Heel Pain, Causes, Signs and Symptoms, Diagnosis and Treatment.

The heel is the prominence at the posterior end of the foot. It is based on the projection of one bone, the calcaneus or heel bone, behind the articulation of the bones of the lower leg.

To distribute the compressive forces exerted on the heel during gait, and especially the stance phase when the heel contacts the ground, the sole of the foot is covered by a layer of subcutaneous connective tissue up to 2 cm thick (under the heel). This tissue has a system of pressure chambers that both acts as a shock absorber and stabilises the sole. Each of these chambers contains fibrofatty tissue covered by a layer of tough connective tissue made of collagen fibers. These septa (“walls”) are firmly attached both to the plantar aponeurosis above and the sole’s skin below. The sole of the foot is one of the most highly vascularized regions of the body surface, and the dense system of blood vessels further stabilize the septa.

The Achilles tendon is the muscle tendon of the triceps surae, a “three-headed” group of muscles—the soleus and the two heads of the gastrocnemius. The main function of the triceps surae is plantar flexion, i.e. to stretch the foot downward. It is accompanied by a “fourth head”, the slight plantaris muscle, the long slender tendon of which is also attached to the heel bone but not visible.