10 Most Likely Causes of Heel Pain

Each of your feet and ankles are made up of twenty six bones, thirty three joints and more than one hundred tendons. The heel bone – medically referred to as the calcaneus – is actually the largest bone in your foot, and is the first portion of the foot which makes contact with the ground as you walk.

Therefore any pain in the heel of your foot can not only lead to severe discomfort; it cause difficulty in carrying out simple everyday activities such as walking. Understanding the causes of heel pain can help in preventing and treating the condition.

What is Heel Pain?

Heel pain is considered to be the most commonly experienced form of foot pain amongst adults, however, often the pain will only affect one foot.

The plantar fascia, a band of connective tissue, and the muscle flexor digitorum brevis which is responsible for supporting the arch of the foot and allowing us to flex our toes, are both located on the sole of the foot. Most conditions which commonly cause heel pain will affect these parts of the foot.

Heel pain is a common foot condition, and it’s estimated that at least 1 in 10 people will experience an episode of pain in their heels at some moment in their life. Usually people who run or jog on a regular basis and adults aged 40 and over will be more likely to be affected by heel pain.

There are multiple treatment and pain relief options available for heel pain which can relieve pain and speed up patient recovery to within a year.

10 Most Likely Causes of Heel Pain

As many of us know, prevention is better than cure. By losing weight, maintaining a healthy weight and balanced diet along with regular exercise, we can prevent damage and pain to our feet.

Many podiatrists recommend wearing appropriate and supportive footwear that cushions and supports the entire foot. If you are suffering from heel pain, it’s likely that some of the following causes are to blame.

1. Plantar Fasciitis

The thick band of tissue on the foot known as the plantar fascia can become inflamed and damaged after overuse (such as from being on your feet for long periods of time), muscle weakness or tightness, an alteration in foot biomechanics or from obesity. 

The condition will present with pain and tenderness felt underneath the heel, especially after rest or when going up stairs. Many patients also have one specific spot which is more painful when touched. Treatment options include plenty of rest, stretching exercises, special orthotics and insoles, and possibly injections for pain relief.

2. Achilles Tendonitis

This condition is one of the most common causes for pain at the back of the heel. Achilles tendonitis is inflammation in the Achilles tendon which connects the calf muscles and heel bone together.

It is causes from repetitive strain on the tendon, either from muscle weakness or tightness, an alteration in foot biomechanics or friction as a result of bone spurs.

Patients will often have pain at the back of their heels, stiffness in their ankle and calf and possibly some swelling at the back of the heel or above the ankle. Treatment comprises of rest, exercises, orthotic shoe insoles for extra foot support and medication or injections for pain and inflammation relief.

3. Bone Spurs

Calcaneal bone spurs can occur either under or behind the heel bone. They are commonly the cause of pain in the heel of the foot or in the ankle. These bone spurs appear as bony lumps which stick out, they are caused by calcium deposits on the bones.

Repetitive overuse such as from sports and running, muscle weakness or an abnormal position of the heel bone can cause the condition.

Patients often get a pain as if they have stood on something sharp as they stand, which can settle into a dull and aching foot pain. Although it’s possible that some patients may not feel any pain at all, a bony lump around their heel will be noticeable.

Treatment for the condition can require some physical therapy through the use of targeted exercises, shoe orthotics such as heel pads, and surgery to remove the bone spur.

4. Heel Fractures

Sometimes a single or even multiple fractures or breaks in the heel bone can be a cause of heel pain. A heel fracture can be caused when an individual repeatedly overloads the heel – such as from excessive running or jumping which may lead to stress fractures, or falls from a certain height then landing feet first.

Patients will notice a pain which feels worse when pressure is placed on the foot and often a large amount of swelling will occur around the affected area. A fractured heel and the pain which results from it can even cause you to walk differently.

Treatment should be sought immediately and medication can be given for heel pain relief. Protection, resting, compressing, icing and elevating the damaged area are all effective methods for relieving heel fractures. However, if the fracture is serious, surgery may be required.

5. Bursitis

Retrocalcaneal bursitis is the inflammation of a small fluid filled sac, known as the bursa which sits between the heel bone and the Achilles tendon. Inflammation can be caused by repetitive friction on the bursa, commonly a result of muscle tightness or weakness or a sudden increase in the level of activity.

Symptoms can present as heel pain when walking, running or standing on tiptoes. The affected area can feel tender to touch and appear swollen, red and warm. Treatment focuses on rest, ice therapy, pain relief medication and exercises for the calf muscles.

6. Os Trigonum Syndrome

This condition tends to affect athletes and ballet dancers more often. It’s the irritation of the soft tissues at the back of the heel as a result of a small bone becoming stuck in the ankle joint. Repeatedly pointing the foot downwards or an ankle injury can cause os trigonum syndrome.

Sufferers of this condition will usually report a deep and dull pain in the heel of the foot which eases with rest. Therefore treatment compromises of rest, ice, steroid injections and possibly surgery depending on the severity of the condition.

7. Tarsal Tunnel Syndrome

The tibial nerve which passes through the tarsal tunnel though the inner side of the ankle can get compressed due to a reduction in the space of the tunnel. This can be due to swelling, cysts, arthritis or even benign tumours.

Patients will feel pain in the heel of the foot which spreads up towards the calf. Sometimes numbness or feelings of pins and needles can occur which are worse at night.

Treatment of the tarsal tunnel syndrome consists of rest, anti-inflammatory medications, exercises and shoe orthotics. If pain is severe, steroid injections can be administered or surgery can also be looked into.

8. Severs Disease

This disease is a common cause of children’s heel pain. Severs disease is when there is inflammation in the growth plate of the heel. It can be caused by a growth spurt, standing for a long period of time or overuse from participating in over strenuous sporting activities.

Symptoms can include pain at the back of or underneath the heel, inflammation and pain when walking. Patients also report that their symptoms become worse with activity and that both feet are affected at the same time.

Podiatrists recommend exercises to strengthen and stretch the affected area along with plenty of rest. The use of orthotics and medication together can allow for symptoms to settle within two months.

9. Fat Pad Atrophy

This is when the layer of fat located beneath the heel bone (and ball of the foot) begins to waste away as a result of excessive strain being placed on it. This condition is more likely present in women who have worn high heels for many years.

Symptoms include a persistent foot ache, especially when walking or standing for a long period of time. Some patients may develop calluses on the balls of their feet and have the sensation of small rock in the bottom of their foot.

The condition can be managed by wearing custom supportive orthotics and through low impact exercises which have less strain on the feet.

10. Rheumatoid Arthritis

Rheumatoid arthritis is the most common form of arthritis. Up to 90% of patients with this condition report having foot problems.

This condition can cause inflammation in the joints of the feet, which reflect as pain around the balls of the feet and can also contribute to the development of other conditions such as bursitis.

Patients will often complain of their feet feeling sore, inflamed and warm to touch in the affected areas. Treatment consists of reducing pressure on the heel of the foot by using specialised orthotics, and taking anti-inflammatory medications for pain relief.

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Final Word | Causes of Heel Pain

Often heel pain can cause individuals to walk differently as an attempt to reduce pressure on the heel of the foot; however this misalignment of the body can lead to pain and pressure in the knees, hips and back.

Causes of heel pain can vary greatly, for a professional diagnosis and treatment it is highly recommended that you consult with a specialised podiatrist.