Of all the 26 bones in the human foot, the heel bone (calcaneus) is the largest. It helps form the heel—which also includes thick connective tissue under the bone (fat pad) and a fluid-filled bursa sac (retrocalcaneal) near the back of the heel. This reduces friction and assists movement of the Achilles tendon over the bone where it attaches.

Leading Causes of Heel Pain

Plantar fasciitis. Heel pain can be caused by a variety of conditions or injuries. Undue stress on the calcaneus and its connective tissues from physical activity, obesity, or improper footwear can lead to plantar fasciitis. This condition is the most common form of heel pain. It occurs when the plantar fascia tissue (which connects the heel bone to the ball of the foot) becomes overly stretched, causing pain and inflammation which is most severe first thing in the morning.

Heel spurs. Plantar fasciitis can become a chronic condition if not treated properly, and it may even lead to heel spurs developing on the heel bone. Heel spurs are calcium deposits that form in response to repeated stress on the heel bone, which may or may not be painful.

Gait anomalies. Certain abnormalities in how a person walks can also cause heel pain, such as excessive pronation. This is where the ankle rolls excessively inward, which can cause the ligaments and tendons that attach to the heel bone to put undue pressure on the heel bone.

Achilles tendinitis. This condition occurs when the Achilles tendon—which connects the calf muscles with the heel bone—strains and stretches abnormally or tears, causing pain and inflammation where the tendon attaches to the heel bone.

Gout. This is a form of arthritis where hardened crystals of uric acid in the bloodstream build up on bones and joints. This can sometimes develop on the heel bone. Symptoms include pain, tenderness, swelling, and redness which can sometimes flare up in the middle of the night.

Acute injuries. A traumatic injury to the heel bone, such as a fracture or bone bruise (contusion), can cause sharp pain, swelling, and an inability to put weight on the heel.

Bursitis. This is a painful inflammation of the bursa sac that acts as a lubricant and cushion between the Achilles tendon and the heel bone.

Haglund’s deformity. Also called “pump bump,” this boney enlargement at the back of the heel is often caused by wearing high heels and is another possible cause of heel pain.

How a Podiatrist Diagnoses and Treats Heel Pain

A podiatrist will be able to properly diagnose heel pain with an examination and possibly after analyzing an imaging test. Treatments will vary depending on the nature and severity of the condition and are conservative in most cases. These modalities may include:

• Taping or strapping
• Orthotics
• Physical therapy
• Changes in footwear
• Steroid injections
• MLS laser therapy
• Extracorporeal shockwave therapy

If you are experiencing persistent heel pain with or without inflammation, redness, heat, or swelling, make an appointment with a podiatrist to have your condition diagnosed and treated properly.