Heel pain is a common foot problem. Pain usually occurs under the heel or just behind it, where the Achilles tendon connects to the heel bone. Sometimes it can affect the side of the heel.
Pain that occurs under the heel is known as plantar fasciitis. This is the most common cause of heel pain.
Pain behind the heel is Achilles tendinitis. Pain can also affect the inner or outer side of the heel and foot.
In most cases, pain is not caused by an injury. At first, it is usually mild, but it can become severe and sometimes disabling. It usually disappears without treatment, but sometimes it can persist and become chronic.
Causes include arthritis, infection, an autoimmune problem, trauma, or a neurological problem.
Fast facts about heel pain
- Heel pain is usually felt either under the heel or just behind it.
- Pain typically starts gradually, with no injury to the affected area. It is often triggered by wearing a flat shoe.
- In most cases the pain is under the foot, towards the front of the heel.
- Home care such as rest, ice, proper-fitting footwear and foot supports are often enough to ease heel pain.
Heel pain is not usually caused by a single injury, such as a twist or fall, but from repetitive stress and pounding of the heel.
Common causes include:
Plantar fasciitis, or inflammation of the plantar fascia: The plantar fascia is a strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot.
This type of pain often happens because of the way the foot is made, for example, if the arches are especially high or low.
When the plantar fascia is stretched too far, its soft tissue fibers become inflamed. This usually happens where it attaches to the heel bone, but sometimes it affects the middle of the foot. Pain is felt under the foot, especially after long periods of rest. Calf-muscle cramps may occur if the Achilles tendon tightens too.
Heel bursitis: Inflammation can occur at the back of the heel, in the bursa, a fibrous sac full of fluid. It can result from landing awkwardly or hard on the heels or from pressure from footwear. Pain may be felt deep inside the heel or at the back of the heel. Sometimes, the Achilles tendon may swell. As the day progresses, the pain usually gets worse.
Heel bumps: Also known as pump bumps, these are common in teenagers. The heel bone is not yet fully mature, and it rubs excessively, resulting in the formation of too much bone. It is often caused by having a flat foot. It can be caused by starting to wear high heels before the bone is fully mature.
Tarsal tunnel syndrome: A large nerve in the back of the foot becomes pinched or entrapped (compressed). This is a type of compression neuropathy that can occur either in the ankle or foot.
Chronic inflammation of the heel pad: This is caused either by the heel pad becoming too thin, or through heavy footsteps.
Stress fracture: This is linked to repetitive stress, strenuous exercise, sports, or heavy manual work. Runners are particularly prone to stress fracture in the metatarsal bones of the foot. It can also be caused by osteoporosis.
Severs disease: This is the most common cause of heel pain in child and teenage athletes, caused by overuse and repetitive microtrauma of the growth plates of the heel bone. It most commonly affects children aged 7 to 15 years.
Achilles tendinosis: This is also known as degenerative tendinopathy, tendonitis, tendinosis, and tendinopathy. It is a chronic condition associated with the progressive degeneration of the Achilles tendon.
Sometimes the Achilles tendon does not function properly because of multiple, minor microscopic tears of the tendon, which cannot heal and repair themselves correctly. As the Achilles tendon receives more tension than it can cope with, microscopic tears develop. Eventually, the tendon thickens, weakens, and becomes painful.
Other causes of heel pain include:
- Achilles tendon rupture, where the tendon is torn
- a plantar fascia tear
- Baxter's nerve entrapment
- calcaneal stress fracture
- calcaneal cysts
- soft tissue mass
- short flexor tendon tear
- systemic arthritis (lupus, rheumatoid arthritis, psoriatic arthritis)
- bone bruise
- problems with circulation
- poor posture when walking or running
- bone cyst, a solitary fluid-filled cyst in a bone
- gout, when levels of uric acid in the blood rise until urate crystals start to build up around the joints, causing inflammation and severe pain
- neuroma, or Morton's neuroma, when a nerve becomes swollen in the ball of the foot, commonly between the base of the second and third toes
- osteomyelitis, an infection of the bone or bone marrow leads to inflammation of the bone
Osteomyelitis may result from an injury or surgery, or the infection may get into bone tissue from the bloodstream. Symptoms include deep pain and muscle spasms in the inflammation area, as well as fever.
Peripheral neuropathy involves nerve damage, and it can lead to pain and numbness in the hands and feet.
It can result from traumatic injuries, infections, metabolic disorders, and exposure to toxins. Diabetes is a common cause.
Rheumatoid arthritis is a progressive and disabling auto-immune condition that causes inflammation and pain in the joints, the tissue around the joints, and other organs in the human body.
It usually affects the joints in the hands and feet first, but any joint may become affected.
Side foot pain
Lateral foot pain affects the outside of the heel or foot, and medial foot pain affects the inside edge.
