Heel pain is one of the most common reasons people visit podiatrists, affecting millions of Americans each year. If you're dealing with heel discomfort, understanding what's causing your pain is crucial for finding the right treatment and preventing future problems. At Marvel Foot & Ankle Centers, our Phoenix podiatrists see patients with heel pain daily, and we've found that education about the causes of heel pain empowers patients to make informed decisions about their treatment.
The heel is a complex structure that bears significant stress with every step you take. In fact, your heels absorb about 1.25 times your body weight with each step during normal walking, and up to 2.75 times your body weight when running. With this constant stress, it's no wonder that heel pain is such a prevalent problem.
Anatomy of Heel Pain
To understand what causes heel pain, it's important to know the basic anatomy of your heel area. The heel consists of the calcaneus (heel bone), which is the largest bone in your foot, along with various soft tissues including muscles, tendons, ligaments, and fascia that work together to support your body weight and enable movement.
The plantar fascia is a thick band of tissue that runs along the bottom of your foot from your heel to your toes, forming your foot's arch. The Achilles tendon connects your calf muscles to the back of your heel bone. Various bursae (fluid-filled sacs) cushion and protect these structures from friction.
When any of these structures become injured, inflamed, or stressed beyond their normal capacity, heel pain can result. The location, timing, and characteristics of your pain often provide important clues about which structure is affected.
Primary Causes of Heel Pain
Plantar Fasciitis: The Most Common Culprit
Plantar fasciitis accounts for about 80% of all heel pain cases, making it by far the most common cause of heel discomfort. This condition occurs when the plantar fascia becomes inflamed or develops small tears due to overstretching or overuse.
The plantar fascia serves as your foot's natural shock absorber and arch support. When this tissue is subjected to excessive stress—whether from increased activity, weight gain, poor footwear, or biomechanical problems—it can become damaged and painful.
Plantar fasciitis typically causes:
- Sharp, stabbing pain in the heel, especially with first steps in the morning
- Pain after sitting for long periods that improves with walking
- Tenderness on the bottom of the heel
- Pain that may radiate along the arch of the foot
Risk factors for plantar fasciitis include:
- Age (most common between 40-60 years old)
- Obesity or sudden weight gain
- High-impact activities like running or jumping
- Occupations requiring prolonged standing
- Flat feet or abnormally high arches
- Tight Achilles tendons or calf muscles
Phoenix residents face unique risk factors including walking on extremely hot pavement (which can affect gait patterns), working in industries that require long hours on hard surfaces, and sudden increases in outdoor activity when temperatures become more comfortable.
Achilles Tendinitis: Pain at the Back of the Heel
Achilles tendinitis is the second most common cause of heel pain, affecting the large tendon that connects your calf muscles to your heel bone. This condition typically causes pain at the back of the heel rather than the bottom.
The Achilles tendon is the strongest tendon in your body, but it's also frequently injured due to its high stress load during activities like walking, running, and jumping. When this tendon becomes inflamed or develops small tears, it can cause significant heel pain.
Achilles tendinitis symptoms include:
- Pain and stiffness at the back of the heel
- Pain that worsens with activity
- Swelling along the tendon
- Morning stiffness that improves with gentle movement
- Tenderness when squeezing the sides of the tendon
Common causes of Achilles tendinitis:
- Sudden increases in physical activity
- Tight calf muscles
- Poor footwear that doesn't support the heel properly
- Hill running or stair climbing
- Sports that involve jumping or quick direction changes
Heel Spurs: Bony Growths That May Cause Pain
Heel spurs are calcium deposits that form bony protrusions on the heel bone. Contrary to popular belief, heel spurs themselves don't always cause pain. However, when they do cause discomfort, it's usually due to the inflammation and tissue irritation that develops around the bony growth.
Heel spurs often develop as a response to chronic plantar fasciitis, forming where the plantar fascia attaches to the heel bone. They can also form where the Achilles tendon attaches to the back of the heel.
Heel spur symptoms may include:
- Sharp, knife-like pain when standing up after rest
- Dull ache throughout the day
- Inflammation and swelling around the heel
- Difficulty wearing certain shoes
Many people have heel spurs without knowing it, as they're often discovered incidentally on X-rays taken for other reasons. The presence of a heel spur doesn't automatically mean it's the cause of your pain.
Bursitis: Inflammation of Cushioning Sacs
Heel bursitis occurs when the small, fluid-filled sacs (bursae) that cushion the tissues around your heel become inflamed. There are several bursae around the heel area, and inflammation of any of these can cause heel pain.
Retrocalcaneal bursitis affects the bursa between the Achilles tendon and the heel bone, causing pain at the back of the heel. Subcalcaneal bursitis affects the bursa under the heel bone, causing bottom-of-heel pain similar to plantar fasciitis.
Bursitis often develops due to repetitive pressure, friction, or trauma to the heel area. Poorly fitting shoes, especially those that rub against the back of the heel, are a common cause.
Stress Fractures: Tiny Cracks in the Bone
Calcaneal stress fractures are small cracks in the heel bone that can cause significant pain. These fractures typically develop gradually due to repetitive stress rather than from a single traumatic event.
