Heel Pain

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is heel pain?

Heel pain is tenderness or soreness affecting the underside or back of the heel of the foot. Your heel forms the connection between your ankle joint and the rest of your foot. The heel bone (calcaneus) forms a joint in the ankle with the talus bone. The Achilles tendon—the largest tendon in the body—attaches the back of the heel bone to the calf muscle. The heel bone also attaches to a strong band of tissue on the underside of the foot, called the plantar fascia. The plantar fascia connects the heel and the base of the toes. Problems with these various structures can cause pain in the heel.

Plantar fasciitis is a common cause of a sore heel. The pain with this condition tends to worsen after exercise or activity, but not during it. It is usually worse in the morning or after long periods of inactivity. You may also find it is more painful to flex your foot upwards and it feels better to bend your toes downwards.

A painful heel can be very uncomfortable and interfere with walking. However, the cause is usually not serious and early treatment often resolves the problem. This includes resting, icing the area, stretching exercises, and using shoe inserts. Seek prompt medical care for severe heel pain and swelling or if you can’t bear weight on your heel. See your doctor soon if heel pain persists for more than a couple of weeks despite using home remedies.

What other symptoms might occur with heel pain?

Depending on the cause of your aching heels, you may notice other symptoms affecting the foot or ankle. Along with pain, you may also experience swelling on the underside or back of the heel. It is also possible to develop a bump at the back of the heel, feel warmth, or notice redness in the area. With an Achilles tendon problem, you may also notice limited range of motion and stiffness in the foot or ankle.

When any of these symptoms continue for several days, see your doctor. You may need X-rays or other imaging exams to rule out such causes as a stress fracture of the heel bone.

What causes heel pain?

When your heel hurts, your doctor will most likely consider plantar fasciitis as a possible cause. That’s because the most common cause of heel pain is plantar fasciitis, a type of overuse injury. This occurs when the band of connective tissue becomes irritated and inflamed. The presence of abnormal bony growths (bone spurs) can aggravate the situation. The feet regularly take the stress and strain of bearing the body’s weight without a problem. But repeated pounding during sports or activities, especially with improperly fitting shoes, can cause damage over time. Being obese, having very high or flat arches, and having tight calf muscles can increase the risk of developing plantar fasciitis.

Other possible causes of heel pain include:

  • Achilles tendon injuries including tendinitis
  • Arthritis
  • Nerve irritation
  • Stone bruise, which is damage to the fat pad of the heel due to stepping on something hard like a small rock
  • Stress fractures, which are small cracks in the bone

What are the risk factors for heel pain?

A variety of conditions can cause heel pain, and each comes with its own risk factors.

Plantar fasciitis is the most common reason for heel pain, with risk factors including:

  • Flat feet or exceptionally high arches, traits that are often hereditary
  • Obesity, which puts added strain on the bones and muscles of the foot
  • Participating in sports or physical activities, such as running, that put repeated, high-impact pressure on the foot
  • Standing for long periods of time on hard surfaces, such as in retail jobs

Heel pain can also result from other conditions that affect the bones, joints and muscles of the foot. These include Achilles tendon injuries, arthritis, and stress fractures, with additional risk factors including:

  • Being older than 45 years (for risk of osteoarthritis) and between 25 and 45 years old (for risk of rheumatoid arthritis)
  • Improperly fitting shoes that don’t have proper cushioning and support to protect foot bones and muscles from stress
  • Playing sports that involve sudden changes in direction, such as basketball or tennis, which raises risk of Achilles tendon injuries. Sudden changes in floor surface, such as from turf to pavement, can also put players at risk of stress fractures.
  • Previous injury to the bones or muscles of the ankle or heel

What are the treatments for heel pain?

Treatment for heel pain will depend on the cause. The most common cause of heel pain, plantar fasciitis, has treatment options including:

  • Applying ice packs to relieve pain and swelling
  • Cortisone injections into the heel, to reduce pain and inflammation
  • Foot exercises and stretches that relieve stiffness in the plantar fascia and strengthen surrounding tendons and muscles
  • Nonsteroidal anti-inflammatory drugs, such as ibuprofen, to relieve pain
  • Resting the foot
  • Shoe inserts or orthotic shoes that provide arch support and distribute weight properly across the foot
  • Stopping or reducing physical activities that put stress on the foot
  • Surgery, including gastrocnemius recession, which lengthens the calf muscle to improve flexibility, and plantar fascia release, in which doctors make a partial cut in the plantar fascia to relieve tension
  • Walking boots and positional splints that can be worn overnight to stretch the calf and foot during sleep

What are the potential complications of heel pain?

Heel pain from plantar fasciitis typically responds to rest, ice, stretching exercises, and special shoe inserts. Physical therapy can also help resolve the problem without further complications. However, it is possible for plantar fasciitis to continue long term, for 12 months or more. Surgery may be necessary to release tension in the fascia if this complication develops.

The best way to avoid chronic foot problems is to seek treatment early. Ignoring the cause and continuing through the pain often leads to more extensive damage. After recovery, you will need to continue stretching exercises and wear proper footwear to prevent recurrences.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Dec 17
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