What Causes Heel Pain?

Heel pain is a prevalent foot complaint and may involve bone, fat pad, ligaments, tendons or muscles.

Common Causes of Heel Pain

Plantar Fasciitis

The most common cause of heel pain is plantar fasciitis, a condition where your main arch ligament (fascia) becomes inflamed and causes pain.

More info: Plantar Fasciitis

Heel Spur

Plantar fasciitis can develop into a heel spur (calcaneal spur) when delayed fascia healing and bone is laid down due to excessive load through the injured soft tissue. Heel spurs are often related to flat feet or pes planus.

More info:

• Heel Spur
• Flat Feet
• Pes Planus

Achilles Heel

The attachment of your Achilles tendon can cause Achilles heel issues onto your heel, and this can be due to tendonitis or a related Achilles tendinopathy. While not necessarily painful, a ruptured Achilles tendon causes functional limitations such as an inability to rise on your toes, walk or run.

More info:

• Achilles Tendinopathy
• Achilles Tendon Rupture

Other Tendinopathies

Peroneal tendonitis is a common lateral heel condition due to altered foot biomechanics or hind-foot control issues. Medially (inside your heel), another tendinopathy known as tibialis posterior tendinopathy can cause heel pain.

More info:

• Peroneal Tendinopathy
• Tibialis Posterior Tendinopathy

Retrocalcaneal Bursitis

Bursitis is another source of heel pain, and it can cause pain between your Achilles tendon and heel.

More info: Retrocalcaneal bursitis

Posterior Impingement Syndrome

Heel pain can also be associated with posterior impingement syndrome conditions, common in dancers or athletes who need to plant their foot, e.g. cricket fast bowlers. It can also occur in any athlete with a relatively unstable ankle, e.g. poorly rehabilitated sprained ankle.

More info: Posterior Impingement Syndrome

Heel Arthritis

Your heel pain can arise from osteoarthritis affecting the subtalar joint or talocrural (ankle) joint.

More info: Heel Arthritis

Stress Fracture

Bone injuries such as fractures can occur from a trauma such as a fall from a height onto your heel. Athletes, especially runners and landing sports, can also suffer overload fractures known as calcaneal stress fractures.

More info: Stress Fracture

Children’s Heel Pain

Sever’s Disease

Sever’s disease is a ubiquitous source of children’s heel pain. Sever’s is related to overactivity and overloading of the calcaneal growth plate.

More info: Sever’s disease.

Referred Sources

You must be thoroughly assessed to ensure an accurate diagnosis and subsequent treatment. Heel pain can also be referred to from a pinched nerve in your lower back, e.g. sciatica. Neural-origin pain such as sciatica and sural nerve pathologies can be tricky to diagnose and requires the professional opinion of an experienced spinal health care practitioner such as your physiotherapist.

Who Suffers Heel Pain?

Anyone can suffer from heel pain, but certain groups seem to be at increased risk, including:

• Middle-aged men and women
• Active people, e.g. running sports
• People who are very overweight
• Children aged between 8 and 13 years
• Pregnant women
• People who stand for long periods.

Common Sources of Heel Pain

Some of the many causes of heel pain can include:

• Abnormal walking style (such as rolling the feet inwards)
• Obesity
• Ill-fitting shoes, e.g. narrow toe, worn-out shoes
• Standing, running or jumping on hard surfaces
• Recent changes in an exercise programme
• Heel trauma, e.g. stress fractures
• Bursitis (inflammation of a bursa)
• Health disorders, including diabetes and arthritis.