Plantar fasciitis is the most common cause of heel pain, accounting for around four out of five cases.
Plantar fasciitis is where 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
You're at an increased risk of gradual wear and tear damaging your plantar fasciitis if you:
- are overweight or obese – if you have a body mass index (BMI) of 30 or over you're considered obese
- have a job that involves spending long periods of time standing
- wear flat-soled shoes – such as sandals or flip flops
Less common causes
Some less common causes of heel pain are described below.
A stress fracture (crack in the bone) can occur if your heel bone is damaged following repeated stress over time.
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 it.
Women who wear high-heeled shoes for many years have an increased risk of developing fat pad atrophy.
Bursitis is inflammation of one or more bursa. Bursa are small fluid-filled sacs under the skin that are usually located over the joints and between tendons and bones.
It's 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 called 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 is a common cause of heel pain in children. It's 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 (the 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.
Bone spurs are an excess growth of bone that forms on a normal bone. They can develop on the heel (a heel spur), and are more common in people with heel pain. However, they can also occur in people without heel pain, and a heel spur itself doesn't cause heel pain.