Heel pain: What causes it?


Heel pain can start as a dull pain and increase in intensity with time. Sometimes it gets to a point where you are unable to work or go through your day comfortably. But what causes heel pain?

Let’s find out?

Causes of heel pain

When you find yourself having heel pain after an injury such as a fall, the chances are that was just a trigger but not the cause of the pain. It is likely that you have been stressing the heel often without knowing repetitively.

The leading causes of heel pain include:

  • Plantar fasciitis This occurs when the plantar fascia is inflamed. The plantar fascia is the ligament located from the heel bone to the foot tip. The inflammation is usually as a result of ligament being stretched further than it can handle. You will feel pain on the bottom side of the foot when your leg has been resting for an extended period. The pain may be slight or severe depending on the level of damage to the plantar fascia. Most people complain about the pain being the worst when they get out of bed. If you are overweight or if you have gained weight in a short period have a predisposition to plantar fasciitis. Another group of people who are likely to suffer from this pain is people who spend a large chunk of their day on their feet as well as runners. If you are between 40 and 70 years old, you are in a group of people who are more susceptible to the condition. Interestingly, women are more likely to suffer from plantar fasciitis that men. Sometimes the structure of your foot may make it easier for you to get a plantar fascia inflammation. People with flat feet and those with high arches are good examples of such cases.
  • Achilles tendinitis The calf and the heel bone are connected by the Achilles tendon. This is the tendon that is required when you walk, jump or run. Excessive physical activities can cause inflammation to it which may cause pain at the back of your heel. Some of the leading causes of Achilles tendinitis include working out without warming up, strains on your calf muscles or sports like tennis that require spontaneous direction changes and stopping abruptly. Your shoes can also contribute to the inflammation especially if you wear ill-fitting shoes or high heels for too long. Bone spurs can also worsen the inflammation. As with anything else in the body, age causes the Achilles tendon to wear out which is also a cause of heel pain. Even if you regularly work out, you should increase the intensity of your exercises steadily; otherwise, you may hurt your Achilles tendon.
  • Heel bursitis There is a sac filled with fluid which is fibrous found at the back of the heel known as the bursa. When you wear high heels for too long or wear ill-fitting footwear, there is inflammation of the bursa, and it results in heel bursitis. It causes pain either at the back or inside the heel. Sometimes the bursa inflammation may also cause swelling on the Achilles tendon. People who suffer from heel bursitis tend to feel more pain later in the day than when they wake up.
  • Tarsal tunnel syndrome The tarsal tunnel is a small space near the ankle. There is a nerve called the posterior tibial nerve. When this nerve is pinched, it results in the tarsal tunnel syndrome. Some of the causative factors of the syndrome include; flat feet, varicose veins, swollen tendons, arthritis, and ankle sprain. Sometimes diabetes can also be a contributor to it.

Final thoughts

When you have heel pain, you should first see a doctor to get an accurate diagnosis. But there are things you can do like wearing shoes that fit correctly, taking a break from the high heels or resting your legs every once in a while.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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