Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern. As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive flattening of the foot or lowering of the arch—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom and back of the heel bone. The posterior tibial tendon helps holds the arch up and provides support during step-off on the toes when walking. If this tendon becomes inflamed, over-stretched or torn, pain can radiate to the bottom of the heel as well as inner ankle, and a gradual loss of the inner arch of the foot can occur. Without treatment, this condition can create dysfunction and the foot can eventually become rigid, changing the way you walk or making it difficult to wear shoes. Excessive pronation may also contribute to strain on the hip, knee, and lower back.