The most common cause of heel pain is plantar fasciitis. The plantar fascia, also called the heel fascia, is made of fibrous connective tissue and its main task is to passively stabilize the longitudinal arch of the foot. The aponeurosis attaches to the lower part of the calcaneus tumor, runs on the plantar side in three strands (medial, central and lateral) and ends at the phalanges of all of the toes. With each step, the longitudinal arch is lowered and the plantar fascia under tension to absorb the stresses. The aponeurosis, as part of the fascia tape, is also responsible for the transfer of force from the Achilles tendon to the forefoot when the heel is raised and dislodged from the big toe.
Plantar fasciitis causes pain on the plantar side of the heel, making it difficult to walk. It is now believed that the heel spurs visible on X-rays are not the primary cause of heel pain and that their presence is independent of the tendon inflammation. Treatment of plantar fasciitis consists mainly in resting, appropriately targeted rehabilitation and wearing orthopedic insoles that relieve the aponeurosis. Surgery is the last resort and is performed when conservative treatment is unsuccessful.