There are a number of causes of heel pain, with plantar fasciitis high on the list. Sharp pain in the heel is a symptom of a medical issue that is usually not serious. However, pain can make walking and standing difficult. Self-care is often enough to relieve pain, but it is essential to get a physician’s diagnosis when severe pain is accompanied by swelling or when pain persists for more than a few weeks.
Anatomy of the Heel
The heel is usually taken for granted until it becomes painful. The heel carries a heavy load throughout a lifetime and takes a pounding day-in and day-out. It is built to withstand the stress, but sometimes things go wrong.
The anatomy of the heel is a remarkable structure of bones, ligaments, and tendons that enable a variety of movements:
- The calcaneus bone, which is the largest bone in the back of the foot
- The talus bone which is connected to the calcaneus bone at a joint called the subtalar joint (allows the foot to bend down and up and side to side)
- Five tarsal bones that connect the heel bone to the toe bones
- The Achilles tendon attaches the calf muscles to the heel bone (enables rising up on the toes)
- A smaller tendon (Tibialis Posterior) attaches a smaller calf muscle to the foot’s underside and runs on top of the heel bone (supports the arch)
- Thick Plantar fascia ligament connects the heel to the front of the foot and supports the arch of the foot
- Number of small ligaments holding the foot bones together
- Number of muscles that are layered on the sole and provide cushioning
- Posterior Tibial nerve enters the sole and provides sensation to the toes and sole of the foot and controls muscles
- Plantar nerves run on the top of the foot and then down the side into the sole and heel
- Posterior tibial artery is the main artery providing the blood supply
- Smaller arteries run down the top of the foot with the lateral tarsal artery branching off into the heel
Understanding the complexity of the heel’s anatomy makes it easier to understand the main heel pain causes. The heel involves a carefully balanced set of bones, ligaments, tendons, muscles, nerves, and arteries, all carefully designed to enable balance and movement.
Heel Pain Has Many Sources
People experience different severities of heel pain and at different times of the day. Some of the common causes of heel pain are as follows:
This condition can cause severe heel pain due to the fibrous tissue band’s painful inflammation in the sole of the foot called the plantar fascia. When the ligament is overstretched, experiences a tissue tear, or is overloaded by too much pressure, the heel becomes painful and stiff.
This is a painful condition in which the bursae (fluid-filled sacs) are inflamed. Bursae are fluid-filled sacs that cushion tendons, bones, and muscles around joints. It usually develops around joints that are subjected to repetitive motion on a regular basis.
Achilles tendon rupture or Achilles tendinitis
An Achilles tendon rupture is an injury to the large strong tendon connecting the heel bone’s calf muscles. Like any tendon, it can be overstretched to the point it ruptures, or it may just partially tear. The Achilles tendinitis is an overuse injury of the Achilles tendon in which the tendon is irritated or inflamed.
Strains and sprains
This heel pain causes the tearing or excessive stretching of muscles or tendons (strain) or ligaments (sprain).
Rheumatoid arthritis is an inflammatory autoimmune disease that can attack joint linings. Osteoarthritis is a wear-and-tear disease in which the joint’s cartilage wears down, and bones rub against each other. It can develop in the three joints that involve the heel bone.
Other heel pain causes include:
- a heel spur (calcium deposit) where the fascia tissue band connects to the heel bone;
- stress fracture;
- peripheral neuropathy;
- and osteomyelitis (bone infection), to name a few.
Assessing Symptoms
A common question concerns how symptoms differ between the causes of heel pain. What are the symptoms of heel bursitis or plantar fasciitis or an Achilles tendon rupture? How do they differ? Identifying the cause of severe heel pain starts with assessing the symptoms.
A common cause of heel pain, plantar fasciitis is inflammation of the tissue that runs across the bottom of the foot. This is the bank of tissue connecting the heel to the bone. It is typically felt like a stabbing pain and a morning heel pain that eases as the person moves about.
Heel bursitis is joint inflammation. The heel is likely to feel stiff, look swollen and red and hurt when moved. Repetitive motions that put pressure on the bursae is usually the cause, but it can also develop due to injury, arthritis, infection, and gout.
An Achilles tendon rupture is normally felt as a sharp pain that occurs suddenly in the back of the lower leg at the ankle after feeling something like a rubber band breaking. There might even be a pop sound.
A heel strain or heel sprain can feel very similar. The symptoms of both injuries include pain around the joint, impaired flexibility, swelling, and difficulty using the joint in a full range of motion. The main difference is that strains usually experience muscle spasms, while the sprain leads to bruising.
Rheumatoid arthritis leading to inflammation can make the foot, including the heel, feel stiff, especially in the morning. There is swelling around the joints, and the inflamed area feels warm and tender. Osteoarthritis is also painful and can present as joint stiffness, swelling, and warmth. Arthritis symptoms often include tenderness when the joint area is touched.
When to See a Doctor
In most cases, a heel injury will heal with self-care that includes rest, applying an ice pack, or even buying more supportive shoes. However, severe sudden heel pain or an inability to use the foot needs a doctor’s immediate attention. A physician should also assess the heel when the pain persists for a couple of weeks or longer.