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Heel Pain: Causes, Risk Factors, Healing Cycle & Treatment

Heel pain is one of the most common chronic pain experienced by people due to various reasons. According to Tu, six out of ten people are suffering from heel pain throughout the world reflecting a significant incidence rate of heel pain. Therefore, it is essential to address the issue through in vitro treatment procedures or at home as heel pain is usually associated with day-to-day activities [1].

Causes and Risk Factors

  1. Bad Shoes

Shoes with high heels, rigid sole, and deformed shape are common causes of heel pain. This is because these types of shoes exert undistributed pressure on the foot muscles, ligaments, and calcaneus bone commonly termed heel bone. Tu justified that people who wear high heels are 8 times more prone to have heel pain or at risk of heel pain [1].

  1. Gait Abnormalities

Pollack, Shashua, and Kalichman highlighted that one in every five people tend to have gait abnormalities in the form of inappropriate walking, standing, and running style, and they don’t even know about it. Imbalanced posture and walking put extra pressure on the foot because, in normal gait, the weight of the body is evenly distributed throughout the foot that actually preventing heel pain [2].

  1. Achilles tendinitis

It is also known as degenerative tendon disease or tendonitis which includes increased inflammation of the tendon due to tendinopathy and tendonitis Tendinopathy is a chronic condition that involves the gradual degeneration of the Achilles tendon. Sometimes the Achilles tendon does not function properly due to very small tears that cannot heal and repair properly. When the Achilles tendon is too tight, there will be a slight tear and the tendons become thicker, weaker, and more painful causing heel pain [3].

  1. Plantar Fasciitis

Plantar fasciitis or plantar fascia is a strong, curved tendon that extends from the heel bone to the toe. It can cause heel pain when the structure of the foot is not rightly arched, for example, if the arch of the foot is particularly high or low. As the plantar fascia expands soft tissue fibers become inflamed. It usually occurs at the heel attachment site, but can sometimes affect the midfoot [4].

  1. Excessive Pronation

When the arch is collapsed inwards due to the irregular alignment of the foot bones, there is excessive pronation of the foot that can cause severe heel pain. It can be corrected with some physiotherapist-led exercises and at-home exercises as well [4].

  1. Heel Spur

The heel spur is characterized by excessive calcination in the calcaneus bone due to excessive scar formation. It can be caused by Achilles tendonitis or plantar fasciitis as these conditions cause inflammation in the heel bone, tendons, and ligaments [5].

  1. Bursitis

Inflammation can occur in the back of the heel, in the bursa, a fluid-filled fibrous sac. In bursitis, a clumsy or stiff heel or shoe pressure significantly causes pain in the heel or the back of the heel. Sometimes the Achilles tendon can swell [4].

  1. Rheumatoid Arthritis

Rheumatoid arthritis refers to the weakened bones and joints due to the lower immunity of a person to heal bones deformation and weakening. This can cause heel pain as the bones and joints involved in the foot become brittle and weak [6].

  1. Gout

Heel pain can be caused by the increased level of uric acid which is deposited in the heel bone or toe in the form of crystals. The condition is termed gout which is much common among diabetic, hypothyroid, and patients with increased uric acid levels [4].

  1. Peripheral Neuropathy

When the nervous system does not function properly or the nerve supply of the foot is restricted, it can cause heel pain.

Healing Cycle of the Heel Pain

A normal healing cycle consists of three distinct phases of inflammation, proliferation, and maturation. The inflammation includes the redness, swelling, increased temperature, and tenderness at the site of pain to attract the white blood cell components to start the proliferation phase. In the proliferation phase, the scar tissue is released at the site to cover the inflamed area and a trigger point is released at which the fascia release is started to heal the superficial and deep layers of the fascia. In the maturation phase, the scar tissue degenerates and the fascia smoothly covers the affected area completing the healing cycle. However, in chronic heel pain, the inflammation and proliferation phases are repeated continuously and the maturation stage does not reach because the cause of the heel pain is not corrected. Therefore, effective treatment should be provided that can help the proliferation phase to be entered into the maturation phase [6].

Non-effective Treatments for heel pain

Most people tend to treat heel pain at home through heating and icing, massaging, electronic stimulators, stretching, and strength exercises during the inflammation stage which is not much effective. This is because these treatments can only provide relief for the short-term to reduce inflammation but the proliferation stage is not healed through these treatment interventions [4].

Effective Treatments for Heel Pain

During the inflammation phase, the most effective treatment techniques include the following

  • Taking rest as much as a person can help in relieving tension and stress in the heel bones, tendons, and ligaments.
  • Magna Heal can be placed at the heel that uses magnetic force to align the ligaments, tendons, muscles, and bones causing the heel pain.
  • Anti-inflammatory diet and supplements to restore certain deficiencies can be helpful in reducing inflammation in the heel [6].

During the proliferation phase, the use of external pressure applied by an expert can be useful to stop heel pain.

  • For scar tissue and trigger points release externally, pressure through the A3 tool is applied at the heel to release scar tissue superficially, whereas the A5 tool is used to put pressure at the deeper level of scar tissue release.
  • For fascia release superficially, the A1 tool is used to exert external pressure that helps the healing process to release fascia at the heel. As fascia comprises four deeper layers namely aponeurotic, epimysium, perimysium, and endomysium, the A5 tool is effective to release fascia at all these layers [6].

Bottom Line

To stop heel pain without undergoing surgical procedures and expensive treatment, contact us to get more information about the treatment strategies of heel pain.


  1. Tu P. Heel pain: diagnosis and management. American family physician. 2018 Jan 15;97(2):86-93.
  2. Pollack Y, Shashua A, Kalichman L. Manual therapy for plantar heel pain. The Foot. 2018 Mar 1;34:11-6.
  3. Tu P, Bytomski JR. Diagnosis of heel pain. American family physician. 2011 Oct 15;84(8):909-16.
  4. Landorf B, Menz B. Plantar heel pain and fasciitis. BMJ Clinical Evidence. 2008;2008.
  5. Salvioli S, Guidi M, Marcotulli G. The effectiveness of conservative, non-pharmacological treatment, of plantar heel pain: a systematic review with meta-analysis. The Foot. 2017 Dec 1;33:57-67.
  6. Caratun R, Rutkowski NA, Finestone HM. Stubborn heel pain: Treatment of plantar fasciitis using high-load strength training. Canadian Family Physician. 2018 Jan 1;64(1):44-6.  

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