Heel Pain

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:

Heel Spurs: 

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.

Plantar Fasciitis: 

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.

Excessive Pronation: 

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.

Achilles tendinitis: 

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.