Heel pain is a common foot issue. It 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, heel pain resolves without treatment, but sometimes, it can persist and become chronic.

In this article, we discuss the causes of heel pain and how a person can remedy it.

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Heel pain may occur due to a single injury, such as a twist or fall, or from repetitive stress and pounding of the heel.

Flat footwear may also stretch the plantar fascia until the area becomes swollen or inflamed, causing pain and discomfort.

Common causes of heel pain include:

Plantar fasciitis

This is inflammation of the plantar fascia. The plantar fascia is a strong, bowstring-like ligament that runs from the calcaneum, or heel bone, to the tip of the foot.

This type of pain often results from a person’s foot anatomy. For example, if the arches are particularly high or low, this can lead to plantar fasciitis.

Heel bursitis

Inflammation can occur at the back of the heel, in the bursa, which is a fibrous sac full of fluid. This condition can result from landing awkwardly or hard on the heels or from pressure from footwear.

A person may feel this pain deep inside the heel or at the back of the heel.

Haglund’s deformity

Haglund’s deformity is a bony enlargement on the back of the heel. It occurs when footwear rubs against the back of the heel, irritating the bony enlargement and surrounding tissue.

Hard-backed shoes and pumps can place pressure on the back of the heel, irritating the Haglund’s deformity. This is why people often refer to this condition as “pump bump.”

Tarsal tunnel syndrome

In tarsal tunnel syndrome (TTS), tissue compresses the large nerve in the back of the foot, resulting in pain.

This type of compression neuropathy can occur either in the ankle or foot.

Stress fracture

Repetitive stress, strenuous exercise, sports, or heavy manual work can cause injury. For instance, runners are at a higher risk of a stress fracture in the metatarsal bones of the foot.

Osteoporosis can also cause stress fractures.

Sever’s disease

This is the most common cause of heel pain in children and young adults. It results from overuse and repetitive microtrauma of the growth plates of the heel bone.

Sever’s disease most commonly affects children aged 7–15 years.

Achilles tendinitis

Achilles tendinitis occurs when the large tendon in the back of the heel becomes inflamed.

Overuse and injury are the most common causes of Achilles tendinitis. People may also refer to tendinitis as tendinosis or tendinopathy.

Other causes

Other causes of heel pain include:

People usually feel heel pain under the foot, toward the front of the heel. The pain typically starts gradually and becomes more severe.

Pain may be severe, however, if there is a tear. A person may have noticed a popping sound at the time of the injury, and pain will be immediate.

A person may experience heel pain at specific sites. These may have different causes and treatments:

  • Bottom of the heel: Health experts typically refer to this as plantar fasciitis. Pain may occur here when too much pressure damages or tears the tissues, leading to inflammation.
  • Achilles tendon: Pain in this tendon on the back of the lower leg may result from repetitive stress, such as from tight calf muscles or suddenly increasing exercise activity and intensity.
  • Side of the foot: Lateral foot pain affects the outside of the heel or foot, and medial foot pain affects the inside edge. It may result from stress fractures, sprains, TTS, and other conditions.

Most people recover with conservative treatments within months.

Treatment options include the following:

Surgery

For most people with plantar fasciitis, treatment will resolve heel pain within 6 weeks. However, surgery may be necessary if pain persists after several months of treatment.

During surgery, a surgeon may detach the plantar fascia from the heel bone. There is a risk that this may weaken the arch of the foot.

Exercises to stretch the calf muscles may help.

Standing calf raise

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.

Band-assisted ankle flexion

Sit on the floor and hold one leg straight. Secure one end of a band to a sturdy object and the other to the top of the foot. Flex and extend at the ankle joint and repeat on both feet.

Rolling stretch

Sit in a chair with both feet on the floor. Place a ball, or another rollable object under the arch of the affected foot and roll it around for 2 minutes.

Discover more exercises for heel pain here.

Home care can help get rid of heel pain that is not severe.

This includes:

  • Rest: Avoid running or standing for long periods, walking on hard surfaces, and engaging in any activities that may stress the heels.
  • Ice: Place an ice pack wrapped in cloth on the affected area, not directly onto the skin, for about 15 minutes.
  • 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 studies suggest that Botox may help treat plantar fasciitis.

According to another study, delivering a standard dose of external beam radiation therapy, similar to that doctors use in cancer treatment, may help.

The following are some of the risk factors for heel pain:

  • having tight calf muscles
  • having high arches
  • running excessively
  • being an older adult
  • carrying extra weight
  • having a job that requires a lot of standing or walking
  • having low arches

Prevention of heel pain involves reducing the stress on the affected part of the body.

Tips include the following:

  • wearing shoes when on hard ground, and not going barefoot
  • reaching or maintaining a moderate 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
  • ensuring that shoes fit properly and do not have worn down heels or soles
  • resting the feet rather than standing, when possible
  • warming up properly before engaging in sports and activities that may place a lot of stress on the heels

A person should consult a doctor if the heel pain persists for over 2 weeks or if they experience:

  • severe pain with swelling near the heel
  • pain, numbness, or tingling in the heel, as well as fever
  • difficulty walking as usual
  • difficulty bending the foot downward or tiptoeing

A person should contact a doctor if the heel pain continues for more than 1 week or if it persists when they are not standing or walking.

A doctor will examine the foot and ask about the pain, how much walking and standing the person does, and what type of footwear they use. They will also ask about the person’s medical history.

The doctor will test the muscles, starting from the knee, and look for any unusual shape or skin changes. This can help differentiate between a growth, psoriasis, and other conditions.

An accurate diagnosis is more likely to lead to effective treatment.

Heel pain most commonly occurs under the foot, behind the heel, and on the inner or outer side of the heel.

It may result from excessive pressure on the heel due to running, standing for long periods, or carrying extra weight. Having tight calf muscles or high arches may also lead to heel pain.

Heel pain is often mild at first, but it may become severe or even disabling. However, it usually resolves without treatment. Doing specific exercises, taking NSAIDs, and applying an ice pack to the heel may help relieve the pain.

Wearing supportive shoes, avoiding standing for long periods of time, and reaching or maintaining a moderate body weight may prevent heel pain from occurring.

If the heel pain is severe or if there is numbness or swelling, a doctor should examine the foot to diagnose the cause and determine the best treatment.

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