There are many variations and causes of heel pain. Generally heel pain is caused by abnormalities in the way you walk. These abnormalities cause stress to bone, ligaments and tendons. Other stresses come from injury, chronic stress (i.e. long distance running), obesity, and improper or poorly constructed shoe gear.
General Heel Pain Causes
Heel Spur: A boney growth on the bottom of the calcaneus (heel bone), which extends forward, toward the toes. This growth is a result of excessive stress or tearing of the soft tissue that attaches to the bottom of the heel bone. The heel spur does not cause pain, but is a secondary result of stress and tearing of soft tissue structures.
Plantar Fasciitis: The plantar fascia is a ligament that starts on the bottom of the heel bone and extends forward to the ball of the foot. This ligament can be sprained or torn by a traumatic injury, or repeated extension beyond its normal length. A sprain or tear can cause swelling and pain, and in some instances chronic pain. Typical symptoms include: pain in the bottom of the heel, especially after periods of rest, pain is worse in the morning and at night, but diminishes with activity during the day. Rest does not typically resolve the pain, as it usually returns when activity is resumed.
Achilles Tendonitis: The Achilles tendon starts as two muscles just behind and below the knee, and extends down the leg, attaching to the back of the heel bone. When the Achilles tendon becomes tight, it is easily strained, or even partially torn. This causes pain and swelling to the back of the heel. Secondary changes, such as bone growth on the back of the heel, calcification of the tendon, and hard nodules forming in the tendon can occur.
Treatment for all heel pain generally includes stretching, anti-inflammatory medication, taping, and orthotic type inserts. Steroid injections are not recommended for Achilles tendonitis as it increases the possibility for an Achilles tendon rupture. Steroid injections can be used in the treatment plan for plantar fasciitis. Some people fail these conservative treatments and require surgery.
Not all heel pain can be prevented, but the following suggestions can limit risks of developing heel pain.
Select proper and well-fitting shoe gear for the activity of choice.
Do not wear old, worn out shoe gear.
Perform daily Achilles tendon stretches.
Stretch before performing activity.