Why Does My Heel Hurt When I Walk?

We all have those days when we hit the snooze button a couple extra times. But hitting that button because you are dreading to get out of bed and take those first few steps as a result of heel pain, should not be the reason you want to stay in bed a little longer.

What structures make up my heel?

To really understand why we have pain in the bottom of our heels, it is important to look at the structures that make up the anatomy of our feet.

• Plantar Fascia: this is a bundle of connective tissue that travels from the bony part on the heel right to the tips of the toes, which plays a very important role during walking!

• Heel Fat Pad: fat tissue that surrounds the heel bone that covers bones, nerves and blood vessels.

• Tibial nerve: this nerve helps activate the muscles in the back of the calf and some of the small muscles in our feet.

This illustration depicts an irritated plantar fascia, and some of the other common culprits that may be the source of your heel pain.

What does each part of your foot do?

So now that we know some foot anatomy, let’s look at what each part does!

The plantar fascia plays a very important role during walking, specifically when we are pushing off of that foot! As we push off to take our next step, the plantar fascia will tighten up allowing our foot to become rigid, and be a good lever to propel us forward. This tightening of the plantar fascia is called the Windlass mechanism.

The heel fat pad is a thick collection of fatty tissue and muscle fibers that help cushion our bones, nerves and blood vessels from impact when walking or running. They also help reduce friction between closely packed structures.

Nerves supply control and strength of muscles and sensation to the skin and other structures. These nerves exit from your lower back and travel down your leg into your foot. Think of them as a super fast information highway that allows your brain to communicate with your body!

Conditions associated with plantar heel pain

 Below are some common conditions people have when experiencing heel pain:

• Plantar fasciitis

• Fat pad syndrome

• Nerve compression

So why am I feeling pain?!

There are several reasons why this could be happening.

The most common reason is a result of repetitive strain on the plantar fascia, leading to an overuse injury. Most commonly there is irritation at the site where the plantar fascia inserts to the heel. This will most often be from repetitive overuse.

The heel fat pad has nerves in it meaning it can cause pain with increased use overtime. Sometimes as we age, the cushioning and elasticity of this structure decreases which can cause compression of nerves or damage to the structures that are protected by the fat pad. 

Nerves that cross the heel can also be a source of pain. Perhaps the nerve is compressed higher up the leg causing heel pain or ankle weakness in key muscles. Weakness of these key muscles will alter your walking or running pattern.    

Other Factors

Although no one factor alone can lead to heel pain, some contributing risk factors may include:

• Higher body mass index (BMI)

• Reduced ankle range of motion

• Job demands with high levels of walking/standing

• Foot anatomy (high arch or flat foot)

• Recent increase in activity

Trauma from sport injuries or previous injuries that were not assessed and treated can also be a cause of injury.

Symptoms

If you’re wondering if your heel pain is similar, here are some common reports from other clients who have heel pain:

• Gradual increase of a dull ache in the bottom of the foot or heel

• Worse in the morning (especially the first couple steps), or after a period of inactivity

• Pain may temporarily improve with activity but worsens afterwards

• A bruised feeling when touching the heel 

Physiotherapy treatment for heel pain

• Finding out what activities to avoid temporarily

• Slowly returning to activity with a comprehensive exercise program

• A home program with stretching & strengthening exercises of the ankle and foot

• Taping, orthotics and changing old footwear

• Manual mobilizations and myofascial release

• Dry needling

What if my heel pain doesn’t respond to the treatments above?

Athlete stretching their plantar fascia, struggling to find relief with typical interventions.

Great question! Ever had a stubborn injury that doesn’t respond with typical interventions. You’ve tried all the suggestions and treatments above but still no change. One thing to consider is the lower back as a source of your heel pain.

According to this study, the chances of the spine being a source of extremity pain is 29.2%. This study screened the lower back with specific movements of the spine to see if their ankle problem improved. At Break Free, our clinicians are skilled in screening the spine as a source of your problem.

Pain, weakness, tingling, numbness or a feeling that things “don’t feel right” in your foot could all be signs of a lower back problem. Your physiotherapist will complete special tests and repeated movements to see if your back is the culprit to your foot problem.    

If you are experiencing pain in the bottom of your foot, and want a thorough analysis of your foot, Book Now with one of our physiotherapists for an assessment to determine the cause and treatment for your heel pain!

Reference:

Trojian, T., & Tucker, A. K. (2019). Plantar Fasciitis. American family physician, 99(12), 744–750