Painful Heel Conditions

Plantar fasciitis is the term for heel and arch pain due to inflammation and strain of the plantar fascia. This thick band of tissue starts at the heel bone, runs across the arch of the foot, and attaches to the base of the toes. Its purpose is to support the arch of the foot. Often, plantar fasciitis is characterized by increased pain after a period of rest—for example, during your first steps upon waking up. This occurs because putting your full weight on your bare foot damages and tears the fibers of the plantar fascia.

Overpronation (a rolling inward of the foot) is the most common cause of plantar fasciitis. As the foot rolls excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes repetitive injury and results in inflammation. Another common cause is having tight posterior calf muscles which is called equinus deformity.

Haglund’s deformity, also known as “pump bump,” occurs on the back of the heel where a bony enlargement develops. When this bone is irritated, it irritates the soft tissue near the Achilles tendon. This results in bursitis, an inflammation of the sac (bursa) between the bone and tendon. Haglund’s deformity is recognizable by the large lump on the back of the heel. This area may also be red, swollen, and painful.

This aptly nicknamed condition occurs when rigid shoes (often women’s high-heeled pumps) rub against the heel bone, causing irritation and inflammation. This can happen in any shoes with a high, stiff back. Additionally, those with high arched feet, a tight Achilles tendon, and people who walk on the outside of their heel are more likely to develop Haglund’s deformity.

Treatment for Haglund’s deformity is aimed at reducing inflammation and pressure on the affected area. Rest, ice, and over-the-counter anti-inflammatory medications such as ibuprofen are often recommended first. Your podiatrist may also suggest stretching exercises, heel lifts, heel pads, shoe modifications, laser therapy, physical therapy, custom molded orthotics, or even immobilization in a cast.

Surgery for Haglund’s deformity is not often necessary. Surgical correction usually consists of removing the bony enlargement, but may also include repairing the Achilles tendon if there is damage. Your foot surgeon will discuss whether surgical intervention to correct a pump bump is right for you. 

Calcaneal apophysitis, also called Sever’s disease, is a painful inflammation of the heel’s growth plate. Because the heel bone (calcaneus) is not fully developed until around age 14, this condition mostly affects children between the ages of 8 and 14, especially ones who are active in sports, dance, gymnastics, and other physical activities.

Sever’s disease is characterized by inflammation of the heel, presenting with pain. This inflammation is caused by daily repetitive impact causing additional wear-and-tear on the heel bone and the Achilles tendon. Sever’s occurs most commonly in young athletes who are constantly running, jumping, and putting pressure on their heels. Other contributing factors to Sever’s disease include increased BMI (body mass index) or being overweight, flatfoot, high arches, or a tight Achilles tendon.

The first step to treating Sever’s disease is to reduce or discontinue your child’s activities which are causing pain. Ice and anti-inflammatory medication such as ibuprofen can help reduce immediate and painful symptoms. Over time, the heel growth plate needs additional support and cushioning. Your foot and ankle specialist may suggest laser therapy, heel lifts and cushions, custom molded orthotics, or a different pair of shoes altogether. Definitely avoid allowing your child to go barefoot. In severe cases, Sever’s may need to be treated with immobilization through casting or bracing. Additionally, physical therapy and a stretching splint called an Equinus brace can help stretch the Achilles tendon and strengthen the foot. However, until the child’s heel bone is fully developed, Sever’s disease can recur.

Sever’s disease can be treated conservatively and will eventually diminish as the heel bone finishes developing and the growth plate closes. However, heel pain that recurs may be a sign of a deeper underlying problem. You should speak with your foot and ankle physician to further diagnose and treat any heel pain issues.