Heel pain can occur on the back and/or bottom of your heel. Pain on the bottom of your heel is often known as plantar fasciitis or heel spur syndrome. Pain on the back of your heel can be caused by inflammation of your achilles tendon, or a bony condition known as a Haglund bump, or pump bump.
The most likely cause of pain on the bottom of your heel is something called plantar fasciitis or heel spur syndrome. Plantar fasciitis is an inflammation of a fibrous band of tissue that connects your heel to the ball of your foot. This occurs when the plantar fascia is strained over time beyond its normal extension, causing small tears. This leads to inflammation of the surrounding soft tissue and degeneration of the fascia. Pain is usually worst early in the morning and after standing when seated for long periods of time. This is often caused by your foot structure, tight leg muscles, and faulty biomechanics such as excessive pronation.
Stress fracture can be another cause of pain on the bottom of your heel. A calcaneal stress fracture is a small fracture caused by repetitive activity and stress on the heel bone. Symptoms can be similar to plantar fasciitis but pain usually increases with increased activity.
Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, or gout can be less common causes.
Bursitis (inflammation of a small fluid filled sac) on the bottom of the heel
Nerve compression, also known as Baxter’s Nerve entrapment
Haglund’s deformity, also known as pump bump may be a cause of posterior heel pain. This is an enlargement of the heel bone in the area where the Achilles tendon attaches to the bone. Haglunds deformity is often made worse when rubbing on the back of your shoes.
Achilles Tendinitis which is inflammation of the Achilles tendon as it runs behind the ankle and connects to the back of the heel bone. This condition is often seen in people that walk or run and don’t properly stretch their posterior leg muscles prior to activity. If left untreated, the fibers of the achilles tendon can stretch or tear, leading to degeneration and increased risk of achilles tendon rupture.
Dr. Hurwitz and Dr. Amin recommend seeking treatment at the first sign of pain or discomfort. If left untreated, heel pain can become worse and more difficult to treat.
Xrays and ultrasound are generally performed to evaluate for any problems in the bone and to assess the quality of your plantar fascia and or tendons.
In rare circumstances, MRI, blood tests, or nerve tests may need to be performed to help make a diagnosis.
Treatment options vary with the severity and location of your heel pain and treatment options may include:
Custom orthotics to help control your abnormal foot function and relieve pressure on the area.
Prescription anti-inflammatory medications to help relieve the pain and inflammation causing you discomfort
Steroid injections or orthobiologic injections to help bring down inflammation in the area
Physical Therapy may be required when a home stretching regimen isn’t enough
When conservative therapy fails to relieve your pain, surgery may be required.