Heel Pain When Walking? Diagnosis & Treatment

Have you spent more time than usual being active on your feet or doing more intense exercise, and you are now experiencing heel pain when walking? In some instances, these kinds of activities lead to heel pain. The good news is, receiving an accurate diagnosis and treatment plan can quickly put you on the road to recovery. Heel pain is a common problem that affects the foot and ankle, and if you encounter this pain consistently, it may be time to see a specialist.

This post looks at the symptoms of heel pain, what plays a role in developing heel pain, ways to relieve your pain, and how Yeargain Foot & Ankle can help you heal.

What is heel pain?

Over the holiday season, we tend to increase our steps/time spent on our feet, especially when shopping for deals. We also put more stress on our feet when commencing or boosting physical activities. Over time, this added stress can irritate sensitive tissues, and you may eventually develop heel pain. Heel pain is the most common problem affecting the foot and ankle.

A sore heel can improve on its own if enough rest is allowed for recovery. Unfortunately, many people tend to ignore the early signs of heel pain and “power through” with the activities that caused their pain. When you continue to apply stress in an area that’s already sore, it’ll only get worse and can become a chronic condition leading to more problems.

Where does heel pain develop?

Heel pain can develop on the bottom or back of the heel, depending on the type of activity. Let’s say you start a sport or activity like CrossFit and do box jumps and other plyometric exercises. These activities can cause pain to the back of your heel, where the Achilles tendon inserts into a bone called Achilles tendinitis. Engaging your Achilles tendon to perform plyometric exercises without proper stretching and training can lead to tendon inflammation. Retrocalcaneal bursitis can also occur due to the shoe rubbing or cutting into the back of the heel. 

Bottom-of-the-heel pain can present in many different forms but also depends on the type of activity. A stone bruise can arise on the fat pad on the underside of your heel if you step on a hard object, such as a rock or stone. It may look bruised and discolored, and the pain typically goes away with rest. Other conditions on the bottom of the heel are plantar fasciitis, Baxter’s neuritis, and a heel fracture.

What causes pain behind the heel?

• Bursitis is a prevalent cause of heel pain. There is a fat pad inside the heel called the bursa, which protects and guards the heel against the friction of everyday use. Running, walking, or irritation from shoes can result in heel pain from the inflamed bursa due to repetitive motion. Conservative treatment consisting of the RICE (Rest, Ice, Compression, Elevation) protocol and anti-inflammatory
  medications can reduce inflammation and relieve heel pain. If first-line therapies don’t provide relief, surgery may be necessary.
• Achilles Tendinitis is the inflammation of the Achilles tendon due to overuse. It’s the body’s longest and strongest tendon, commonly inflamed among athletes in high-impact sports like basketball, tennis, and running. Athletes feel back-of-the-heel pain from putting too much stress too quickly in the Achilles tendon. Nonsurgical modalities like immobilizing the foot what a walking boot, RICE protocol, and orthotics, can help repair the tendon. Severe damage to the Achilles tendon that doesn’t respond to nonsurgical treatment may require surgery.
• Haglund’s deformity is chronic inflammation and irritation of the Achilles tendon on the back of the heel due to an enlarged bony prominence or bump on the heel bone. This often leads to painful bursitis, a fluid-filled sac between the tendon and bone that becomes inflamed. It was coined “pump bump” due to the belief that women’s pump-style high heels were a leading factor in the growth of the bone. The non-surgical approach reduces swelling and bursitis around the bone spur. Surgery is warranted if nonsurgical methods are unsuccessful.
• Calcaneal apophysitis (Sever’s disease) is a common cause of heel pain in active children ages 8 and 14 and can occur in one or both feet. Overuse and stress on the heel bone through participation in sports are major causes of calcaneal apophysitis. The heel bone’s growth plate is sensitive to repeated pounding on hard surfaces, soccer, track, basketball, and running, resulting in muscle strain and inflamed tissues. The RICE protocol and anti-inflammatories are the primary treatment for this condition. 

What causes pain beneath the heel?

• Plantar fasciitis or inflammation of the thick band of tissue that originates on the bottom of your heel bone and extends to your toes, supporting your arch. Plantar fasciitis is the most common cause of heel pain, and it’s the number one condition we treat at Yeargain Foot & Ankle. It can also cause pain in the arch of the foot, where a large amount of stress is absorbed while walking or performing physical activities. Treatments include rest, stretching, anti-inflammatories, orthotics, and supportive shoes. Surgical intervention is needed in less than 10% of all plantar fasciitis cases.
• Heel fracture is when the heel bone is broken or fractured in a traumatic fashion. Trauma can be from a motor vehicle accident, falling from a ladder, or even a stress fracture transitioning into a fracture due to continued stress in a bone. Immobilization with a cast or walking boot is performed if the fracture is nondisplaced, meaning the bone is within its anatomical position. Surgical intervention is required when the bone fragments shift out of place and are no longer in anatomical position.
• A less common cause of pain beneath the heel can be caused by nerve entrapment. Symptoms include burning, shooting down the foot into the toes, or radiating pain. While noninvasive options like medication can help with nerve pain, patients often require surgery to “untrap’’ or decompress the nerve-causing pain. 

What are the symptoms of heel pain?

• The pain you experience from heel pain can vary depending on the cause and location. In addition to pain, you may experience
  • Discoloration (redness or bruising).
  • Stiffness.
  • Swelling.
  • Tenderness.
  • Pain after immobility or first steps in the morning

How is heel pain managed or treated?

• Nonsurgical methods are typically used to treat heel pain. Therapies are performed to ease the inflammation causing the pain and minimize stress and strain on the heel. These included:
  • Injections: Steroid injections can ease pain and swelling but are limited in the quantity and location of the heel pain. 
  • Orthotics: Custom orthotics and other shoe inserts can take pressure off the heel and ease the pain. Wearing supportive shoes is also advised when using orthotics or inserts.
  • NSAIDs: Nonsteroidal anti-inflammatories combined with icing the area will reduce pain and swelling. 
  • Physical therapy or stretching exercises: At-home stretches and physical therapy can help reduce the inflammation driving your pain. Ultrasound therapy can break up soft tissue adhesions and reduce inflammation as well.
  • Taping: Taping is a quick way to support your arch or heel to relieve pain. Taping can also be used while performing physical activities to prevent injuries. 

When a ganglion is located in the foot or ankle region, Podiatrists are the specialists in diagnosing, treating non-surgically, and can perform a surgical removal of the cyst if necessary either in the office, or in a simple day-surgery procedure.

When should I call the doctor?

• Call a foot and ankle specialist if you experience:
  • Pain that doesn’t improve in a couple of weeks with rest and NSAIDs.
  • Any pain that makes it difficult to walk or move.
  • Severe foot, heel, or ankle swelling, inflammation, and pain.

What questions should I ask my doctor?

• Questions you can ask your foot and ankle specialist are as follows:
  • What is causing my heel pain?
  • What is the best treatment to alleviate my symptoms?
  • What can I do to prevent my heel pain from returning?
  • What symptoms require a more urgent evaluation?