Most pain associated with the heel can be tied to plantar fasciitis. The plantar fascia is a long, wide, thin ligament in the bottom of your foot that connects the heel to the front of your foot and helps support your arch.

Forces acting on the foot from excess pressure or repetitive activity cause the arch to flatten out. At the same time, the plantar fascia is trying to keep this from happening. These opposing forces put tremendous stress on the tissue, causing microtears in the ligament. When enough continuing stress exceeds the body’s ability to heal itself, the tissue under the heel becomes injured and painful.

Symptoms

The symptoms of plantar fasciitis include severe heel pain, especially first thing in the morning. Most people say that it hurts from "the instant their heel touches the ground." Some even feel pain and stiffness when starting to walk after sitting for a while. It gets worse after prolonged weight-bearing, walking, or standing. Pain can also radiate into the arch or sole of the foot.

Plantar fasciitis is often seen in persons over 40 years old or in those who are overweight. There is also an increase in visits to doctors during the spring and summer months as people resume activities involving walking or running. Among runners and other athletes, shoes that do not support the foot properly commonly lead to plantar fasciitis.

Diagnosis

Diagnosis is most often made by assessing the place (middle of the bottom of the heel) and timing of the pain. The doctor will also question you on your activity levels and history of pain.

While fractures, infection, and arthritis can also occur, the place and timing of the pain is usually different. Sometimes an x-ray or other imaging test is needed to exclude these other causes.

Treatment