Among adults, heel pain is the most commonly experienced form of foot pain. The calcaneus, which is the heel bone, is the largest bone in the foot. It is the first portion of the foot to make contact with the ground during walking. The plantar fascia, which is a band of connective tissue, and the flexor digitorum brevis muscle, which supports the arch and allows us to flex our four lateral toes, are both located on the sole of the foot. Conditions that cause heel pain affect both of these parts of the foot.
Plantar fascitis is one of the most common causes of heel pain. Inflammation of the plantar fascia causes a stabbing pain. The pain usually occurs with the first steps of the day and decreases as the foot muscles become more flexible. Long periods of standing and changing from a sitting to standing position can trigger the pain. Runners, people who are overweight, pregnant women and people who wear shoes that do not have adequate arch support are all at risk for developing plantar fascitis.
Tarsal Tunnel Syndrome
Compression of the posterior tibial nerve causes tarsal tunnel syndrome. The tibial nerve curves downward from the back of the leg to the ankle. This part of the body includes muscles, the tibial nerve and the posterior tibial vein and artery. According to the American Family Physician, compression results from a soft tissue mass, scar tissue from a previous fracture, inflammation of an adjacent tendon or over pronation.
Entrapment of the Lateral Plantar Nerve
The lateral plantar nerve is a branch of the tibial nerve. Entrapment of this nerve causes burning pain in the heel. This pain worsens with daily activity and can even occur while at rest. Injury to the nerve is a complication of abdominal surgery, pregnancy and sports injuries.
Stress Fracture of the Heel Bone
Overuse of the heel bone leads to a stress fracture. This condition is common among runners and anyone who has a recent and abrupt increase in daily exercise or activity. The onset of pain is gradual and subtle but worsens with weight-bearing activities.
Sever’s disease occurs most often in physically active girls between the ages of eight and 10 years and physically active boys between the ages of 10 and 12 years. During early puberty, the bones grow faster than the muscles and tendons, and the foot is the first body part to grow to full size. During this time, muscles and tendons become tight and the heel is less flexible. Injury arises from excess pressure placed on the heel during weight-bearing activity, and the injury leads to Sever’s disease. Heel pain associated with Sever’s disease can occur in one or both heels, and usually presents with the start of a new sport or new sport season and increases with running or jumping.
Heel spurs are bony protrusions on the heel bone. Calcium deposits form when plantar fascia pulls away from the bone. People with flat feet or over pronation, unusually high arches and women who wear high-heeled shoes are prone to developing heel spurs. Pressure of the spurs on the surrounding muscles and tendons causes pain.
Inflammation of the Achilles tendon causes heel pain. The Achilles tendon, which is the longest and strongest tendon in the body, is located in the back of the leg and is attached to the heel. It connects the leg muscles to the foot. The inflammation results from over stressing the tendon. People who exercise infrequently or poorly conditioned athletes have the highest risk for developing Achilles tendonitis.
Achilles Tendon Bursitis
Achilles tendon bursitis occurs when the bursa, which is a fluid-filled sac located the skin of the heel and the Achilles tendon, becomes inflamed. Wearing high-heeled shoes or walking in a way that puts added pressure on the soft tissue at the back of the heel leads to bursitis. Initially, a red, swollen tender spot develops at the back of the heel. As inflammation of the bursa increases, a red lump forms, causing pain at and above the heel.