Stress fractures are more common in people who suddenly increase their physical activity, those with poor bone density, and individuals who participate in high-impact sports. Unlike other causes of heel pain, stress fracture pain typically doesn't improve with rest and may worsen with continued activity.
Stress fracture symptoms include:
- Deep, aching pain in the heel
- Pain that worsens with weight-bearing activities
- Localized tenderness over the fracture site
- Possible swelling around the heel
Risk Factors That Contribute to Heel Pain
Biomechanical Factors
Flat feet (pes planus) can place excessive stress on the plantar fascia, leading to inflammation and pain. Conversely, high arches (pes cavus) can also contribute to heel pain by creating uneven weight distribution.
Gait abnormalities affect how your foot strikes the ground and can place abnormal stress on heel structures. These may develop due to previous injuries, muscle imbalances, or structural problems in the feet or legs.
Leg length discrepancy can cause uneven stress on the heels, with the longer leg typically experiencing more problems.
Lifestyle and Activity Factors
Sudden activity increases are a major risk factor for heel pain. This is particularly relevant for Phoenix residents who may be sedentary during extreme summer heat and then dramatically increase activity levels when temperatures cool.
Poor footwear choices significantly contribute to heel pain. Shoes that lack proper arch support, have worn-out cushioning, or don't fit properly can stress heel structures. Walking barefoot on hard surfaces, common in Phoenix homes with tile flooring, can also contribute to heel pain.
Occupational factors play a significant role. Jobs that require prolonged standing or walking on hard surfaces increase heel pain risk. Phoenix's construction, healthcare, hospitality, and retail industries all present these challenges.
Physical and Health Factors
Age is a significant factor, as the tissues in your feet naturally lose flexibility and cushioning over time. Most heel pain conditions peak between ages 40-60.
Weight directly impacts heel stress. Every pound of body weight translates to approximately 3-5 pounds of additional force on your feet during walking. Even modest weight gain can significantly increase heel pain risk.
Overall health conditions can contribute to heel pain. Diabetes, arthritis, thyroid disorders, and circulation problems all increase the risk of developing foot and heel problems.
Phoenix-Specific Risk Factors
Living in Phoenix presents unique challenges that can contribute to heel pain:
Extreme heat affects footwear choices and activity patterns. Many residents avoid outdoor activities during summer months and then suddenly increase activity when temperatures drop, creating conditions for overuse injuries.
Hard flooring surfaces are common in Phoenix homes due to the climate, but walking barefoot on tile, concrete, or stone can stress heel structures.
Desert hiking is popular among Phoenix residents, but the rocky, uneven terrain can stress feet and heels, especially for occasional hikers who aren't properly conditioned.
Seasonal activity patterns in Phoenix often involve dramatic changes in activity levels, which can contribute to overuse injuries including heel pain.
When Heel Pain Requires Professional Attention
Immediate medical evaluation is needed for:
- Severe heel pain that prevents normal walking
- Signs of infection (redness, warmth, fever)
- Numbness or tingling in the foot
- Pain following a traumatic injury
Prompt professional consultation is recommended for:
- Heel pain that persists more than a few days
- Pain that interferes with daily activities
- Morning heel pain that doesn't improve with basic stretching
- Recurring episodes of heel pain
At Marvel Foot & Ankle Centers, our Phoenix podiatrists use comprehensive diagnostic approaches to identify the exact cause of your heel pain and develop personalized treatment plans.
Diagnostic Approaches
Clinical examination includes assessment of your pain location, intensity, and triggers, along with physical examination of your foot structure and biomechanics.
Imaging studies may include X-rays to identify heel spurs or stress fractures, ultrasound to evaluate soft tissue structures, or MRI for detailed assessment of complex cases.
Gait analysis can identify biomechanical factors contributing to your heel pain and guide treatment decisions.
Treatment Philosophy
Understanding what causes your heel pain is the foundation for effective treatment. At Marvel Foot & Ankle Centers, we believe in addressing not just your symptoms, but also the underlying factors that contributed to your pain. This comprehensive approach leads to better outcomes and helps prevent future problems.
Treatment typically begins with conservative approaches including stretching, proper footwear, and activity modification. More advanced treatments like custom orthotics, physical therapy, or injection therapy may be recommended for persistent cases.
Taking Control of Your Heel Pain
Heel pain doesn't have to limit your lifestyle or prevent you from enjoying Phoenix's year-round opportunities for outdoor activities. By understanding what causes heel pain and working with experienced podiatrists, you can find effective relief and prevent future problems.
If you're dealing with heel pain, don't assume it will resolve on its own. Early intervention typically leads to faster recovery and better outcomes. The experienced podiatrists at Marvel Foot & Ankle Centers are here to help you understand the cause of your heel pain and develop an effective treatment plan tailored to your specific needs and lifestyle.
Contact Marvel Foot & Ankle Centers today to schedule your comprehensive heel pain evaluation and take the first step toward understanding and resolving your heel discomfort.