As someone living with RA I assumed that I was having a flare up when one day I woke up with pain in my right heel. I took my medications as usual and in addition some pain relievers for more immediate results. The pain continued. I changed shoes and noticed that there was a little more comfort with shoes that had a raised heel. However I would suffer more when I went to bedroom slippers or lower heeled shoes.

I had X-Rays that showed nothing, received cortisone shots when the pain became really unbearable, yet I continued to suffer. Things progressively got worse and after suffering for a year I had an MRI done. The result : a partial tear in my Achiles Tendon. I am not an athletic person and could not imagine how this occurred until my orthopaedic surgeon told me that with RA it is very likely to occur without warning. To prevent a very delicate surgery I opted for a long treatment of therapy and a very unattractive boot to the knee that hurt my back and itched in the summer months. My heel is better but needs to be cared for to prevent future damage.

Here are eight common conditions that cause heel pain:

• Plantar fasciitis Plantar fasciitis is a painful inflammation of the plantar fascia, a fibrous band of tissue on the sole of the foot that helps to support the arch. Plantar fasciitis occurs when the plantar fascia is overloaded or overstretched. This causes small tears in the fibers of the fascia, especially where the fascia meets the heel bone. Plantar fasciitis tends to occur in the following groups of people: people with diabetes, obese people, pregnant women, runners, volleyball players, tennis players and people who participate in step aerobics or stair climbing. You also can trigger plantar fasciitis by pushing a large appliance or piece of furniture or by wearing worn out or poorly constructed shoes. In athletes, plantar fasciitis may follow a period of intense training, especially in runners who suddenly push themselves to run longer distances. People with flat feet have a higher risk of developing plantar fasciitis.

• Heel spur A heel spur is an abnormal growth of bone at the area where the plantar fascia attaches to the heel bone. It is caused by long-term strain on the plantar fascia and muscles of the foot, especially in obese people, runners or joggers. As in plantar fasciitis, shoes that are worn out, poorly fitting or poorly constructed can aggravate the problem. Heel spurs may not be the cause of heel pain even when seen on an X-ray. In fact, they may develop as a result of plantar fasciitis.

• Calcaneal apophysitis In this condition, the center of the heel bone becomes irritated as a result of a new shoe or increased athletic activity. This pain occurs in the back of the heel, not the bottom. Calcaneal apophysitis is a fairly common cause of heel pain in active, growing children between the ages of 8 and 14. Although almost any boy or girl can be affected, children who participate in sports that require a lot of jumping have the highest risk of developing this condition.

• Bursitis Bursitis means inflammation of a bursa, a sac that lines many joints and allows tendons and muscles to move easily when the joint is moving. In the heel, bursitis may cause pain at the underside or back of the heel. In some cases, heel bursitis is related to structural problems of the foot that cause an abnormal gait (way of walking). In other cases, wearing shoes with poorly cushioned heels can trigger bursitis.

• Pump bump This condition, medically known as posterior calcaneal exostosis, is an abnormal bony growth at the back of the heel. It is especially common in young women, in whom it is often related to long-term bursitis caused by pressure from pump shoes.

• Local bruises Like other parts of the foot, the heel can be bumped and bruised accidentally. Typically, this happens as a "stone bruise," an impact injury caused by stepping on a sharp object while walking barefoot.

• Achilles tendonitis In most cases, Achilles tendonitis (inflammation of the Achilles tendon) is triggered by overuse, especially by excessive jumping during sports. However, it also can be related to poorly fitting shoes if the upper back portion of a shoe digs into the Achilles tendon above the heel. Less often, it is caused by an inflammatory illness, such as ankylosing spondylitis, Reiter's syndrome, gout or rheumatoid arthritis.

• Trapped nerve Compression of a small nerve (a branch of the lateral plantar nerve) can cause pain, numbness or tingling in the heel area. In many cases, this nerve compression is related to a sprain, fracture or varicose (swollen) vein near the heel.