The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.

Chronic Heel Pain Syndrome is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear or being overweight.
One of the main causes of Chronic Heel Pain Syndrome is a condition known as Plantar Fasciitis. The plantar fascia is a band of tissue that extends along the bottom of the foot, from the toe to the bottom of the heel. A rip or tear in this ligament can cause the inflammation of these tissues, resulting in heel pain. People who do not wear proper fitting shoes are often at risk of developing this condition. Unnecessary stress from ill-fitting shoes, weight change, excessive running, and wearing non-supportive shoes on hard surfaces are all causes of Plantar Fasciitis.

Achilles Tendonitis is another cause of heel pain. Similar to Plantar Fasciitis, the inflammation of the Achilles tendon can cause heel pain due to muscle tearing. A lack of flexibility of the ankle and heel is an indicator of Achilles Tendonitis. If left untreated, this condition can lead to Plantar Fasciitis and create even more pain in your heel.

A third cause of heel pain is a Heel Spur. A Heel Spur occurs when the tissues of the plantar fascia undergo a great deal of stress, leading to a separation of the ligament from the heel bone entirely. Micro-tears along the Plantar Fascia leads to bleeding, scarring and calcification of the Plantar Fascia. This separation results in a pointed fragment of bone on the under surface of the heel bone. 

Treatments for Heel Pain are easy and effective as long as problems are addressed quickly. The most common solution for Heel Pain is simply taking stress off the feet, particularly off of the heel. This will help ease pain and allow the tendons and ligaments to relax. In the case of both Plantar Fasciitis and Achilles Tendonitis, icing will reduce swelling in any part of the foot. Anti-inflammatory medication is highly recommended. Stretching before and after exercises will help the foot muscles prepare for stress and decrease the chances of inflammatory pain. In most cases, it is crucial to address the underlying biomechanical cause with custom molded foot orthoses.  Unfortunately in many cases, because each foot is so unique in structure and function, over the counter arch supports provide unpredictable outcomes. In more advance stages of Chronic Heel Pain Syndrome, treatments may require cortisone injections or percutaneous cryotherapy (Cryoplantalis®). In extreme cases, relieving heel pain might require surgery. Always make sure to discuss these symptoms and treatment options with your podiatrist to keep yourself active and pain free.