Orthopedic surgeons encounter people experiencing all types of pain on a regular basis, and one of the more common complaints that arises is heel pain.  

Heel pain, unlike other types of pain, is almost always debilitating in some way, as most of us cannot avoid being on our feet all day.  In addition, many people do not have any control over the shoes worn to work or the surface upon which they stand. 

Here's what may be causing your heel pain:

Plantar Fasciitis

Plantar fasciitis is one of the most common causes of heel pain.  Plantar fasciitis is characterized by pain and degeneration of the plantar fascia, a thin band of tissue that connects the heel to the remainder of the foot and toes and supports the arch of the foot.  When the plantar fascia degenerates, it weakens and causes the bottom of the foot and heel to hurt after long periods of rest or during physical activity. 

This disease may also cause pain at the instep or arch. Plantar fasciitis causes stabbing pains that can come and go throughout the day depending on activity level, and is generally worse in the morning when first getting out of bed (or after extended periods of resting).  Often, plantar fasciitis causes constant pain as the heel is constantly under stress and load.

Heel Spurs

Heel spurs, a common cause of heel pain, are  calcium deposits that creates a bony protrusion, or spur, on the underside of the heel bone.  Heel spurs may be painless depending on their size, but often occur with heel pain and are often associated with plantar fasciitis. Recent studies have shown that the pain intensity is proportional to the size of the spur.

Heel Bursitis

Heel bursitis, both retrocalcaneal and retroachilles, are common types of bursitis and can pain in the foot just above the heel.  Bursitis of the heel causes pain and swelling when the bursae at the back of the heel becomes irritated or inflamed.  Because of the symptoms, heel bursitis is often confused with problems in the Achilles tendon which is connected to the back of the heel. 

Problems with the Achilles tendon can cause bursitis in cases where repeat irritation and stretching occur at the tendon.  However, bursitis may occur with a completely normal tendon.

Achilles Tendonosis

More commonly referred to as tendonitis, Achilles tendonosis is a chronic condition associated with the degeneration of the Achilles tendon and is a common cause of heel pain.  In some cases, microscopic tears appear in the Achilles tendon over time and create issues with the tendon’s functionality.  These tears develop when the tendon is put under more stress and tension than it can handle, and is unable to properly repair itself. 

Over a long period of time, the tendon can weaken, causing pain around the heel where the tendon attaches to the foot.  Tendinosis consists of a breakdown of certain parts of the tendon.  Most of the tendon’s integrity and function remains, but pain ensues.  The degeneration causes the release of painful proteins and inflammatory substances.

Stress Fractures

Stress fractures are often a cause of heel pain and occurs through repetitive stress from activities like strenuous exercise or sports.  Athletes, including runners, are prone to stress fractures due to the frequency and amount of stress placed on their feet and heels during repeat activity. 

Those with abnormal bone, such as osteoporotics or those with renal failure, may develop stress fractures during completely normal activities.  Stress fractures often hurt during activity only in the early stages.  Later, as the fracture matures, it is painful before, during and after activity.