In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we've suffered.
When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury.
Pain, such as may occur in our heels, also alerts us to seek medical
attention. This alert is of utmost importance because of the many
afflictions that contribute to heel pain.
Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach 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.
The heel bone is the largest of the 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 its ability to keep us on our feet. Heel pain,
sometimes disabling, can occur in the front, back, or bottom of the
A common cause of heel pain is the heel spur, 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. 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 result from
biomechanical imbalance, running or jogging, improperly fitted or
excessively worn shoes, or obesity.
Both heel pain and heel spurs are frequently associated with 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. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and can be quite painful.
The condition occurs when the plantar fascia 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 it attaches to the heel bone.
The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.
Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.
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
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 order 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.
Some general health conditions can also bring about heel pain.
Heel pain can also occur in children, most commonly between ages 8
and 13, as they become increasingly active in sports activity in and out
of school. This physical activity, particularly jumping, inflames the
growth centers of the heels; the more active the child, the more likely
the condition will occur. When the bones mature, the problems disappear
and are not likely to recur. If heel pain occurs in this age group,
podiatric care is necessary to protect the growing bone and to provide
pain relief. Other good news is that heel spurs do not often develop in
A variety of steps can be taken to avoid heel pain and accompanying