Heel Pain

Information on Heel Pain by the plantar fasciitis organization..

Heel pain accounts for one of the most common types of pain felt in the foot. Pain in the heel of the foot can be caused as a result of exercise, daily work routines or recreational activities. Some type of repetitive stress on the foot is often at the root of heel pain. The largest bone in the foot is the calcaneus, or heel bone. When we walk, the heel bone is usually the first part of the foot that hits the ground and is responsible for supporting much of the body's weight. This makes the heel of the foot prone to injury.

There are several structures involved in the development of heel pain. The plantar fascia ligament runs along the bottom, or sole, of the foot. It connects to the heel bone and runs the length of the foot towards the toes. This band of fibrous tissue maintains the arch of the foot and bends and contracts and we walk or run. The most common heel pain injury occurs when tears and inflammation develop along this ligament (plantar fasciitis). In addition, wear and tear and injury to the heel can also cause the formation of a spur on the heel bone. When this occurs, a pointed outgrowth of calcium extends from the heel bone, digging into sensitive tissue in the heel with every step. The Achilles tendon may also play a role in heel pain. Damage to this tendon not only can deliver pain itself through tears and inflammation, but it can play a role in the development of plantar fasciitis.

Heel pain can often occur from the constant and repetitive weight absorbed by the heel during movement. While we walk, the arch of the foot flattens out and the plantar fascia helps stabilize the foot as it flexes and relaxes. The weight absorbed by the foot often results in damage to the foot. In many cases, it may be from abnormal gait. Gait is the manner in which our foot hits the ground as we walk. With inappropriate movement, the plantar fascia becomes prone to excessive strain, and therefore damage.

What are the Conditions that cause Heel Pain?

Plantar Fasciitis is the most common form of heel pain. The tears and inflammation that develop along the plantar fascia ligament result in dull aching pain or a burning sensation along the bottom of the foot. Pain becomes particularly noticeable after periods of rest, such as during the first few steps after getting out of bed in the morning, or after getting up after a prolonged period of sitting.

Another common form of heel pain is the development of a heel spur. A heel spur, as mentioned above, is the formation of a bony hook extending from the heel. Typically, these growths develop near the area where the plantar fascia connects to the heel bone. The repetitive pressure on the plantar fascia that results from stretching excessively away from the heel bone causes a response from our body that delivers calcium to the area. The heel pain that ensues develops from the nerves and sensitive tissue that become irritated when the bone fragment digs into the bottom of the heel. Pain may decrease after walking as the tissue in the heel gets used to the fragment and adjusts around it. However, pain will be particularly problematic following periods of rest.

Strained muscle tissue may cause heel pain in several areas. A tight plantar fascia causes additional tension, particularly while exercising, placing runners and other athletes at risk if the ligament is not properly warmed up prior to exercise. Additionally, a tight Achilles tendon along the back of the foot can also add tension along the plantar fascia, resulting in possible damage, not to mention the damage and pain that can occur along the Achilles tendon itself (Achilles tendonitis). It is recommended that athletes properly stretch the foot as well as the calf in order to reduce tension on muscle and other tissue in the foot.

Who's at Risk for Heel Pain?

Age plays a large role in the development of heel pain, particularly among those over 40. Being active is also a common factor of heel pain. Over time, the elasticity of the tissue in our feet decreases with age, causing us to become prone to damage and also slowing the body's ability to heal damage. Adolescents are also not immune to heel pain. Those who are active in sports are particularly prone to excessively stretching or straining the plantar fascia or Achilles tendon, causing severe heel pain. In most cases, heel pain develops in only one heel.

There are many risk factors that lead to heel pain. Abnormal gait and excessive, repetitive stress are common factors in the development of pain and damage. Among the other risk factors involved with the development of heel pain are:
  • Repetitive exercise or activities, such as long distance running or jumping from activities such as basketball
  • Obesity
  • Walking barefoot on hard surfaces
  • Prolonged standing
  • Wearing poor fitting shoes, or shoes that do not provide enough support or cushioning
  • Not stretching properly or at all before and after exercise
  • Those who are on their feet for long periods of time

Other Heel Pain Ailments

As mentioned, plantar fasciitis and the inflammation of the plantar fascia ligament is the most common cause of heel pain. heel spurs and Achilles tendonitis are also very common conditions. Other possible conditions that cause heel pain are:
  • Pronation
  • Sever's Disease
  • Tarsal Tunnel Syndrome
  • Stress Fracture
  • Arthritis
  • Sprains
  • Bursitis
Depending on the specific form of heel pain, symptoms may vary. Pain stemming from plantar fasciitis or heel spurs is particularly acute following periods of rest, whether it is after getting out of bed in the morning, or getting up after a long period of sitting. In many cases, pain subsides during activity as injured tissue adjusts to damage, but can return again with prolonged activity or when excessive pressure is applied to the affected area. Extended periods of activity and/or strain of the foot can increase pain and inflammation in the foot. In addition to pain, heel conditions can also generate swelling, bruising, and redness. The foot may also be hot to the touch, experience tingling, or numbness depending on the condition.

Preventing heel pain is crucial to avoid pain that can easily interrupt a busy or active lifestyle. Athletes can prevent damage by stretching the foot and calf both before and after an exercise routine. The plantar fascia ligament can be stretched by using a tennis ball or water bottle and rolling it across the bottom of the foot. With regular stretching, the stretching and flexibility of tissue through the foot can be significantly improved, helping to prevent damage and injury. Athletes should also ease into new or more difficult routines, allowing the plantar fascia and other tissue to become accustomed to the added stress and difficulty. Running up hills is also common among athletes in their routines. However, this activity should be reduced since it places an increased amount of stress on the plantar fascia and increases the risk of plantar fasciitis.

Maintaining a healthy weight is also an essential heel pain prevention technique. Obesity brings additional weight and stress on the heel of the foot, causing damage and pain in the heel as well as in other areas of the foot.

Heel pain is commonly caused from shoes that do not fit properly. In addition, shoes need to have ample cushioning and support, particularly through the heel, ball of the foot, and arch. Shoes should also be replaced if they become too worn. One sure sign of wear and tear is overly worn areas of a shoe's insoles. If the heel or ball of the foot is particularly worn, damage could easily occur since the bottom of the foot is not getting the cushioning it needs.

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