What does it mean when your heel hurts?


Like anywhere else in the body, there can be a bunch of different reasons why your heel hurts. It could be anything from plantar fasciitis, to a stress fracture in your heel bone called the calcaneus. In fact, there may not even be anything wrong with your heel at all, the pain could be coming from your back! Your heel bone is the first part of your body to interact with the ground when you are walking. If there is something wrong with it, your heel will let you know with every step! I frequently see patients with heel pain in my orthopedic practice in Colorado Springs. The first step is getting an accurate diagnosis.

What can cause heel pain?

If you have pain in the bottom of your heel that is worse when you first wake up in the morning, you might have plantar fasciitis. The plantar fascia is a thick band of tissue on the bottom of your foot that tightens while you sleep. So when you take your first steps in the morning it can hurt. Plantar fasciitis is a very common condition which I have written about before. Another less common cause of pain on the bottom of your heel is either fat pad atrophy, or trauma to the fat pad. There is a layer of fat beneath your heel bone that cushions it. Damage to this area can take up to 6 months to heal. Sometimes in elderly people, the fat pad can atrophy also causing pain while walking. This may be the case if they have had steroid injections to that area. There is also a small nerve in the heel that can be compressed called Baxter’s nerve. Baxter’s nerve compression can mimic plantar fasciitis, and it can also cause abnormal sensation in the heel. Sometimes the pain is coming from a nerve that is being pressed in your back, in this case it will be pain that travels all the way down the back of your leg to the bottom of your foot, likely with back pain.

Pain in the back of the heel can sometimes be due to Achilles tendonitis. Suffice to say here that Achilles tendonitis comes from tight calves, and can pull on the back of your heel causing pain.

Pain on the side of your heel when walking can be due to a stress fracture. This happens usually in those who are running regularly either for sports or recreation. A stress fracture of your heel will hurt with every step you take. Sometimes a nerve that has been compressed in your spine can also cause pain on the side of your heel.

How do I know what is causing my heel pain, and what should I do about it?

The first step in getting rid of your heel pain is getting an accurate diagnosis. There are a bunch of different things that can cause heel pain, and if you don’t have an accurate diagnosis then you likely won’t get appropriate treatment. A wrong diagnosis often means months of treatments that don’t work. 

The best way to get an accurate diagnosis is to see your orthopedic doctor or podiatrist and make sure they spend time with you to figure it out. 5 minutes won’t cut it. If that’s all the time they have for you, then go somewhere else. The treatment that you need will be dictated by what your diagnosis is. Fortunately, for most of the above conditions that I mentioned, surgery is not the first step. If you find a doctor who wants to operate on you right off the bat, get a second opinion. Surgery is rarely the first option I give my patients in my orthopedic practice in Colorado Springs.

I hope I was able to answer your questions about what it means that your heal hurts. If you would like me to treat your heel pain contact us below to make an appointment if you are in the Colorado Springs area. I also am available for virtual consults.

-Written by Dr. Daniel Paull


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