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Pain The Basics of Pain

Down at the Heels

Most of us take our heels for granted, until they start hurting. It is hard to believe that heels can cause so much havoc, but it turns out that pain felt under the heel bone—which works in collaboration with 33 joints and a network of more than 100 tendons, muscles and ligaments—can bring the most stoic person to their knees. Heel pain is one of the most common types of foot pain, and podiatrists say they are seeing more people complaining of it. The increase in heel pain rates is due, in part, to the aging population and rising rates of obesity. But one of the major causes of heel pain is associated with positive trend: More Americans are starting exercise programs. The problem is that they often lack shoes with good arch support and don't incorporate stretching into their regimen.

Below, Dr. Ronald Jensen, a member of the Board of Trustees of the American Podiatric Medical Association (APMA) and a podiatrist in private practice in Modesto, California, explains what causes heel pain, and how to treat it.

How common is heel pain?
The APMA feels that there is an epidemic of heel pain afflicting this country. Questions related to heel pain make up over 70 percent of the inquiries to consumer hotlines cosponsored by the APMA and the USA Today over the last ten years. Heel pain is probably one of the most common diagnoses that we treat.

What is the most common cause of heel pain?
The most common cause of heel pain is a condition called plantar fasciitis, which is inflammation of the plantar fascial ligament. The plantar fascial ligament is a tight band of tissue that originates from the bottom of the heel bone and spreads in a web like fashion to the pads of the toes. If this ligament becomes "overworked" it can become inflamed and painful. The reason it's most common to feel the pain underneath the heel is you have all the tension being placed on that ligament concentrated in a very narrow area underneath the heel bone itself. The pain can be experienced anywhere along the length of that ligament: right underneath the heel, in the central portion of the arch, or less commonly out towards the ball of the foot.

What else contributes to heel pain?
Shoes that do not give adequate support to the foot are among the most common causes of heel pain. Some of the new athletic shoes that are being designed have large cutouts through the arch area, which causes the shoe to flex at the midfoot instead of the ball of the foot, which is much more natural. As a result, the plantar fascial ligament is overstretched.

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