Heel Pain: Symptoms, Causes, Treatment & Care

Heel pain can affect the bottom, back, or sides of the heel ^4,6. It can make walking and daily tasks difficult ⁴. Plantar heel pain can also reduce physical function and quality of life.

Pain location and timing can offer useful clues about the cause ^6,7. Mechanical problems are common, but nerve and systemic conditions can also cause heel pain ^1,6. Systemic conditions affect more than one part of the body.

This guide explains heel pain symptoms, common causes, treatment, and when to seek care. It also covers risk factors, diagnosis, prevention, home care, and warning signs.

Several structures near the heel can produce pain. These include the heel bone, plantar fascia, Achilles tendon, bursae, nerves, and heel fat pad. A bursa is a fluid-filled sac that cushions a joint ⁴.

Plantar heel pain affects about 4% to 7% of the community. It can limit social activity, physical function, and a person’s view of their health. Plantar fasciitis is the most common cause of plantar heel pain ^1,6.

Pain under the heel may involve the plantar fascia, fat pad, bone, or nerves ^1,6. Pain at the back often involves the Achilles tendon, bursa, or Haglund deformity ^4,6. Haglund deformity creates a bony bump at the back of the heel ⁴.

Location can guide the assessment, but it cannot confirm the cause by itself ^6,7. A health history and foot examination are key parts of an accurate diagnosis ^1,6. Imaging may be useful when the clinician suspects certain bone or soft-tissue problems ^1,6.

Pain under the inner heel is a common plantar fasciitis symptom ^6,7. Tenderness may develop near the inner heel bone and along the plantar fascia ⁶. The plantar fascia is a strong tissue band that helps support the foot’s arch.

Deep pain in the center of the heel may suggest heel pad syndrome ^6,7. Walking barefoot on hard surfaces can trigger this type of central heel pain. A bone bruise may also make the bottom of the heel tender during walking ⁴.

Pain behind the heel may come from Achilles tendinopathy ⁶. Achilles tendinitis can cause pain, swelling, and stiffness at the back of the heel ⁴. Bursitis can cause a tender, bruise-like feeling in this area ⁴.

Haglund deformity can lead to irritation near the Achilles tendon and bursa ^2,6. Shoes with higher heels may make pain from the bump worse ⁴.

A stress fracture may cause pain along the heel’s bottom, side, and back ⁴. Inner midfoot pain can occur with tarsal tunnel syndrome ^6,7. Outer midfoot pain can occur with sinus tarsi syndrome ^6,7.

Plantar fasciitis may cause sharp, stabbing, aching, or throbbing pain ^5,6,8. The pain often occurs near the inner part of the heel ^6,7. Pressure along the plantar fascia may produce sharp pain ⁶.

Heel pad syndrome can cause deep, bruise-like pain in the heel’s center ⁶. Bursitis may cause a similar feeling at the back of the heel ⁴. A heel bone bruise can remain tender without visible skin discoloration ⁴.

Burning, tingling, or numbness may point to a nerve-related problem ^6,7. Possible causes include nerve entrapment, a neuroma, or pain referred from the lower spine ⁶. Clinicians may consider lumbar radiculopathy even when back pain is absent ⁶.

Nerve-related plantar pain often involves branches of the posterior tibial nerve ^6,7. These branches include the medial plantar, lateral plantar, and Baxter nerves ^1,6.

Sharp heel pain with the first steps after rest is typical of plantar fasciitis ^5,6. This may happen after sleep or after sitting for a long period ^5,6. Pain may ease during walking and return with continued weight-bearing activity ^5,6.

Stress fracture pain often starts after increased weight-bearing activity ^6,7. A change to a harder walking surface may also come before the pain ^6,7. The pain may begin during activity and later occur at rest ^6,7.

Swelling or bruising may occur with a calcaneal stress fracture ^6,7. The calcaneus is the heel bone.

Achilles tendinitis can develop from overuse ⁴. Runners and basketball players are more prone to this problem ⁴. Sinus tarsi pain may worsen during activity or while walking on uneven ground ⁶.

Plantar fasciitis is linked to repeated strain on the tissue supporting the foot arch. Excess stress can cause small tears, irritation, or inflammation in the plantar fascia. Research has also described a process involving tissue breakdown rather than inflammation alone ⁷.

