Heel pain

The most frequent causes of heel pain are not single injuries, such as a fall or twist, but repetitive or excessive heel pounding.

Plantar fasciitis is inflammation of the thick connective tissue on the sole of your foot that attaches to your heel. The pain is usually felt at the bottom of your heel and is often worse in the morning because of stiffness that occurs overnight. The following increase your risk of developing this painful problem:

• Shoes with poor arch support or stiff soles.
• Quick turns that put stress on your foot.
• Tight calf muscles.
• Repetitive pounding on your feet from long-distance running, especially running downhill or on uneven surfaces.
• Pronation -- when you tend to land on the outside of your foot and roll inward when walking or running. To know if you pronate, check the soles of your shoes to see if they are worn along the outer edge.

Bone spurs in the heel can accompany plantar fasciitis, but are generally not the source of the pain. If you treat the plantar fasciitis appropriately, the bone spur is likely to no longer bother you.

Heel bursitis (inflammation of the back of the heel) can be caused by landing hard or awkwardly on the heel, or by pressure from shoes.

Achilles tendinitis is inflammation of the large tendon that connects your calf muscle to your heel. This can be caused by:

• Running, especially on hard surfaces like concrete.
• Tightness and lack of flexibility in your calf muscles.
• Shoes with inadequate stability or shock absorption.
• Sudden inward or outward turning of your heel when hitting the ground.

Schroeder BM. American College of Foot and Ankle Surgeons: Diagnosis and treatment of heel pain. Am Fam Physician. 2002; 65(8): 1686, 1688.

American College of Radiology (ACR), Expert Panel on Musculoskeletal Imaging. Chronic foot pain. Reston, VA: American College of Radiology; 2002.

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