Plantar fasciitis is the most common cause of heel pain, accounting for about four out of five cases.
Plantar fasciitis is when the thick band of tissue that connects the heel bone with the rest of the foot (the plantar fascia) becomes damaged and thickened.
Damage to the plantar fascia is thought to occur following:
- sudden damage – for example, damaging your heel while jogging, running or dancing; this type of damage usually affects younger people who are physically active
- gradual wear and tear of the tissues that make up the plantar fascia – this usually affects adults who are 40 years of age or over
Increased risk
You are at an increased risk of gradual wear and tear damaging your plantar fasciitis if you are:
- overweight or obese – you are obese if you have a body mass index (BMI) of 30 or over
- have a job that involves spending long periods of time standing
- wear flat-soled shoes, such as sandals or flip flops
Less common causes
Less common causes of heel pain are described below.
Stress fracture
A stress fracture can occur if your heel bone is damaged during an injury.
Fat pad atrophy
Fat pad atrophy is where the layer of fat that lies under the heel bone, known as the fat pad, starts to waste away due to too much strain being placed on the pad.
Women who wear high-heeled shoes for many years have an increased risk of developing fat pad atrophy.
Bursitis
Bursitis is inflammation of one or more bursa (small fluid-filled sacs under the skin usually found over the joints and between tendons and bones).
It is possible to develop bursitis anywhere inside the body, not just in the foot.
Tarsal tunnel syndrome
The nerves in the sole of your foot pass through a small tunnel on the inside of the ankle joint, known as the tarsal tunnel. If a cyst forms or the tunnel is damaged, the nerves can become compressed (squashed). This can cause pain anywhere along the nerve, including beneath your heel.
Sever’s disease
Sever’s disease is a common cause of heel pain in children. It is caused by the muscles and tendons of the hamstrings and calves stretching and tightening in response to growth spurts.
The stretching of the calf muscle pulls on the Achilles tendon. This pulls on the growing area of bone at the back of the heel (growth plate), causing pain in the heel.
The pain is further aggravated by activities such as football and gymnastics. The pain often develops at the side of the heel, but can also be felt under the heel.
Calf and hamstring stretches and, if necessary, heel pads are usually effective treatments for Sever’s disease.