Fractures can be another cause of heel pain. Your heel bone, called the calcaneus, can incur fractures like any other bone. Calcaneal fractures, however, are dangerous because of the physiology of the calcaneus and the bones with which it forms a joint. The breaking of the calcaneus’s thin, yet hard outer shell reveals a softer bone inside that shell. Once the outer shell is broken, the entire bone is prone to collapse and fragmentation. Breaking the calcaneus can have negative effects on the joint it creates with the talus and cuboid bones, bones further of the foot. A fracture that disturbs the joint (inter-articular fractures) can cause damage to multiple bones and the cartilage between, and could have long-term effects including arthritis and chronic pain.
Calcaneal fractures are usually caused by traumatic events: big falls, car accidents and the like. Like other stress fractures, calcaneal fractures can also be caused by overuse or repetitive stress on the heel. Pain can vary, depending on whether the fracture is traumatic or not. Some patients with calcaneal fractures report not being able to put any weight on their foot, and others report pain and symptoms similar to that of plantar fasciitis (general pain growing progressively worse over a number of days or weeks). Calcaneal fractures, however, will produce pinpoint pain after pressing down on the middle or sides of the heel bone, which does not usually occur with plantar fasciitis. Additionally, in your primary assessment and to reach a correct diagnosis, your podiatrist will inquire into your recent activities (since, often, abrupt increases in exercise or sudden weight gain can cause calcaneal stress fractures), and may take an X-ray to examine the bone.