The cause of plantar heel pain can be identified for some people, although for many people with plantar heel pain the cause is difficult to identify.
At a microscopic level, there may be changes that have occurred to the area where the plantar fascia and muscles insert on the bone (micro trauma).
People who have plantar heel pain may have a swelling of the plantar fascia around the area where it inserts on the heel bone and also within the heel bone itself.
An extension of bone (also called heel spurs) may also be present in some people with plantar heel pain (Figure 1). If you have an extension of bone, this does not mean you will not get better. Although, people have a higher risk of plantar heel pain when this extension of bone is present.
Importantly, even if the cause of your heel pain cannot be found there are still many treatments that you can use to treat you heel pain effectively.
What factors are more common in people with plantar heel pain?
Plantar heel pain is common in people who are considered overweight or obese. It is thought that increased weight might increase tension on the heel leading to increased sensitivity of the plantar fascia and surrounding tissues. It has also been proposed that obesity might also weaken the plantar fascia due to high levels of cholesterol in the blood stream. However, it is unclear how much each of these issues contribute to heel pain. Also, there is little evidence that reducing weight will help reduce the risk of plantar heel pain.
Obviously, obesity is a major risk factor for many conditions, so an attempt to address this potential issue might have positive consequences for physical and mental health. The Better health Channel and the Victoria State Government have a useful resource on obesity.
Overuse or underuse
It is uncertain if plantar heel pain relates to overuse (doing too much exercise too soon) or underuse (not doing enough exercise). However, for people that have pain beneath the heel a certain level of exercise might worsen their symptoms.
There is limited evidence that stopping exercise is of benefit to people with plantar heel pain. The heel is comprised of tissues (such as the plantar fascia and muscles) that love movement, although some tissues (such as the heel bone) might not like movement if it under stress. Alternatively, some people with plantar heel pain will experiment with their level of activity to determine if their symptoms are made worse with a certain amount and intensity of exercise.
The important thing is to find a form of exercise that is enjoyable and doesn’t make symptoms worse during exercise, immediately after exercise and 24-48 hours after exercise (find out how to change activities to reduce pain).
Having tight calf muscles
There is some evidence that tightness within the calf muscles might be associated with plantar heel pain. Experts and people with plantar heel pain often recommend stretching the calf muscle to help relieve tension and pain beneath the heel (Find out how to improve the flexibility of your calf muscles)
Wearing poor shoes
People with plantar heel pain will often say that their heel pain:
- is worse when walking barefoot
- is worse when wearing flat, unsupportive shoes
- is worse when wearing unsupportive thongs or flip flops
- is better when wearing supportive shoes (e.g. runners)
- is better when wearing a shoe that is slightly elevated in the heel
Please use this a guide as some people with plantar heel pain might have a different experience and some shoes might not be socially acceptable (Learn about the types of shoes that might be better)
Links to research
Riel H, Cotchett M, Delahunt E, et al Is ‘plantar heel pain’ a more appropriate term than ‘plantar fasciitis’? Time to move on. British Journal of Sports Medicine 2017;51:1576-1577 (https://bjsm.bmj.com/content/51/22/1576)
The following short video highlights some of the issues relating to the underlying pathology and the terms used to describe pain beneath the heel