At some points in life, you may sometimes feel that you cannot stand on your heels anymore. It may because you stood all day, ran too far or walked in shoes with poor support. Additionally, there are many causes of heel pain that you have to pay attention to before it’s too late.

The heel bone is the largest among 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 ability to keep us on our feet.

Heel pain has many causes. It is the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues attaching 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; or being overweight.

Questions around your heel pain

  • Have you ever had this type of heel pain before?
  • When did your pain begin?
  • Do you have pain upon your first steps in the morning or after your first steps after rest?
  • Is the pain dull and aching or sharp and stabbing?
  • Is it worse after exercise?
  • Is it worse when standing?
  • Did you fall or twist your ankle recently?
  • Are you a runner? If so, how far and how often do you run?
  • Do you walk or stand for long periods of time?
  • What kind of shoes do you wear?
  • Do you have any other symptoms?

Main causes of heel pain

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.

  • These are abnormal growths of bone on the bottom of your heel. You can get them from wearing the wrong shoes or from an abnormal walk or posture, or even from activities like running.
  • People with flat feet or high arches are more likely to have painful heel spurs.
  • These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.

Plantar fasciitis (bottom of the heel)

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 bottom of the heel 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 lacking appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

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 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 (back of the heel)

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 onto 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

  • 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.

Feet. They carry you from here to there every day. But you may not think much about them until they hurt. Remember to treat them right by:

  • Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain.
  • Always stretch and warm-up before exercising.
  • Wear comfortable, properly fitting shoes with good arch support and cushioning. Make sure there is enough room for your toes.

Hello Health Group does not provide medical advice, diagnosis or treatment.

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