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Heel Pain

Common Causes of Heel Pain

Heel Pain is Far Too Common Affecting Men and Women of All Ages, Both Active and Inactive People

In the quest for healthy bodies, pain is an unwelcome enemy. Heel pain can make it difficult to get stuff done. Heel pain is our body's way of warning us that something is wrong with our feet. Pain in the heel is an immediate red flag that you may have an heel injury or possibly a developing injury.

Imagine that you were to sprain an ankle. That pain warns you that the ligaments and soft tissues have suffered some type of trauma. In a very similar way, heel pain warns us that further activity may cause additional injury. Persistant heel pain alerts us to seek medical attention. On this page we are going to describe some of the more common sources of heel pain.

1. Heel Pain
2. Plantar Fasciitis
3. Heel spurs
4. Excessive Pronation
5. Disease and Heel Pain
6. Pain on the Back of the Heel
7. Children's Heel Pain

1. Heel Pain

Heel pain is often a result of faulty biomechanics ( such as an abnormal walking gait ) placing excessive stress on the heel bone and the soft tissues attached to it. The stress could also result from an injury. Common sources of injury are:

  • a bruise incurred while walking or running
  • jumping on hard surfaces
  • wearing poorly constructed footwear
  • being overweight.

The heel bone, medically termed the calcaneus is the largest of 26 bones making up the human foot. The foot contains 33 joints and a complex network of more than 105 tendons, muscles, and ligaments. The calcaneous, like all bones, is subject to outside influences as it allows us locamotion. Heel pain can occur in the front, back, or bottom of the heel depending on the type of stress the foot is subjected too.

2. Plantar Fasciitis

Heel pain and heel spurs are often associated with an inflammation of the plantar fascia, a band of fibrous connective tissue that runs along the bottom of the foot from the ball of the foot to the heel. The inflammation is called plantar fasciitis, although many people also refer to this as heel spurs. It is common among both athletes who run and jump a lot and inactive people. The pain can be very excruciating.

Plantar fasciitis occurs when the plantar fascia is strained repeatedly beyond its normal extension. The load causes the soft tissue fibers making up the fascia to tear or stretch along its length. The body reacts to this trauma with inflammation and pain, classic symptoms of tendonitis. The body may even react to this inflammation with growth of a bone spur where it attaches to the heel bone right in front of the base of the heal in the rear of the foot.

This pain in the heel may be aggravated by shoes that lack good arch support or that have seen too many miles and are worn out. The chronic irritation of an athletic lifestyle also contributes to the heel pain.

Rest is critical for healing any type of tendonitis. Unfortunately, we use our feet every time we stand up so it's impractical to rest the foot long enough for it to completely heal. Anytime time you stand up, particularly after a night's sleep, you may experience a sharp pain in the heel. This heel pain is the result of the sudden elongation of the fascia band, as it stretches to support the load. As you go throughout the day, your heel pain may lessen or even disappear. Unfortunately, the pain often returns after prolonged rest or extensive walking or standing.

3. Heel Spurs

A common side effect and potential cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, which is often visible in X ray, appears as a bony protrusion that can extend forward as much as half an inch. This calcium deposit is the result of the body attemption to cope with the load and stress that the site is subjected too. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome."

Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may be the result of:

  • biomechanical imbalance
  • running or jogging
  • improperly fitted or worn-out shoes
  • obesity
There is a 'chicken or the egg' situation regarding heel spurs. Heel spurs appear to the result of the body attempting to adapt to the stress of the foot. Simultaneously, they may also be the source of additional pain in the heel.

Historically, some doctors attempted to treat the heel pain by removing the heel spur. Some surgeon's believe that theis is only treating the symptom of the injury. Some patients to receive positive results.

4. Excessive Pronation

Heel pain occasionally results from excessive pronation. The normal motion of the foot includes the flattening of the arch of the foot as it to adapts to the ground surface and absorbs shock during normal walking is called pronation.

The normal movements of the foot as you walk is:

  • the heel contacts the ground first
  • the weight shifts first to the outside of the foot
  • The weight then moves toward the big toe.
  • As the arch rises, the foot generally rolls upward and outward, becoming rigid and stable as it lifts the body and propells it forward. Excessive inward motion, medically called Excessive Pronation, creates abnormal amounts of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation is also a contributing factor with injury to the lower back, knee, and hip.

5. Disease and Heel Pain

Heel pain is most commonly the result of biomechanical stresses. There are some diseases that may also contribute to heel pain:
  • Rheumatoid Arthritis
  • Bursitis
  • neuroma
Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, can cause heel discomfort in some cases.

Heel pain may also be the result of an inflamed bursa (bursitis), a small, irritated sack 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.

6. Pain on the Back of the Heel

Haglund's deformity ("pump bump") is 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 stitchng of a heel counter of a particular shoe.

Pain at the back of the heel is associated with inflammation of the achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. The inflammation is called achilles tendonitis. This heel injury is common among people who walk and run a lot and have tight tendons. Achiles tendonitis condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at the insertion point on to the heel bone. Inflammation, pain, and the possible growth of a bone spur on the back of the heel bone may be the result. The chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon aggravate this irritation.

Bone bruises are another common heel injury. A contusion or bone bruise is the inflammation of the tissues that cover the heel bone. A bone bruise is a painful injury caused by the direct impact of a hard object or surface on the foot.

Stress fractures of the heel bone also also seen on occasion, but these are less frequent.

7. Children’s Heel Pain

Heel pain also occurs in children, usually between ages 8 and 13, as they become increasingly involved in sports activity. The physical activity, particularly jumping, inflames the growth centers of the heels. The more active the child, the more likely the condition will occur. As the the bones mature, the problems typically disappear and are unlikely to recur. Heel pain occuring in this age group requires podiatric care protect the growing bone and to provide pain relief. Heel spurs are very rare in children.

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