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The heel bone is the largest of the foot bones. It is designed to form a firm support for the weight of your body and to absorb the impact when your feet hit the ground during running and walking. Due to the amount of force that goes through your heel it is not surprising that heel pain is such a common occurrence.

Although heel pain can be mild and will sometimes disappear on its own, in some cases the pain persists and can become a chronic problem. There are a variety of causes for heel pain. The most common cause is a condition called plantar fasciitis. Plantar fasciitis is the inflammation of the plantar fascia, which causes pain on the underside of the heel. The plantar fascia works like a very strong rubber band between the heel and the ball of your foot to form the arch of your foot. If the band is short, you’ll have a high arch, and if it’s long, you’ll have a low arch, this is what some people call flat feet. The later stages plantar fasciitis can often cause a heel spur, which is a calcium deposit in the plantar fascia attachment due to a constant strain on the heel bone. The heel spur does not usually cause pain but can be a sign of severe plantar fascia problems.

There are a number of things that can predispose you to developing plantar fascitis. For example:

  • A sudden increase in activity such as taking up a new sport or an unusually long walk in unsuitable shoes. I have noticed an increase in heel pain due to the recent trend of very flat shoes for men and women.
  • Weight gain, for example during pregnancy, puts greater pressure on the plantar fascia.
  • Conditions such as over pronation causes the feet to roll-in excessively putting greater pressure on the plantar fascia. (This is often referred to as flat-footed.) This rolling is caused by a change to the walking pattern (for example walking with toes pointing out) and also in response to a flattening of the front part of the foot over the balls of the feet. Patients may notice a bunion forming on the inside surface of their big toe due to these issues.
  • Running on hard pavements and increasing your hill work can also cause plantar fasciitis. Stretching before and after exercise is often neglected yet it is one of the most important steps to help prevent injuries and heel pain. If you are a reasonably regular runner it is also important to wear the correct shoe for your body. Shoes are divided in to two main types, supportive and shock absorbing. If you are a fast runner then shoes that absorb a lot of shock are better for you, where as if you are a slow, longer distance runner then your should aim for as much support as is comfortable. Also, stretching the bottom of the foot, as well as the calf can significantly reduce strain throughout the foot. When easing into a new or increasingly difficult routine is also important to limit the amount of sudden pressure on the foot.
  • An inactive lifestyle that is centred around a desk job will decrease your calf muscle flexibility which can be a underling cause of heel pain. This leaves you very prone to injury and aggravation around the heel with only a slight increase in activity, such as a sudden dash for the bus.

There are many other causes of pain in and around the heel that we have not discussed. As with all medical conditions a correct diagnosis is of paramount importance for the appropriate treatment and management of the condition.