These may result from:
- a stress fracture
- a sprain
- cuboid syndrome, when a small bone in the foot becomes dislocated arthritis
- peroneal tendonitis, when repeated tension irritates the tendon
- tarsal coalition, a congenital foot problem
- bunions, corns, and callouses
- posterior tibial tendonitis, which results from stress and overuse
Most causes of foot pain are mechanical, related to strain, injury, or bone structure problems.
Most people recover with conservative treatments within months.
Treatment options include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce pain and swelling.
- Corticosteroid injections may work if NSAIDs are not effective, but these should be used with caution, because long-term use can have adverse effects.
- Physical therapy can teach exercises that stretch the plantar fascia and Achilles tendon and strengthen the lower leg muscles, resulting in better stabilization of the ankle and heel.
- Athletic taping gives the bottom of the foot better support.
- Orthotics, or assistive devices, and insoles can help correct foot faults and cushion and support the arch during the healing process.
Different brands are available to buy on Amazon.
Extracorporeal shock wave therapy aims sound waves at the affected area to encourage and stimulate healing. This is only recommended for long-term cases that have not responded to conservative therapy.
If nothing else works, a surgeon may detach the plantar fascia from the heel bone. There is a risk that this may weaken the arch of the foot.
A night splint may be fitted to the calf and foot and kept on during sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and stretches them.
These are available to buy online, but it is best to consult a medical professional before using them.
Treatment for heel bursitis
If it is possible to distinguish heel bursitis as a separate condition from plantar fasciitis, an effective treatment may be to use a cushioning insole or heel cup to limit the movements that are causing the problem.
Rest is also recommended, and a steroid injection may be needed.
Treatment for heel bumps
Inflammation behind the heel may be relieved with ice, compression and a change of footwear.
Achilles pads, tortoise and heel grip pads may offer temporary relief.
Cortisone injections may help with pain.
For most people, treatment will get rid of heel pain within 6 weeks. However, in severe cases, and if pain persists, surgery may be necessary.
Exercises to stretch the calf muscles may help.
Here are some examples:
- Sit in a chair, hold the leg out straight, and flex and extend at the ankle joint. Repeat 10 times on each foot.
- Stand facing a wall. Place the foot that has the heel pain behind the other foot. Keep the front knee bent and the back leg straight, with the foot on the ground. Pull the hips forward toward the wall until you feel a stretch in the calf of the lower leg. Repeat 10 times. If there is pain in both heels, stretch both calves.
Home care can help get rid of heel pain that is not severe.
Rest: Avoid running or standing for long periods, walking on hard surfaces, and any activities that may stress the heels.
Ice: Place an ice-pack wrapped in cloth on the affected area for about 15 minutes, but not directly onto the skin.
Footwear: Shoes that fit well and provide good support are crucial, especially for athletes.
Foot supports: Wedges and heel cups can help relieve symptoms.
Some recent studies have suggested that
Prevention of heel pain involves reducing the stress on that part of the body.
- wearing shoes when on hard ground, and not going barefoot
- maintaining a healthy body weight to reduce stress on the heels
- choosing footwear with heels made of material that can absorb some stress, or using inserted heel pads
- ensure shoes fit properly and do not have worn down heels or soles
- avoid shoes that seem to trigger pain
- rest your feet rather than standing if you are susceptible to heel pain
- warm up properly before engaging in sports and activities that may place lots of stress on the heels
- wear suitable sports shoes for each task
Heel pain typically starts gradually and becomes more severe. Often there is no injury to the affected area. It may be triggered by wearing a flat shoe. Flat footwear may stretch the plantar fascia until the area becomes swollen, or inflamed.
Pain may be severe, however, if there is a tear. The person may have noticed a popping sound at the time of the injury, and pain will be immediate.
Heel pain is usually felt under the foot, toward the front of the heel.
Symptoms may be worse just after getting out of bed in the morning, and after a period of rest during the day, and then they improve with a little activity. They may worsen again toward the end of the day.
When to see a doctor
See a doctor if you experience:
- severe pain with swelling near the heel
- pain, numbness or tingling in the heel, and fever
- pain in your heel and fever
- difficulty walking normally
- difficulty bending the foot downward or standing on tiptoe
You should arrange to see a doctor if:
- heel pain continues for more than a week
- heel pain persists when you are not standing or walking
A doctor will examine the foot and ask about the pain, about how much walking and standing the person does, what type of footwear they use, and details of their medical history.
Squeezing the heel can help detect nerve problems, the presence of a cyst, or a stress fracture.
This may enough to make a diagnosis, but sometimes blood tests or imaging scans are needed.
Plantar fasciitis is the most common type of heel pain, but many other causes are possible. An accurate diagnosis is more likely to lead to effective treatment.