Heel Pain

Overview

Heel pain is one of the most common foot complaints. It may be felt under the heel (on the sole), behind the heel near the Achilles tendon, or around the bone itself. The pain can be sharp, aching, or burning, and it often interferes with walking, standing, and exercise.

Most heel pain comes from overuse or strain of the tissues that support and move the foot, rather than from a serious disease. The single most common cause is plantar fasciitis, an irritation of the thick band of tissue along the bottom of the foot. The good news is that the great majority of heel pain improves with simple measures such as rest, stretching, supportive shoes, and time, though it can be stubborn and slow to resolve.

Common Causes

The location of the pain helps identify the cause. Frequent causes of heel pain include:

• Plantar fasciitis: Irritation of the tissue along the sole, causing pain under the heel that is typically worst with the first steps in the morning.
• Achilles tendinitis: Pain and stiffness behind the heel where the Achilles tendon attaches.
• Heel spur: A bony growth often linked with plantar fasciitis.
• Heel bursitis: Inflammation of a fluid-filled sac behind or beneath the heel.
• Stress fracture: A small crack in the heel bone from repetitive impact.
• Fat pad atrophy: Thinning of the natural cushion under the heel with age.
• Nerve irritation: A pinched nerve in the foot or ankle causing burning heel pain.

In children and teens, heel pain during growth spurts may come from irritation of the heel's growth plate (Sever disease). Less commonly, heel pain reflects inflammatory arthritis or an infection.

Associated Symptoms

Heel pain often comes with other signs that point to the cause. These can include:

• Stiffness that eases as you warm up, then returns after rest
• Tenderness when pressing on a specific spot
• Swelling or warmth behind or under the heel
• A pulling or tightness in the calf or arch
• Pain that worsens with standing, walking, or climbing stairs

Heel pain with significant swelling, redness, warmth, fever, an inability to bear weight, or pain following a fall or sudden injury needs prompt evaluation, as it may signal a fracture, infection, or tendon rupture.

Diagnosis & Evaluation

Most heel pain is diagnosed from your history and a foot exam alone. A clinician will ask where it hurts, when it is worst, and what activities trigger it, then press on different areas and test movement. Further evaluation may include:

• X-rays to look for a stress fracture, heel spur, or other bone changes.
• Ultrasound or MRI to assess the plantar fascia, tendons, or soft tissue.
• Blood tests if an inflammatory or infectious cause is suspected.

Imaging is not always necessary, especially when the pattern clearly fits plantar fasciitis.

Treatment & Management

Most heel pain responds to conservative care, though plantar fasciitis in particular can take weeks to months to settle. Helpful measures include:

• Resting from high-impact activity and reducing time on hard surfaces
• Calf and plantar fascia stretching, done regularly
• Supportive, cushioned shoes and over-the-counter heel inserts or orthotics
• Ice over the painful area after activity
• Over-the-counter anti-inflammatory pain relievers as needed
• Night splints for stubborn plantar fasciitis
• Physical therapy for persistent cases

When pain does not improve after several months of consistent treatment, a clinician may consider injections or, rarely, other procedures. Treating the specific cause, such as a stress fracture or Achilles problem, may require activity changes or immobilization.

Self-Care & Prevention

• Wear supportive, well-cushioned shoes and replace worn-out footwear
• Stretch your calves and feet before and after exercise
• Increase activity gradually rather than suddenly
• Maintain a healthy weight to reduce load on the heels
• Avoid going barefoot on hard surfaces if you are prone to heel pain

When to See a Doctor

See a doctor if heel pain is severe, lasts more than a few weeks despite self-care, or keeps you from normal activity. Seek prompt care for:

• Inability to walk or bear weight on the foot
• Significant swelling, redness, or warmth
• Fever along with heel pain
• A sudden snap or severe pain in the back of the heel (possible tendon rupture)
• Numbness, tingling, or pain following an injury

Related Topics

Frequently Asked Questions

References

1. American Academy of Orthopaedic Surgeons (AAOS). Plantar Fasciitis and Heel Spurs.
2. Mayo Clinic. Plantar fasciitis — Symptoms and causes.
3. MedlinePlus, U.S. National Library of Medicine. Heel pain.
4. NHS. Heel pain.