.
- Usually the medial band is damaged, but it can also be the central band.
- The plantar fascial bands are supplied by the medial and lateral plantar nerves.
- The thickness of a normal plantar fascia is approximately 3 mm.
- In patients with plantar fasciitis, the maximum thickness is significantly increased to 7 mm
- Plantar fasciitis is described as a painful inflammatory process.
- Generally at the origin of the plantar fascia on the calcaneus.
- It can also be central in the plantar arch.
- **It is very uncommon for plantar fascia pain to be on the outside of your foot or toward the toes.
- 40 to 60 years
- More common in women
- High Arch and Flat Foot
- Occupations that require standing
- Common in athletes, nurses, mailmen, factory workers, mechanics etc
- People with footwear that is loose & has no arch support.
- Obese patients -this leads to chronic stretching & degeneration & pain.
- Pregnant patients- the ligaments get loose and stretch
- Tight Calf muscles
- Pain is usually localized to the medial calcaneal tubercle
- Initially pain is sharp and worse with the first step of the day after a period of non–weight bearing.
- Chronically it is dull and painful over time
- Radiographs(X-rays) – Check for a Heel Spur- this is bone formation at the insertion of the plantar fascia- Note: this is not what causes the pain- but correlates the diagnosis
- Ultrasounds- Inflammed fascia is normally hypoechoic- but normal fascia is normally iso-echoic
- MRI- The best method- but almost never needed (highly overkill)
Low Dye Strapping
- I love this type of taping- it holds the foot in an ideal structure and re-inforces the arch for a couple days until the inflammation of the fascia can die down.
- Tip 1: ***If low dye taping does work for you- In my experience an orthotic will complete cure your heel pain the majority of the time***
Get the right shoes
- Tip 1: ***Get atleast a 1 inch heel on your running shoe – according to the Podiatric Sports Association***
- Tip 2: ***Make sure the shoe bends in the front and not in the middle or the back of the shoe**
- Tip 3: ***Avoid sandals & going barefoot on hard surfaces**
Stretching of the Achilles Tendon and Plantar Fascia
- Tip 1:***Studies show that stretching your achilles tendon 3x per day for 2mins at a time will cure the pain in 25% of
- Tip 2:**Stretching your feet(the plantar fascia) as well as the Achilles tendon boosts that number from 22% to 55%
- according to studies!*** So start stretching immediately!
- Tip 3:***Use night splints to stretch your feet for you while you sleep!***
- Wear these at night to keep your feet stretched (the toes point straight rather than down when you sleep)
- Tip 1: ***Studies show that night splints helped almost 100% of patients***
- Tip 2: ***Ease into them while napping, you forget you are even wearing them after 1-2 naps!***
- Studies show good relief after 2-4 weeks when combined with anti-inflammatory medications & ice.
- Ultrasound & whirlpool therapy also helps greatly.
- No exact numbers available from studies.
- Take a 2 week regimen of regular advil, Ibuprofen or any other NSAID(see pharmacist for dosing).
- Watch for allergies.
- Topical NSAIDS are frequently helpful- but no exact numbers are available from studies.
Injection of Corticosteroids:
In my experience- **this is the gold standard for immediate relief!** Fixed with a 5 minute visit to the podiatrist.
- Tip 1:***Studies show almost all people recieve temporary relief that last for up to 6-8 weeks, in about 25% it never comes back***
- Tip 2: If you remove the cause during the pain-free injection period(6-8weeks) then the pain should never come back.
***The long term Gold Standard- whereas corticosteroids are the short term gold standard***
- Tip 1: ***Orthotics combined with anti-inflammatories & Injections have an 85% permanent cure rate for plantar fasciitis! Compared to just 30% without orthotics***
- Tip 2: Get some arch supporting orthotics like PowerStep (25$) not the gel inserts of Dr. Scholl – they just cushion but not support the arch.
- Tip 3: Get some heel lifts if you can over Dr. Scholl, but PowerSteps are better than both.
- Tip 4: Powersteps > Heel Lift > Dr. Scholl Gel inserts
Extracorporeal Shock-Wave Therapy
Sound waves are propagated to damaged tissues to induce microtrauma.This microtrauma stimulates healing by attracting blood vessels and nutrients to the plantar fascia.
- Tip 1:*** Used as a last ditch effort before surgery if you are rich- because it is not covered by any insurance***
- Tip 2: I say avoid it- its expensive and unproven!
Studies show that only 5-10% of people will ever need surgery on their Heel for Plantar Fasciitis.
Open Plantar Fasciotomy
- Open plantar fasciotomy allows for release of the tight plantar fascial bands.
- Studies show that this surgery is 37% effective with a fascial release only & 45% successful in curing with fascial release as well as removal of the bone spur.
- Most do experience relief.
Endoscopic Plantar Fasciotomy ***Great choice***
- Popular due to minimally invasive nature.
- Minimizes complications and recovery time compared with open procedures.
- A scope is inserted through a very small incision and the fascia is resected.
- Satisfaction ranged from 60% to 80% with this procedure in relief of heel pain.
- Percutaneous cryosurgery uses subfreezing temperatures to produce analgesic effects.
- Nerves are detected & frozen for 3 mins, then thaw for 30 seconds & repeated.
- Numbness will occur for many months.
- Research shows 78% success – but more research is still needed for this procedure.
Radiofrequency Nerve Ablation
- Another minimally invasive procedure that ablates the nerve with an electrode through the skin.
- Patients are allowed to bear weight immediately after the procedure.
- Coblation therapy with Topaz is a form of bipolar radiofrequency.
- Causes microscopic damage to the fascia, which increases the blood supply to the fascia; this causes it to rebuild and flood the area with growth factors.
