Confusion About Heel Pain

The most common types of heel pain problems arise from general overuse or repetitive heel pad strain, but heel pain is complex and, if left, can resist treatment. In this article, there are four key subjects that you need to know about. The first relates to children, while the other conditions are adult-related. There are conditions such as rheumatoid arthritis, gout and ankylosing spondylitis that may affect the heel, as well as rarer conditions and of course, fractures. If the pain does not subside with self-help remedies recommended after several weeks, then seek professional medical help from a podiatrist or medical practitioner. 

• Sever’s disease (apophysitis)
• Haglund’s heel bump
• Repetitive heel pad strain
• Plantar fasciitis

You can go to YouTube to find out about most foot conditions. The USA is by far the most prolific filmmaker on ‘how to’, but remember, there is often a sales pitch behind such films. The first myth you need to be mindful of is the heel spur.  Of course, I have my pitch on heel pain, which may also provide useful first-aid remedies. Surgery is not considered in this article, but my current recommendation is the website FootEducation.com for further information representing impartial, no-nonsense advice produced by health professionals specialising in feet.

Children and adults present with heel pain problems for different reasons. I hope we can make some sense of this in this article. Severs apophysitis (children) and Haglund’s heel bump (children & adults). Fasciitis and heel pad strain for adults. Read bout the myth of the heel spur together with these common problems when you download my FREE self-help sheet Self-help Heel pain – pull out sheet.

Sever’s Disease or Calcaneal Apophysitis

In children (10-16), the growth plate can become irritated. This is not a disease and is often thought of as growing pains. The problem arises when sections of bone determined by the growth plate meet to contribute to the lengthening of the bone and are put under strain from an overactive Achilles tendon.

Remedy: Apophysitis

The most important thing that any parent can do is to ensure there is no visible reason for heel pain—a blister, verruca, or small hair from an animal. Get the magnifying glass and have a good look. Is the heel hot and swollen, painful to touch, and does simple pain medicine make no difference? If pain cannot be relieved by medication, seek professional help, especially if the foot has been rested.

Apophysitis in adolescents is actually self-limiting, and all we are doing is waiting for the two sites making up the heel bone to mature i.e join together. The aim is to remove the tension-pull effect on the smaller part of the heel. To do this, raise the heel with a 1/4 in foam or felt pad, or use a heel pad from a sports shop used for heel pain. Nothing more is required. Adjust the thickness, and put two pieces together if necessary. Felt compresses and thins out, so it needs replacing, and this is why it is only good as a temporary measure. A denser, firmer pad lasts longer, so shop around.

You can rub ant-inflammatory gels over the heel to help as well, but rest and stopping high-activity sports are important for a week to ten days. Then, reduce the frequency for up to six weeks, allowing the heel to settle. Of our four children, only the male developed this problem, and indeed, it self-cured, perhaps with a little help from Dad!

Heel bump or Haglund’s deformity

A condition that affects children and adults

The bump is not prominent, as shown in Haglund’s disease (deformity) below. As with the heel spur, which lies under the heel bone,  traction pulls at the back of the heel from the big Achilles tendon. This can arises during adolescence and later in life when increased activity triggers pain and inflammation. The Achilles tendon is often the site where the tendon produces harmless spurs. Heel pain for the young person can be quite distressing but more so after activity. X-rays are usually unremarkable and are not always required.

 

 The bump (below) is shown inside the profile and consists of bone and overlying soft tissue. Gel sleeve (above right). The pad is contoured and made as a sleeve or half-sock

 The bump arises most commonly in adults, although it can occur in adolescents. Known also as a retrocalcaneal exostosis, Haglund’s deformity names are often confusing. Symptoms are easier to spot because discomfort arises over the bump. Many shoes can irritate the location, so select shoes around the heel. The telltale sign is the bump illustrated. Apart from the obvious increase in the size of the heel, the inner heel lining is worn at one point. Redness and tenderness can be due to simple friction or chilblains during the autumn and winter seasons.

Remedy: Haglund’s deformity

• If the skin is damaged, it should be protected by a blister dressing or felt pad. Blister dressings are available from high-street pharmacies, often with their foot care products. Made from a gel, they cushion and are water-resistant.
• Felt pads are often best fitted inside the shoe, and a cavity should be created to relieve pressure from the bump.
• A soft sac or bursa can form over the skin and needs protection from friction.
• A heel lift may be useful to change the position. ¼ inch (6mm) felt, or foam insert works well
• I have personally found a gel pad similar to the one illustrated above useful, but replacement is required with heavy use. These are great in walking boots.

 

Repetitive Heel Pad Strain

Reading the literature, it is easy to believe that heel = fasciitis. In truth, sometimes this is possible, and the two exist; at other times, this is not the case, despite management often overlapping. I have had both conditions myself: fasciitis and heel pain, the latter being an overuse syndrome. Fasciitis came on midway through a family camping holiday when I was in my mid-thirties. Heel pain arose after I decided to keep fit and used a treadmill aggressively at 45 years of age. Location can offer a guide. Read my article on bruised heel pain

 

Remedy: general advice for heel pain

Long-standing periods and work shifts (above 8 to 10 hours) will make heel pain worse. 

• Painkillers work to reduce pain but will not resolve the problem. Stop excessive exercise for 2-3 weeks.
• Use a foam heel pad such as silicone jelly.
• Sports shops also sell thin heel pads that don’t take up too much room, but these pads are short-lived. Heel lift pads can be used for Sever’s disease.
• If pain persists or increases in intensity, then seek help no later than 4-6
• gently daily about three times a day using a Thera band as shown or stretch the band against the ground as in tendo Achilles stretches. The tendo Achilles and fascia share a close relationship.
• Tuli heel cups are well worth considering and work well for many heel pain sufferers. They are sourced through the internet, so they are freely available with a prescription.
• Check your footwear for any cause of the problem, and try to re-negotiate shorter shifts at work or change roles so you are sitting some of the time.
• If within a month the pain is still present, then seek assistance or earlier if the pain escalates.

Illustrations show Thera band stretch (Above) and Tuli Heel cup (Below

Plantar Fasciitis

(See my other article on this website and what the internet says about fasciitis)

Fasciitis arises less frequently than heel pad pain. However, fasciitis can involve the heel pad and arch and can become disabling if not treated. Follow the same advice for heel pad pain for the same time periods, but remain as active as possible. Do not exert the foot, i.e., run or undertake sports requiring squats or springing until the symptoms have calmed. High-heeled shoes may actually be more beneficial.

Remedy: plantar fasciitis

• Once the pain starts, if the area is tender to press, avoid arch supports initially.
• Use localised non-steroidal gel or creams or locally applied warming creams**
• Apply local strapping (see fan design) to remove tension
• Increase heel height inside the shoe up to ¼ in 6mm
• Once pain is easier, longer-term help can be gained from an orthosis.
• Stretching once the condition improves helps prevent reoccurrence as shown with Theraband.
• Also, use stretches for the tendo Achilles
• Use a small rolling pin, or cylinder to provide some deep massage

** Warming creams contain salicylates such as methyl salicylate, and they are heat-making when rubbed onto the skin. The idea is to bring fresh blood to the area and speed up healing on non-infected, unbroken skin.

---

Burning pain and tarsal tunnel need to be ruled out. Here are some ideas about what to look for.

Surgery –  Read John’s experience and when to consider this form of management.

---

Thanks for reading ‘More Heel Problems’ by David R Tollafield 

Consider this introductory book to the adult foot, available from Amazon or the Institute of Podiatrists.

 

Published by Busypencilcase Communications Est. 2015 for ConsultingFootPain

Modified January 2025