Heel pain is a troublesome problem that can make walking difficult, as every step becomes painful. It can occur due to multiple causes. Plantar fasciitis is the most common cause of heel pain. It is inflammation of the thick band of tissue connecting the heel to the toes along the sole of the foot. It usually presents as sharp, stabbing pain with the first few steps after a period of rest. It occurs more commonly in middle-aged women due to multiple reasons. As the protective effect of oestrogen declines with advancing age, women become more prone to inflammation. Hard or high-heeled footwear, ill-fitting tight shoes, and poorly fitting or heavy boots can strain this tissue.

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Long-standing plantar fasciitis can lead to bony growths on the underside of the heel bone, further contributing to pain.

Inflammation of the tendon connecting the calf muscles to the heel (Achilles tendinitis) is another common cause of heel pain. It usually occurs due to overuse or excessive physical activity. High-impact activities such as running, as well as sudden injuries, can cause stress fractures or bruising of the bone, resulting in pain while walking.

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Bursae are fluid-filled sacs located around the heel. They provide cushioning and reduce friction between the heel bone, Achilles tendon, and skin. Inflammation of these bursae can also cause heel pain. Repetitive overuse, tight or rigid footwear, and excessive physical activity are common causes of bursitis.

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In overweight individuals, excess body weight places additional stress on the legs, including the heels, resulting in pain during movement. Gout and other forms of arthritis affecting the foot, such as rheumatoid arthritis, can also cause heel pain. Individuals with high arches or flat feet are more prone to recurrent or chronic heel pain.

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A detailed medical history and clinical examination can help identify the cause of heel pain. To reduce pain, high-impact activities should be restricted. These include running, dancing, jumping, skipping rope, and other activities involving frequent impact of both feet on the ground. When the feet strike the ground, gravity creates force and places stress on the muscles and joints, resulting in pain.

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Applying an ice pack over the painful area for 15 to 20 minutes, two to three times daily, can provide relief. Soaking the feet in warm water can relax muscles and improve blood circulation. It may also help relieve pain unless the cause is acute and severe inflammation.

One should avoid getting out of bed abruptly. Gentle stretching of the calf muscles and feet before standing can be helpful. Walking barefoot should be avoided. Shoes with good cushioning and a comfortable fit should be worn. In cases such as flat feet, over-the-counter heel pads or orthotics may be used. Orthotics are externally applied devices that support the musculoskeletal system, such as braces, splints, or special pads. If required, a splint may be worn while sleeping to prevent pain after waking.

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Women should avoid high-heeled shoes. High heels shift almost 75% of body weight onto the toes, placing excessive pressure on the feet and potentially causing heel and calf pain. In extreme cases, they may lead to excessive stretching or rupture of muscles and ligaments.

If pain is severe, pain-relieving medicines may be taken. However, they should not be used continuously for long periods, as many can cause gastritis, hypertension, and kidney damage. Once pain improves, individuals should begin specific exercises to reduce pressure on the heels and strengthen the muscles supporting the arch of the foot.

The writer is a specialist in internal medicine.