- Patient shouldn’t walk for 3 weeks.
Best Heel Pain Products:
- There are usually two phases to treating plantar fasciitis pain.
- The two phases of treatment include controlling the acute inflammation, and correcting the biomechanics which led to the problem in the first place.
- If the tendons and ligaments are inflamed, they are almost frozen in place and cannot function properly.
- Once the inflammation is decreased, we need to correct the bio-mechanical causes to ensure that they can never become over worked and inflamed again!
- This doesn’t matter whether it’s plantar fasciitis, plantar fibroma, sore bottom of foot, or even Achilles tendon pain. Treatment is all roughly very similar.
Plantar Fasciitis or Achilles Tendonitis Inflammation:
Massage & Ice Products:
- Ice is the an excellent option that can be safe for almost everyone.
- There is some debate whether icing is worth doing, but for chronic pain this can help limit the need for medications and keep your options open.
- This works great for your arch, less for the ball of the foot.
- The more muscle and ligament tissue there is, the better ice will work there.
Menthol Based Gels:
- Biofreeze is one of our favorites.
- These gels have been studied to work 2x as long as ice.
- This works great for the ball of the foot.
- This can be very effective for bottom of the heel and Achilles tendon sore regions.
- These can work great for loosening your muscles.
- This allows less tightness and pressure on the ball of your foot.
- This is very effective for the arch, the gastrocnemius or calf muscle and for the hamstring and thigh muscles.
- This also works very well for the gluteus muscles if you are having butt cheek or hip pain.
Remove the Plantar Fascia or Achilles Tendon Stress:
- The key is to prevent future pain.
- This means keeping you active while keeping stress off of your plantar fascia tendon. This will prevent future re-injury and development of plantar fasciitis.
- If you can get rid of the pain and swelling, this will let you start walking normally.
- If you can walk normally, the vast majority of your pain should gradually start to go away.
- The best way to ensure that your plantar fascia, foot and ankle ligaments are not overworked is to support them.
- The best way to support them is to use great orthotics and great shoes.
- Some people may also need to rely on supportive ankle braces and other supportive modalities.
The Best Heel Pain & Plantar Fasciitis Shoes:
- Getting a great supportive pair of shoes will make sure that there is pressure removed from the heel and plantar fascia region.
- This is especially important if you have plantar fasciitis, heel spur pain or Achilles tendonitis.
- Consider shoes combined with a good supportive orthotic for best pain relief!
- The following link will show you what our favorites are.
Best Heel Pain & Plantar Fasciitis Orthotics:
- These are our recommended orthotics for plantar fasciitis.
- Custom orthotics can work very well, but they should not be a first line of treatment.
- There are different types for different shoes.
- Women’s shoes usually need a less bulky orthotic, but allow for less correction.
- A full length orthotic requires a running shoe, boot or comfortable walking/dress shoe.
- We recommend doing everything you can to get a good supportive shoe that can fit a full length orthotic.
- This is the best way to maximize your orthotics for great results.
Best Full Length Orthotics:
- These will only work in wider shoes or a good supportive running shoe.
- This will not work in sandals, flats or most women’s dress shoes.
Best Dress Shoe Orthotics:
- These are a great choice for dress orthotics.
Best 3/4 Length Orthotics:
- These are great options for women’s dress shoes and thinner shoes.
- These are not the most supportive pair of orthotics.
Get A Great Dynamic Stretch:
- It is possible to stretch on your own, but these products can also really help!
- This will take pressure off of the ball of your foot.
- We personally prefer this method of stretching.
Get A Great Static Stretch:
- These devices are great for stretching while you are resting.
- This will also help take pressure off of the ball of your foot.
- This works great for plantar fasciitis.
- It can be used while watching TV or at night time.
Best Heel Compression Brace:
- A good compression brace can stabilize your foot from turning outward.
- This prevents your foot from pronated.
- Pronated foot will turn your foot outward in your foot will rub on the outside of the shoe.
- For many of her patients this has solved their pain and is very comfortable to wear inside your shoe.
- This solves both pain and outward pronation for a relatively low cost.
Best Heel Stability Brace:
- Stability brace goes little bit further than the compression brace to stop your foot from turning out.
- This takes pressure off of your heel and plantar fascia.
- At the same time this is a little bit bulkier and does not affect every shoe.
- We find people are little bit happier trying the compression brace before the stability brace.
- If you think you might have a broken heel, a calcaneal stress fracture or something of similar severity, these products might help!
- Always remember to see a foot and ankle specialist like a podiatrist if you are having plantar fasciitis or more severe pain!
Plantar Fascia Tear, Broken Heel Bone, Achilles Tendon Tear:
- If you have a traumatic injury such as a torn plantar fascia ligament, calcaneus stress fracture, heel fracture or insertional Achilles tendon injury: consider protecting your foot!
- The best way to do this is of course to see your podiatrist and get evaluated with an x-ray, ultrasound and potentially even an MRI or CT scan.
- If you are unable to do so it may benefit you to be in a cast, fractured boot, or even keep the weight off of it with a rolling knee scooter or other protective devices.
- We as podiatrists frequently take patients off work for very long period of time when they suffer a traumatic injury, unfortunately there is no other way around us in labor jobs.
- If you have a sit down job there are ways to get people back to work quicker, but this can be very difficult otherwise.
Heel Injury Boot Treatment:
- There are pros and cons to using a boot to treat your heel injury. If you are immobilized too long the cons are that you will gradually become stiff and overworked to your other leg. The Pros are that you injured heel will hopefully have a chance to gradually heal!
- Our favorite fracture boots and their supplies:
Offloading and Scooter treatment:
- These are favorite knee scooters and walking devices: