Heel pain is a very common foot problem. The sufferer usually feels pain either under the heel (plantar fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone.
Even though heel pain can be severe and sometimes disabling, it is rarely a health threat. Heel pain is typically mild and usually disappears on its own; however, in some cases the pain may persist and become chronic (long-term).
There are 26 bones in the human foot, of which the heel (calcaneus) is the largest. The human heel is designed to provide a rigid support for the weight of the body. When we are walking or running it absorbs the impact of the foot when it hits the ground, and springs us forward into our next stride. Experts say that the stress placed on a foot when walking may be 1.25 times our body weight, and 2.75 times when running. Consequently, the heel is vulnerable to damage, and ultimately pain.
In the majority of cases, heel pain has a mechanical cause. It may also be caused by arthritis, infection, an autoimmune problem trauma, a neurological problem, or some other systemic condition (condition that affects the whole body).
Contents of this article:
You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.
Here are some key points about heel pain. More detail and supporting information is in the main article.
- Heel pain is usually felt either under the heel or just behind it.
- Heel pain has a prevalence of 3.6%.
- US studies estimate that 7% of older adults report tenderness under the heel.
- Plantar fasciitis is estimated to account for 8% of all running-related injuries.
- There are 26 bones in the human foot, of which the heel is the largest.
- Pain typically comes on gradually, with no injury to the affected area. It is often triggered by wearing a flat shoe.
- In most cases the pain is under the foot, towards the front of the heel.
- The majority of patients recover with conservative treatments within months.
- Home care such as rest, ice, proper-fitting footwear and foot supports are often enough to ease heel pain.
- To prevent heel pain, it's recommended to reduce the stress on that part of the body.
Causes of heel pain
Heel pain is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel.
Common causes of heel pain include:
Plantar fasciitis (plantar fasciosis) - inflammation of the plantar fascia. The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot.
When the plantar fasciitis is stretched too far its soft tissue fibers become inflamed, usually where it attaches to the heel bone. Sometimes the problem may occur in the middle of the foot. The patient experiences pain under the foot, especially after long periods of rest. Some patients have calf-muscle cramps if the Achilles tendon tightens too.
Heel bursitis - inflammation of the back of the heel, the bursa (a fibrous sac full of fluid). Can be caused by landing awkwardly or hard on the heels. Can also be caused by pressure from footwear. Pain is typically felt either deep inside the heel or at the back of the heel. Sometimes the Achilles tendon may swell. As the day progresses the pain usually gets worse.
Heel bumps (pump bumps) - common in teenagers. The heel bone is not yet fully mature and rubs excessively, resulting in the formation of too much bone. Often caused by having a flat foot. Among females can be caused by starting to wear high heels before the bone is fully mature.
Tarsal tunnel syndrome - a large nerve in the back of the foot becomes pinched, or entrapped (compressed). This is a type of compression neuropathy that can occur either in the ankle or foot.
Chronic inflammation of the heel pad - caused either by the heel pad becoming too thin, or heavy footsteps.
Stress fracture - this is a fracture caused by repetitive stress, commonly caused by strenuous exercise, sports or heavy manual work. Runners are particularly prone to stress fracture in the metatarsal bones of the foot. Can also be caused by osteoporosis.
Severs disease (calcaneal apophysitis) - the most common cause of heel pain in child/teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the calcaneus (heel bone). Children aged from 7-15 are most commonly affected.
Achilles tendonosis (degenerative tendinopathy) - also referred to as tendonitis, tendinosis and tendinopathy. A chronic (long-term) condition associated with the progressive degeneration of the Achilles tendon. Sometimes the Achilles tendon does not function properly because of multiple, minor microscopic tears of the tendon, which cannot heal and repair itself correctly - the Achilles tendon receives more tension than it can cope with and microscopic tears develop. Eventually, the tendon thickens, weakens and becomes painful.
A heel pain sufferer commonly feels pain either under the heel (plantar fasciitis) or just behind it (Achilles tendinitis).
Heel pain may also be caused by:
Achilles tendon rupture - the tendon of the heel cord behind the ankle is torn.
Bone cyst - a solitary fluid-filled cyst (cavity) in a bone.
Gout - levels of uric acid in the blood rise until the level becomes excessive (hyperuricemia), causing urate crystals to build up around the joints. This causes inflammation and severe pain when a gout attack happens.
Neuroma (Morton's neuroma) - a swollen nerve in the ball of the foot, commonly between the base of the second and third toes.
Osteomyelitis - osteomyelitis means infection of the bone or bone marrow; inflammation of the bone due to infection. Osteomyelitis sometimes occurs as a complication of injury or surgery. In some cases, the infection may get into bone tissue from the bloodstream. Patients with osteomyelitis typically experience deep pain and muscle spasms in the inflammation area, as well as fever.
Peripheral neuropathy - neuropathy is a collection of disorders that occurs when nerves of the peripheral nervous system (the part of the nervous system outside of the brain and spinal cord) are damaged. The condition is generally referred to as peripheral neuropathy, and it is most commonly due to damage to nerve axons. Neuropathy usually causes pain and numbness in the hands and feet. It can result from traumatic injuries, infections, metabolic disorders and exposure to toxins. One of the most common causes of neuropathy is diabetes.
Problems with your gait - wrong posture when walking/running.
Rheumatoid arthritis - rheumatoid arthritis, sometimes referred to as rheumatoid disease, is a chronic (long lasting), progressive and disabling auto-immune disease condition that causes inflammation and pain in the joints, the tissue around the joints, and other organs in the human body. Rheumatoid arthritis usually affects the joints in the hands and feet first, but any joint may become affected. Patients with rheumatoid arthritis commonly have stiff joints and feel generally unwell and tired.
New research from the US suggests that wearing shoes such as high heels, pumps and sandals was strongly linked in women's later life with heel and ankle pain.
On the next page we look at the symptoms of heel pain, diagnosis and when to seek medical advice. On the final page we discuss treatments and prevention of heel pain.