Outer heel pain is sometimes also referred to as lateral heel pain. The term refers to pain that runs along the outer side of the ankle. It is a symptom, rather than a condition, and therefore indicates a problem in the back of the foot. Depending on what is causing the pain, outer heel pain may be felt before, during, or after physical activity. It can be quite uncomfortable and in severe cases, outer heel pain may even prevent some people from undertaking daily activities such as walking or standing.
What can cause outer heel pain?
Outer heel pain can be caused by a few different conditions. The pain may be acute, where there is sudden development of pain, or pain experienced over a recent short period of time, or chronic, which describes lasting conditions with persistent effects, and often more complex problems.
The more common conditions causing outer heel pain are peroneal tendonitis and sinus tarsi syndrome.
The peroneal tendons are strong structures that connect the peroneal muscles at the base of the calf to the bones of the foot. One tendon attaches to the outer part of the foot, and the other runs under the foot and attaches in the area close to the inside of the arch of the foot. Peroneal tendonitis is now more commonly and accurately referred to peroneal tendinopathy, as it is not in fact, an inflammatory condition, but one that is characterized by structural changes to the affected peroneal tendon. These changes occur in response to load, such as a sudden increase in weight-bearing exercise such as weightlifting, running or jumping, inadequate footwear, or lower limb issues such as imbalances or foot biomechanics.
Sinus Tarsi Syndrome
The sinus tarsi is the ‘tunnel’ or tube that runs between the talus and calcaneus bones of the foot. Within this tunnel, there are structures that contribute to the stability of the ankle. Sinus tarsi syndrome is generally caused by traumatic injury (such as an ankle sprain, for example) or simple overuse (such as repetitive walking or standing), but it can also occur if a patient has an over-pronated foot (where the foot rolls inwards or downwards). Over-pronation causes compression of the structures in the sinus tarsi, and therefore outer heel pain.
What are the common symptoms experienced with outer heel pain?
Outer heel pain is often associated with a number of other symptoms, and these may include:
- An unstable foot
- Tenderness in the outer heel
- Difficulty walking
- Difficulty standing on the affected foot.
Patients who have peroneal tendinopathy generally experience gradually worsening outer heel pain. They experience pain and ankle instability during and after weight-bearing exercise. There may be pain when turning the foot in and out. In patients where sinus tarsi syndrome is the problem, the outer heel pain is most severe when the person is standing, walking on an uneven surface, or rolling the foot inwards and outwards.
How is the condition causing outer heel pain diagnosed?
Your sports podiatrist will have had great experience in diagnosing the causes of outer heel pain. They will conduct a thorough examination. This will include taking detailed notes about your previous and current exercise regime and conducting an extensive physical examination to check your range of motion and determine the painful area. Sometimes your sports podiatrist may even order medical imaging, such as an ultrasound or MRI in order to better visualize the structures of the lower limb to allow them to rule out some conditions and aid in their diagnosis.
What are the treatment options for outer heel pain?
Regardless of what is causing your outer foot pain, the RICE (rest, ice, compression, elevation) method is an easy way to start getting some relief at home.
- Rest your foot; try to keep your weight off it as much as is practical
- Ice your foot with an ice pack wrapped in a towel, for 20 minutes at a time, a few times a day
- Compress your foot by wearing an elastic bandage with comfortable pressure. Be mindful to not wrap too tightly or you may cause further injury!
Elevate your foot above your heart to reduce swelling (lying down and raising propping your foot up on some pillows is an easy way to achieve this).
Individual treatment of outer heel pain will largely depend on the condition that is causing the pain symptoms and the patient’s individual circumstances. Once your sports podiatrist has determined the cause of your pain, an appropriate treatment plan can be commenced. To begin with, often the treatment is aimed at reducing the load on the heel, so that the irritated structures can settle and begin to heal. Once your pain starts to subside, you will most likely be prescribed with appropriate exercises for your lower limb muscles and improve your balance and range of motion in the ankle.
Some of the other common treatments used for outer heel pain, depending on the causative condition, may include:
Non-steroidal anti-inflammatory drugs can be an effective way to reduce inflammation in acute conditions
- Corticosteroid injections
Corticosteroid injections can help relieve swelling and pain in the area
- Shockwave therapy
Extracorporeal shockwave therapy (ESWT) as it is otherwise called, is a targeted treatment, where high-energy bursts of sound waves are directed into the affected area. This stimulates the dilation of the blood vessels in the area, to facilitate tissue regeneration and therefore recovery to the damaged structures. Shockwave therapy is also useful in providing some analgesia, or pain relief, which in most cases is almost immediate!
If your outer heel pain is being caused by an acute condition, you are likely to notice an improvement in within a couple of weeks of commencing your treatment program. However, with chronic conditions you can expect a longer recovery period.
You need to remember that it is important to complete the entire treatment and rehabilitation program that your sports podiatrist prescribes for you, and stick closely to their professional recommendations. This is the best way to ensure the best recovery outcome, prevent any foot problems from occurring in the future, and reduce your risk of re-injury.
Is outer heel pain preventable?
The development of the conditions that cause outer heel pain, such as peroneal tendinopathy and sinus tarsi syndrome is often due to weaknesses and imbalances of the structures in the lower limb, or due to overuse. To prevent these conditions, it is useful to always stretch and warm up with appropriate, functional exercises before and after playing sport or engaging in physical activity. Ask your sports podiatrist to recommend some exercises that will work to improve your lower leg muscles and improve your range / dynamic muscular control. When considering your exercise regime, incorporate a gradual increase in your training load or intensity. Aim to maintain your cardiovascular fitness and muscular strength throughout your sport’s ‘off- season’, as this will reduce your risk of developing outer heel pain due to injury.
Please note that the content provided in this article should not be taken as general advice and is for informational purposes only. If you are suffering with outer heel pain, then you should consult with a suitably qualified sports podiatrist to discuss your concerns. Appointments can be made online at www.sydneyheelpain.com.au or by calling 93883322.
Karl Lockett – sports podiatrist.
Written by Karl Lockett