Everything you need to know about heel pain

heel pain

Imagine walking for hours on end in foam flip flops over gravel paths, dirt roads, and concrete. After a handful of hours, your feet are probably going to start aching. Not just because there’s zero support in most flip flops, but because the pressure of the ground combined with poor foot and ankle mechanics can leave you susceptible to overuse and injury. 

For every one mile you walk, you’re putting about 60 tonnes of stress on each foot. Your feet can handle a pretty heavy load, but over time, too much stress can push your feet to their limits. It gets worse when you’re an athlete who’s constantly pounding your feet on hard surfaces or wearing shoes that irritate sensitive tissues.

Most people don’t realize how complex feet are. The foot and ankle are made up of 26 bones, 33 joints, and more than 100 tendons, with the heel being the largest bone in your foot. So, it’s no wonder that when we spend hours on our feet in poorly designed or poorly fitting shoes, our feet start to hurt.

A sore heel will usually improve on its own without the need for surgery if you provide adequate rest, but one of the big problems is that most people ignore the early signs of heel pain and keep doing the activities that caused it. When you continue to use a sore heel, it’s only going to get worse and may become a chronic condition leading to more issues down the road. 

So, let’s talk aboutheel pain

Why causes heel pain?

Heel pain, especially stabbing heel pain that radiates, is most commonly caused by plantar fasciitis, but there are other conditions or injuries that can lead to pain both in the heel and the entire foot.

These include [1]:

1. Plantar fasciitis 

If you’re dealing with foot pain radiating from the heel, chances are it’s plantar fasciitis. It’s the most common cause of throbbing medial plantar heel pain that develops when the strong band of tissue (fascia) that supports the arch of the foot becomes irritated and inflamed. It presents as pain that’s worse in the morning and after long periods of rest, but pain also increases when the plantar fascia is stressed during passive dorsiflexion of the foot and toes (bringing towards shin). 

The plantar fascia is designed to absorb the high stresses and demands we place on our feet, but sometimes the pressure can be too much and it results in damage or tears to the tissues. The body's natural response to injury is inflammation, which results in heel pain and stiffness of the plantar fascia.

2.Calcaneal stress fracture

A calcaneal stress fracture is the second most common cause of stress fractures in the foot and can result in serious heel pain due to a tiny fracture present in the heel bone. It’s generally caused by repetitive overload to the heel, which makes it common in athletes who engage in heavy weight-bearing activities, basketball, soccer, and other running sports. Calcaneal stress fracture pain will typically only arise with activity, but eventually progresses to pain even at rest. 

The weight-bearing bones of the foot and lower leg are especially vulnerable to stress fractures because they absorb large amounts of repetitive force during activities like walking, running, and jumping. While most stress fractures are due to overuse, a sudden change in the duration, frequency, or intensity of an activity can also cause them. 

3. Heel spur

Heel spurs are less common causes of heel pain than the last two, but nevertheless do occur. They’re the result of a bony-like growth (calcium deposit) that extends between your heel bone and arch. They will often begin at the front of or underneath the heel and eventually work their way to other parts of the foot, extending forward by as much as a ½”.  For some people, heel spurs may cause extreme pain and discomfort, while for others the symptoms are minimal.

Unlike fractures, heel spurs don’t just happen; they develop slowly over time and tend to pop up when people ignore the initial signs of heel pain. Most commonly they’re the result of repetitive stress from walking, running, or jumping on hard surfaces, but can also develop from wearing shoes that lack support.

4. Nerve entrapment

If you’ve ever experienced a pinched nerve before, you know how painful it can be. It aches and radiates, tingles, sometimes burns, and can be a huge impediment to training and daily function, especially in the feet. If you’re experiencing any of these symptoms, you’re likely dealing with an impinged nerve. 

Heel pain caused by nerve entrapment is generally the result of impinged nerves stemming from branches of the posterior tibial nerve. With entrapped nerves, pain is generally only felt on one side and develops from prolonged pressure on a specific nerve that causes inflammation, irritation, and pain. 

5. Heel pad syndrome

The pain that develops from heel pad syndrome is often mistakenly attributed to plantar fasciitis, but people with this condition experience deep, bruise-like pain in the centre of the heel. When walking barefoot or on hard surfaces, the pain tends to get worse. Heel pad syndrome is typically caused by inflammation, but it can also arise from damage to or atrophy of the heel pad, as well as decreased elasticity of the heel pad or obesity (excess weight). 

While the 5 we just mentioned are the most common causes of heel pain, they are by no means the only ones. The diagnosis of heel pain varies based on where the pain is felt--plantar, posterior, medial, or lateral.

How to treat (and prevent) heel pain

Heel pain can be a huge pain in the butt and can impede on mobility and daily functionality, so whether you're struggling with heel pain currently or are trying to prevent it, taking the necessary precautions to strengthen the feet and improve foot and ankle mobility is key to avoiding it and reducing pain.


How do we do that?

#1 Rest

When you’re dealing with any sort of injury or inflammation, rest is gold. So often people give themselves a day or two of rest and are right back at it, only to be dealing with the same condition again. Injuries require rest to heal and though it may be difficult, your feet will thank you.

#2 Incorporate massage 

Using massage techniques on the feet and calves can reduce inflammation and help to correct functional risk factors like tightness of the gastrocsoleus complex and weakness of the intrinsic foot muscles. Using recovery tools like theEI8HTBALL are also great for targeting trigger points, relieving tension, and boosting recovery.

#3 Wear proper footwear

You wouldn’t wear pants that are too small for you, so why wear shoes that don’t fit? Finding shoes that fit properly is key to avoiding foot problems down the road. That means having room for your toes to spread, along with a wide toe box that matches your actual foot and biomechanics. When you wear improper shoes, it can stress the tissue in the bottom of the foot even more, which eventually leads to deformation of the tissue and chronically stretch and irritate it.

#4 Stretch and Strengthen

More often than not we focus on the strength and mobility of the large muscles and joints and forget about the little guys. It’s important to not only focus on pain relief when you have heel pain but to learn how to stretch and strengthen the foot after recovery. Building intrinsic foot muscle strength and understanding how to stretch the foot can reduce injury and ensure previous injuries do not return. Check out our Instagram or Facebook page for foot exercises. 

#5 Purchase the Plantar Fasciitis Training Program

Frankly put, plantar fasciitis is a pain (no pun intended) and treating it can be a challenge. In this guide, we focus on delivering you long term solutions that help to strengthen your feet to prevent future recurrences and relieve pain, rather than provide temporary relief.The Plantar Fasciitis Training Program is a 12-week program delivered via PDF that gives you everything you need to know about PF. 

  • Foot anatomy overview (functions and muscles)
  • 12-week program with a terminology cheat sheet 
  • Video explanations and detailed tutorials
  • 60-minute sessions with optional daily mobility work
  • A set of Toe Spacers 

    There’s no denying that heel pain is a pain in the butt and we want to do everything we can to avoid having it happen in the first place, and if it does, treat it and prevent it from recurring. Becoming aware of what causes heel pain and taking the time daily to engage in foot exercises and massage to help stretch and strengthen the muscles and joints of the foot and ankle are huge for rehabbing injuries and preventing problems in the future.