Heel Pain — There Are Many Possible Causes
Table of Contents
The many causes of heel pain
It is easy to assume that any heel pain is plantar fasciitis, but in fact several conditions present with similar symptoms. Accurate differential diagnosis is the starting point for proper treatment. Causes are distinguished by considering the location of pain (sole, side, back), the pattern (worse in the morning vs. after activity), and accompanying findings (swelling, tender points, skin changes).
Features of the major causes
- Plantar fasciitis: Tenderness on the underside of the medial calcaneal tubercle. Most painful with the first step in the morning, gradually easing with walking. The most common cause, accounting for about 80% of all heel pain.
- Calcaneal fat pad atrophy: Dull pain in the center of the heel. With age, the fat tissue beneath the calcaneus thins out and shock absorption decreases. Symptoms worsen on hard surfaces.
- Haglund deformity: A bony prominence on the upper-back of the calcaneus rubs against the Achilles tendon attachment, causing pain. Redness and swelling appear where the heel counter of shoes contacts the area.
- Calcaneal stress fracture: Pain is reproduced when the heel is squeezed from both sides (squeeze test). Occurs in middle-aged women with osteoporosis or with a sudden increase in exercise.
- Tarsal tunnel syndrome: Tingling and burning radiate below the medial malleolus. A positive Tinel sign is characteristic.
Korean medicine treatment strategies for each cause
For plantar fasciitis, direct acupuncture and pharmacopuncture at the calcaneal attachment; for fat pad atrophy, shock-absorbing insoles and blood-flow-enhancing herbal medicine (Danggui-sayeok-tang); for Haglund deformity, acupuncture and chuna manipulation around the Achilles tendon along with shoe modification; for stress fracture, rest and bone-strengthening herbs (Dipsaci Radix, Drynariae Rhizoma) — these are the basic strategies.
Common management — shock-absorbing insoles
Whatever the cause, reducing the impact on the heel is the universal principle. Heel cup insoles made of silicone or viscoelastic material absorb 30–40% of the impact at the calcaneal area. Avoid walking barefoot and wear cushioned slippers even indoors. For overweight individuals, weight loss also contributes to reducing heel load.