Common plantar fasciitis symptoms include heel pain, arch pain, stiffness, and swelling ⁸. A tight Achilles tendon may occur with these symptoms ⁸. Pain is often worse after sleep, sitting, or another period of rest ^5,8.

Heel pad syndrome causes deep, widespread pain in the heel’s center ^1,6. Barefoot walking on a hard surface can bring on this pain. Repeated small injuries may damage the heel pad’s cushioning structure.

Other causes of pain under the heel include bone bruises and plantar warts ^1,4,6. Stress fractures and trapped nerves can also cause plantar heel pain ^1,6. Plantar warts are included among the recognized causes of heel pain ^6,7.

Heel spurs may appear in people with plantar fasciitis ^6,7. However, heel spurs do not closely match the presence or severity of symptoms ^6,7. They can also appear in people without plantar fasciitis ⁶.

Achilles tendon disorders include tendinitis, tendinosis, and partial or complete tears. Tendinosis refers to tendon breakdown, while tendinitis can follow sudden overload. Untreated tendinosis can progress to a partial or complete tear.

Bursitis occurs when a cushioning bursa becomes swollen ⁴. Spending a long time on the feet can precede heel bursitis ⁴. Retrocalcaneal bursitis involves the bursa near the Achilles tendon and heel bone ^2,6.

Haglund deformity is a raised area of bone at the back of the heel ^4,6. It may cause inflammation of the nearby bursa ⁶. It can also occur with insertional Achilles tendinosis.

A bone bruise may follow contact with a hard or sharp object ⁴. The heel can hurt during walking and sometimes while resting ⁴. Skin discoloration may not appear ⁴.

Calcaneal stress fractures result from repeated overload of the heel bone ^6,7. Running, jumping, and a new activity can raise the risk. Increased activity length or intensity can also raise the risk.

People with osteopenia face a higher risk of calcaneal stress fractures. Osteopenia means reduced bone density. The calcaneus is the most commonly fractured tarsal bone.

Tarsal tunnel syndrome results from pressure on the posterior tibial nerve near the inner ankle ^1,6. Baxter nerve entrapment is another possible cause of plantar heel pain. Nerve entrapment may follow overuse, trauma, or an injury from earlier surgery ⁶.

S1 radiculopathy can cause referred plantar heel pain. Lumbar nerve problems between L4 and S2 may also cause neuropathic heel pain ⁶. Neuropathic pain comes from an affected nerve.

Rheumatoid arthritis can cause plantar heel pain. Seronegative spondyloarthropathies are another possible systemic cause. Tumors and infection are less common causes that clinicians may consider.

Nerve-like pain in both heels may lead to an assessment for systemic illness ⁷. This pattern differs from nerve-related heel pain, which is commonly on one side ⁷.

Sever disease is a common cause of heel pain in active children ^4,6. It often affects children and young teens who run or jump often ⁴. The activity irritates the growth plate at the back of the heel ⁴.

Running, jumping, and high-intensity workouts can strain the heels and arches. Sudden increases in activity may also add repeated stress to the heel ^1,6. A harder walking surface can increase the risk of a heel stress fracture ⁶.

Long periods of standing or walking on hard floors raise plantar fasciitis risk. Teachers, factory workers, and healthcare workers may have this type of exposure. Prolonged standing can also add repeated strain to the plantar fascia.

Excess body weight adds pressure to the foot and heel. Obesity can worsen repeated strain on the plantar fascia. Tight calf muscles and ankle instability may also contribute to plantar fascia problems.

Age can affect plantar fasciitis risk. Plantar fasciitis is the most common diagnosis of heel pain. However, heel pain can affect both adults and children ⁴.

Flat feet and high arches may increase the risk of heel pain ^4,5. An unusual walking pattern may increase strain on the plantar fascia. Foot structure and walking mechanics can therefore affect heel pain risk ⁴.

Old shoes lose support and stability as they wear down. Shoes without arch support or cushioning may also raise heel pain risk ⁴. Shoes should suit the activity being performed.

Running shoes may not provide suitable support for court sports. Flat sandals, flip-flops, and flexible shoes may lack built-in arch support ⁸. Improperly fitted shoes are another risk factor for heel pain ⁴.

