Heel pain is one of the most prevalent foot complaints, affecting millions of people worldwide. Whether it strikes suddenly or develops gradually, this discomfort can significantly impact daily activities, limiting mobility and reducing quality of life. Understanding the common causes of heel pain is essential for proper treatment and prevention. While some heel pain resolves independently, many conditions require medical intervention to achieve lasting relief.
Plantar Fasciitis: The Leading Culprit
Plantar fasciitis remains the most common cause of heel pain, accounting for approximately 80% of cases. This condition involves inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of the foot, connecting the heel bone to the toes. The plantar fascia supports the arch of the foot and absorbs impact during walking and running.
When the plantar fascia becomes overstressed or develops tiny tears, inflammation occurs, resulting in sharp pain—typically in the heel but sometimes radiating across the sole of the foot. The pain is often most severe in the morning when taking the first steps after sleep, as the tissue tightens overnight. Factors that increase risk include excessive physical activity, sudden increases in activity level, obesity, tight calf muscles, and unsupportive footwear.
Heel Spurs and Bone-Related Issues
Heel spurs are calcium deposits that develop on the underside of the heel bone. While not always painful themselves, heel spurs frequently cause significant discomfort, particularly when walking or standing for extended periods. These spurs often develop as a result of chronic tension from the plantar fascia pulling on the heel bone, making them closely associated with plantar fasciitis.
Another bone-related condition, calcaneal stress fractures, can occur from repetitive stress or inadequate rest. These small fractures in the heel bone develop gradually and cause persistent aching that worsens with activity.
Achilles Tendonitis
The Achilles tendon, connecting the calf muscle to the heel bone, can become inflamed and painful—a condition known as Achilles tendonitis. This often results from overuse, sudden increases in physical activity, or inadequate warm-up before exercise. Athletes and individuals who frequently engage in repetitive activities like running or jumping are particularly susceptible. The pain typically develops gradually and may worsen during or after physical activity.
Bursitis: Inflammation of Fluid-Filled Sacs
Bursae are small, fluid-filled sacs that cushion and reduce friction between bones, tendons, and muscles. When these become inflamed—a condition called bursitis—they can cause significant heel pain. Retrocalcaneal bursitis occurs between the Achilles tendon and heel bone, while subcutaneous bursitis develops under the skin at the heel’s base. This inflammation typically results from repetitive friction, pressure from shoes, or direct trauma to the area.
Sever’s Disease: A Condition of Youth
Sever’s disease primarily affects children and young adolescents whose heel bones are still developing. The growth plate in the heel is particularly vulnerable to stress and strain, especially during growth spurts when the bone grows faster than the surrounding muscles and tendons. Young athletes who participate in high-impact sports often experience Sever’s disease, which manifests as pain at the back of the heel, particularly after activity. Fortunately, this condition typically resolves with rest and conservative treatment as the growth plate matures.
Haglund’s Deformity
Haglund’s deformity, commonly called “pump bump,” is an enlargement of the heel bone that typically develops at the back of the heel. This bony bump can irritate the surrounding tissues and cause pain, especially when wearing shoes that rub against the area. While the exact cause remains unclear, it may involve genetic predisposition, tight Achilles tendons, or biomechanical factors. High heels can exacerbate this condition, though the deformity can develop in individuals wearing any type of footwear.
Tarsal Tunnel Syndrome
Similar to carpal tunnel syndrome in the wrist, tarsal tunnel syndrome involves compression of the posterior tibial nerve as it passes through the tarsal tunnel near the heel. This compression causes burning pain, tingling, or numbness in the heel and sole of the foot. Causes include swelling, flat feet, bone spurs, or cysts that narrow the tunnel, compressing the nerve. This condition may develop gradually and sometimes radiates pain throughout the foot and lower leg.
Inflammatory Arthropathies
Various forms of arthritis can affect the heel joint and surrounding structures. Rheumatoid arthritis, psoriatic arthritis, and other inflammatory conditions cause heel pain through cartilage deterioration and joint inflammation. These systemic conditions often cause pain in multiple joints and typically require specialized medical management.
Lifestyle and Biomechanical Factors
Beyond specific medical conditions, several lifestyle and biomechanical factors contribute to heel pain. Obesity increases stress on the feet and plantar fascia. Sudden increases in physical activity without adequate conditioning place excessive strain on heel structures. Worn-out or unsupportive footwear fails to provide proper cushioning and arch support. Flat feet or high arches create biomechanical imbalances that increase stress on the heel.
Age plays a significant role, as the plantar fascia becomes less flexible with time, and the fat pad under the heel naturally diminishes over the years, providing less cushioning. Tight calf muscles and Achilles tendons limit ankle flexibility, increasing stress on the heel during movement.
Prevention and Management
Preventing heel pain involves maintaining a healthy weight, wearing supportive and well-cushioned shoes appropriate to your foot type, and gradually increasing activity levels rather than making sudden changes. Stretching exercises for the calf muscles and plantar fascia, particularly before activity, help maintain flexibility and reduce strain.
Conclusion
Heel pain stems from various causes, ranging from inflammation and biomechanical issues to bone-related problems and systemic conditions. While plantar fasciitis remains the most common culprit, understanding the full spectrum of potential causes is essential for appropriate treatment. Most cases respond well to conservative management, including rest, stretching, proper footwear, and anti-inflammatory approaches. However, persistent or severe heel pain warrants professional evaluation to ensure accurate diagnosis and effective treatment. By recognizing risk factors and implementing preventive measures, many people can avoid heel pain or minimize its impact on their daily lives.
