The heel bone is the largest of the 26 bones in the human foot, which also has 33
joints and a network of more than 100 tendons, muscles, and ligaments. Like all
bones, it is subject to outside influences that can affect its integrity and its ability
to keep us on our feet. Heel pain, sometimes disabling, can occur in the front,
back, or bottom of the heel.
Heel pain has many causes. Heel pain is generally the result of faulty
biomechanics (walking gait abnormalities) that place too much stress on the heel
bone and the soft tissues that attach to it. The stress may also result from injury, or
a bruise incurred while walking, running, or jumping on hard surfaces; wearing
poorly constructed footwear (such as flimsy flip-flops); or being overweight.
Common causes of heel pain include:
A bony growth on the underside of the heel bone. The spur, visible by X-ray,
appears as a protrusion that can extend forward as much as half an inch. When
there is no indication of bone enlargement, the condition is sometimes referred to
as "heel spur syndrome." Heel spurs result from strain on the muscles and
ligaments of the foot, by stretching of the long band of tissue that connects the
heel and the ball of the foot, and by repeated tearing away of the lining or
membrane that covers the heel bone. These conditions may result from
biomechanical imbalance, running or jogging, improperly fitted or excessively
worn shoes, or obesity.
Both heel pain and heel spurs are frequently associated with plantar fasciitis, an
inflammation of the band of fibrous connective tissue (fascia) running along the
bottom (plantar surface) of the foot, from the heel to the
ball of the foot. It is common among athletes who run and jump a lot, and it can
be quite painful.
The condition occurs when the plantar fascia is strained over time beyond its
normal extension, causing the soft tissue fibers of the fascia to tear or stretch at
points along its length; this leads to inflammation, pain, and possibly the growth
of a bone spur where the plantar fascia attaches to the heel bone. The
inflammation may be aggravated by shoes that lack appropriate support,
especially in the arch area, and by the chronic irritation that sometimes
accompanies an athletic lifestyle.
Resting provides only temporary relief. When you resume walking, particularly
after a night's sleep, you may experience a sudden elongation of the fascia band,
which stretches and pulls on the heel. As you walk, the heel pain may lessen or
even disappear, but that may be just a false sense of relief. The pain often returns
after prolonged rest or extensive walking.
Heel pain sometimes results from excessive pronation. Pronation is the normal
flexible motion and flattening of the arch of the foot that allows it to adapt to
ground surfaces and absorb shock in the normal walking pattern.
As you walk, the heel contacts the ground first; the weight shifts first to the
outside of the foot, then moves toward the big toe. The arch rises, the foot
generally rolls upward and outward, becoming rigid and stable in order to lift the
body and move it forward. Excessive pronation—excessive inward motion—can
create an abnormal amount of stretching and pulling on the ligaments and tendons
attaching to the bottom back of the heel bone. Excessive pronation may also
contribute to injury to the hip, knee, and lower back.
Pain at the back of the heel is associated with Achilles tendinitis, which is
inflammation of the Achilles tendon as it runs behind the ankle and inserts on the
back surface of the heel bone. It is common among people who run and walk a lot
and have tight tendons. The condition occurs when the tendon is strained over
time, causing the fibers to tear or stretch along its length, or at its insertion on to
the heel bone. This leads to inflammation, pain, and the possible growth of a bone
spur on the back of the heel bone. The inflammation is aggravated by the chronic
irritation that sometimes accompanies an active lifestyle and certain activities that
strain an already tight tendon.
Other possible causes of heel pain include:
Rheumatoid arthritis and other forms of arthritis, including gout, which usually
manifests itself in the big toe joint; an inflamed bursa (bursitis), a small, irritated
sac of fluid; a neuroma (a nerve growth); or other soft-tissue growth.
Such heel pain may be associated with a heel spur or may mimic the pain of a
heel spur; Haglund's deformity ("pump bump"), a bone enlargement at the back of
the heel bone in the area where the Achilles tendon attaches to the bone. This
sometimes painful deformity generally is the result of bursitis caused by pressure
against the shoe and can be aggravated by the height or stitching of a heel counter
of a particular shoe; a bone bruise or contusion, which is an inflammation of the
tissues that cover the heel bone. A bone bruise is a sharply painful injury caused
by the direct impact of a hard object or surface on the foot.