These habits may help reduce repeated strain:

Diagnosis starts with a health history and foot examination ^1,6. The clinician asks about pain location, onset, timing, triggers, and relief ⁶. Questions may also cover recent injuries and changes in activity ⁶.

The clinician examines the foot and ankle at rest and during weight-bearing ⁶. The examination may include bones, joints, tendons, movement, and tender areas ⁶. The clinician may check for a painful lump by pressing on the area ⁶.

Plantar fasciitis often causes tenderness near the inner heel bone ⁷. Tenderness may also follow the plantar fascia ⁶. Pulling the foot and toes upward may bring on plantar fascia pain ^6,7.

Imaging is not required for a typical plantar fasciitis diagnosis ⁶. It may help rule out other causes when symptoms do not fit the usual pattern ⁶.

X-rays can check for fractures, arthritis, bone alignment, and joint damage ⁴. They may also help find bone tumors. Weight-bearing X-rays can help rule out other causes of heel pain ⁶.

Early calcaneal stress fractures may not appear on plain X-rays ^6,7. MRI, computed tomography, or bone scans may then be needed ^6,7. Computed tomography creates detailed images using multiple X-ray views.

Ultrasound can assess the plantar fascia and heel fat pad. It may also help find some forms of nerve entrapment. MRI can show soft-tissue problems and some bone disorders.

Electrophysiological studies may be used for suspected nerve-related causes. These tests assess signals linked to nerve function. Laboratory studies may be used when a systemic cause is possible.

The assessment may compare plantar fasciitis with heel pad syndrome and stress fractures ^1,6. Plantar warts and nerve entrapment may also produce pain under the heel ^1,6.

Clinicians may consider lumbar radiculopathy, rheumatoid arthritis, or another systemic condition ^1,6. Infection and tumors are less common possibilities. Pain location, timing, sensation, and activity patterns help guide the assessment ^6,7.

Many heel conditions improve over time with nonsurgical care ⁴. Common options include rest, ice, stretching, taping, footwear changes, and pain medicines ^4,6,9.

The following home-care steps may ease mild heel pain:

Aspirin, ibuprofen, and acetaminophen are listed nonprescription options for heel pain. Medicine choice may depend on personal health needs and other medicines.

Core care for plantar heel pain includes education, taping, and plantar fascia stretching. Footwear advice is also part of this approach. Taping and stretching may improve first-step pain over the short term.

Physical therapy may include stretching, strengthening, massage, and rehabilitation ^4,6. Arch taping, night splints, and physical therapy can join other plantar fasciitis treatments ⁶.

Prefabricated or custom orthotics may be used with other initial treatments ⁶. Orthotics may unload sore tissues when resting the foot is difficult. Custom orthoses may help selected patients with ongoing plantar heel pain.

Shockwave therapy may help patients who have limited improvement after core care. The evidence includes benefits for first-step pain over several follow-up periods. A clinician can decide whether this option fits the diagnosis.

Corticosteroid injections may provide short-term relief from plantar fasciitis pain ⁶. However, they increase the risk of plantar fascia rupture or heel fat pad damage ⁶. A clinician should guide any injection decision.

Calcaneal stress fracture treatment includes reducing activity ^6,7. Some patients may need little or no weight-bearing when pain is severe ⁶. Heel pads or walking boots may also be used ^6,7.

Achilles tendon tears have several operative treatment options. These include direct repair, tendon transfer, and graft reconstruction. Treatment depends on the specific tendon problem.

The following warning signs need immediate medical attention:

Some symptoms need an office appointment rather than emergency care:

A clinician will often begin with a history and physical examination ^1,6. Imaging or other tests may follow when bone, nerve, or systemic causes are suspected ^1,6.

Heel pain can involve the plantar fascia, fat pad, bone, Achilles tendon, bursa, or nerves. Plantar fasciitis is the most common cause of plantar heel pain ^1,6. First-step pain after rest is a common plantar fasciitis pattern ^5,6.

Many heel problems improve with rest, stretching, orthotics, and time ⁴. Treatment should address the condition found during assessment ^1,6. Persistent pain or pain at rest warrants an office visit.

Severe post-injury pain requires immediate medical attention. Major swelling or loss of normal walking also requires immediate medical attention. Heel pain with fever and nerve symptoms requires immediate medical attention.