The heel bone is the largest of the 26 bones in the human foot. The foot also has 33 joints and more than 100 tendons, muscles, and ligaments. Heel pain can occur in the front, back, or bottom of the heel.
Heel pain has many causes. Heel pain is generally the result of improper biomechanics (abnormal walking gait) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury incurred while walking, running, or jumping on hard surfaces, wearing excessively worn out shoes, or being overweight.
The most common causes of heel pain consist of:
Heel spurs are bony calcification growth on the underside of the heel bone. The spur is a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as “heel spur syndrome.” Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the plantar fascia that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone.
Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the continuous irritation caused by a hyper mobile heel bone that allows excessive stretching during certain activities that strain an already tight tendon.
Over Pronation or Excessive Pronation:
Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.
As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the ankle, knee, hips and lower back.