Causes of Sudden Heel Pain Without Injury

Introduction

Heel pain can be quite a debilitating condition and at some point common conditions such as plantar fasciitis could affect 5% of the population in the Western world. The most common cause is plantar fasciitis, but there are many other reasons why patients can get heel pain. This blog will discuss the causes of sudden heel pain.

Common Causes of Sudden Heel Pain Without Injury

Plantar Fasciitis

This is by far the most common cause of heel pain. Typically, patients present with pain first thing in the morning and after periods of rest. It can be self-limiting in some patients in that it resolves over six to eight weeks itself. However, sometimes a more chronic condition can develop and it could last for a long time. Essentially, what happens is the plantar fascia is a ligament that supports the arch of the foot. It can get injured near the base of the heel and become inflamed and thickened and over time becomes scarred and fibrous.

Treatment of this kind of condition includes initially physiotherapy, rehabilitation, stretching, use of insoles, using structured shoes. Often poor footwear or putting on weight can be the underlying cause. If that does not work, then shockwave therapy has a good evidence base and, as a last resort, injections can be performed using steroids to reduce inflammation.

Achilles Tendinitis

This is a chronic injury where you get thickening of the Achilles tendon and swelling. This can usually be related to foot function because you have flat feet or the Achilles tendon is short or tight in certain patients. It could be due to poor footwear. The pain is typically wore first thing in the morning but can be throughout the day. The back of the Achilles could be constantly sore, it could stop you from walking and doing exercises. Treatments can include physiotherapy, eccentric exercises, injection therapy and rehabilitation, as well as insoles to correct underlying mechanics.

Heel Bursitis

This is also known as policeman’s heel. It’s often associated with fat pad atrophy where you have a prominent bone, you develop a bursal sac thickening at the plantar heel. It can be also associated with heel spur. Occupations requiring standing for long periods can often result in this. Period of immobilisation and boot or steroid injection can help in cases that do not resolve.

Nerve Issues

This can be due to tarsal tunnel syndrome or calcaneal nerve entrapment. The nerves that supply the heel get trapped within a tunnel near the medial ankle. This can cause radiating pain throughout the day. Often these require surgical decompression. Steroid injection could be attempted. This is kind of the heel pain that doesn’t settle for years even after standard treatment and is often misdiagnosed as plantar fasciitis initially.

Arthritis or Gout

This usually affects the joints around the heel such as subtalar joint and referred pain to the heel. This is a less common problem associated with heel pain, but one could get X-rays or MRI scans to assess for arthritis affecting the subtalar joints.

Flat Feet or Fallen Arches

Flat feet or fallen arches are associated with reduced arch, increased strain on the soft tissue structures in the arch and the medial ankle. This can result in heel pain either due to nerve stretching or tendon swelling. Often the flexor hallucis longus tendon, flexor digitorum longus tendon can be inflamed as it runs through the arch, it is often confused with heel pain.

When to See a Specialist

You should see a specialist if your heel pain does not settle within a couple of weeks and after some stretching at home or if the pain appears to be persistent or you’re unable to walk.

FAQs

What causes my sudden heel pain without injury?

It could be a range of conditions that cause this, but the most common cause is definitely plantar fasciitis. You will need to see a specialist to rule out plantar fasciitis. An ultrasound scan can usually help diagnose the problem quite quickly.

What physical therapy treatment can help with sudden heel pain?

The most common is stretching your Achilles tendon and your arch. You can use a golf ball or a tennis ball to stretch the fascia. This should help.

How to relieve pain at the bottom of the foot?

A combination of stretching and icing the area or using anti-inflammatory medication, stretching can also help.

How to cure heel pain fast?

If pain relief is required quite quickly, then a steroid injection to the heel can often resolve the pain, but we will need to address the underlying cause.