Why Does My Heel Hurt on the Side (Lateral Heel Pain)?

Pain on the side of your heel, particularly the outer (lateral) side, often stems from overuse or underlying weaknesses and imbalances in the lower limb, leading to conditions like peroneal tendinopathy or sinus tarsi syndrome. The development of these conditions is frequently attributed to weaknesses and imbalances of the structures in the lower limb, or due to overuse, putting undue stress on the tendons, ligaments, and joints surrounding the heel. Understanding the specific cause is key to effective management and relief.

Common Causes of Lateral Heel Pain

Several conditions can lead to discomfort on the side of your heel. Here are some of the most common:

Peroneal Tendinopathy

The peroneal tendons run along the outer side of your ankle, behind the fibula bone, and attach to various points on the foot. Peroneal tendinopathy refers to inflammation or degeneration of these tendons.

• Symptoms: Pain, tenderness, and swelling along the outer ankle and heel, often worsening with activity, especially running on uneven surfaces or during push-off. You might feel a popping or clicking sensation.
• Causes:
  • Overuse: Repetitive activities like running, jumping, or excessive walking, especially without proper conditioning.
  • Weakness or Imbalance: Insufficient strength in the peroneal muscles or imbalances with other leg muscles can lead to the tendons working harder than they should.
  • Improper Footwear: Shoes that lack adequate support or are worn out can contribute.
  • Foot Structure: High arches can put increased stress on these tendons.

Sinus Tarsi Syndrome

The sinus tarsi is a small canal located on the outer side of the ankle, between the talus and calcaneus (heel) bones. It contains ligaments, blood vessels, and nerves. Sinus Tarsi Syndrome involves inflammation or damage to the structures within this space.

• Symptoms: Deep, persistent pain on the outer side of the ankle, often worse with standing, walking on uneven surfaces, or turning the foot inwards. Some people report a feeling of instability in the ankle.
• Causes:
  • Ankle Sprains: Most commonly, it develops after an inversion ankle sprain (where the foot rolls inwards), which can damage the ligaments in the sinus tarsi.
  • Chronic Instability: Repeated ankle sprains or general ankle instability can lead to chronic inflammation.
  • Overuse: Repetitive movements that strain the outer ankle.

Other Potential Causes of Side Heel Pain

While peroneal tendinopathy and sinus tarsi syndrome are frequent culprits, other conditions can also cause pain on the side of your heel:

• Ankle Sprains: Even after the initial acute pain subsides, lingering pain and instability can occur on the side of the heel due to ligament damage.
• Cuboid Syndrome: This occurs when the cuboid bone, located on the outer side of the midfoot near the heel, shifts slightly out of its normal alignment.
  • Symptoms: Pain on the outer side of the foot, often radiating towards the heel, which may worsen when pushing off the foot or walking. It can feel like something is "off" or "stuck."
  • Causes: Often follows an ankle sprain, repetitive stress, or imbalances in foot mechanics.
• Stress Fractures: A tiny crack in one of the bones of the foot or ankle (like the calcaneus or fifth metatarsal) due to repetitive stress.
  • Symptoms: Pain that gradually worsens with activity and improves with rest, often accompanied by localized tenderness and swelling.
• Sural Nerve Entrapment: Compression or irritation of the sural nerve, which runs along the outer side of the ankle and foot.
  • Symptoms: Burning, tingling, numbness, or shooting pain on the outer side of the heel, ankle, or foot.
• Bursitis: Inflammation of a bursa (fluid-filled sac) on the side of the heel, often caused by friction or pressure.

Contributing Factors

Several factors can increase your risk of developing side heel pain:

• Weaknesses and Imbalances: Insufficient strength in the muscles supporting the ankle and foot, or an imbalance between opposing muscle groups (e.g., strong calf muscles but weak ankle stabilizers), can lead to improper biomechanics and increased strain.
• Overuse: Engaging in repetitive activities without adequate rest or gradual progression can overload tendons and joints.
• Improper Footwear: Worn-out shoes, shoes that lack proper arch support, or those that don't fit well can alter foot mechanics and place undue stress on the heel and ankle.
• Biomechanical Issues: Flat feet, high arches, or abnormal gait patterns can lead to uneven distribution of forces across the foot and ankle, predisposing to injury.
• Sudden Increase in Activity: Abruptly increasing the intensity, duration, or frequency of exercise without allowing the body to adapt.
• Previous Injuries: A history of ankle sprains can lead to chronic instability, increasing susceptibility to future issues.

When to Seek Professional Help

It's advisable to consult a healthcare professional, such as a podiatrist, orthopedic specialist, or physical therapist, if your heel pain:

• Is severe or worsening.
• Does not improve with rest and home care after a few days.
• Is accompanied by significant swelling, redness, or warmth.
• Prevents you from performing daily activities or bearing weight.
• Is associated with numbness, tingling, or weakness in your foot.

A thorough examination, including a physical assessment and potentially imaging tests like X-rays or MRI, can help pinpoint the exact cause of your pain.

Management and Prevention Strategies

Managing side heel pain often involves a combination of strategies aimed at reducing inflammation, promoting healing, and addressing underlying issues.

Initial Home Care

• R.I.C.E. Protocol:
  • Rest: Avoid activities that aggravate the pain.
  • Ice: Apply ice packs to the affected area for 15-20 minutes, several times a day, to reduce inflammation.
  • Compression: Use an elastic bandage to help reduce swelling.
  • Elevation: Elevate your foot above heart level to minimize swelling.
• Pain Relief: Over-the-counter pain relievers like ibuprofen or naproxen can help manage pain and inflammation.

Long-Term Solutions and Prevention

• Targeted Exercises: A physical therapist can prescribe specific exercises to strengthen weak muscles (like the peroneal muscles) and improve flexibility and balance in the lower limb. Examples include:
  • Ankle inversions/eversions: Using a resistance band to strengthen the muscles that turn your foot inwards and outwards.
  • Calf raises: To build calf strength and stability.
  • Balance exercises: Standing on one leg or using a wobble board to improve proprioception and ankle stability.
• Proper Footwear: Wear supportive shoes that fit well and provide adequate cushioning and stability for your foot type and activity level. Replace athletic shoes every 300-500 miles. Consider custom orthotics if you have significant biomechanical issues.
• Gradual Activity Progression: When returning to activities, increase intensity and duration slowly to allow your body to adapt and prevent re-injury.
• Cross-Training: Incorporate low-impact activities like swimming or cycling to maintain fitness without overloading your feet and ankles.
• Stretching: Regular stretching of the calf muscles and Achilles tendon can help improve ankle flexibility and reduce tension.
• Physical Therapy: A physical therapist can provide hands-on treatment, create a personalized exercise program, and guide you through rehabilitation, especially after an injury like an ankle sprain.

Summary of Common Lateral Heel Pain Conditions

For a quick overview, refer to the table below:

Addressing the root cause, whether it's related to overuse or underlying weaknesses and imbalances in your lower limb, is crucial for lasting relief and preventing future occurrences of side heel pain.