Heel Pain

What is heel pain?

Heel pain is a very common foot and ankle problem. You might experience pain, soreness or tenderness anywhere in your heel, but the most common areas are underneath it or the back of it. There are many different health conditions that can cause heel pain, including plantar fasciitis and Achilles tendinitis.

Heel pain can make it difficult to walk and participate in daily activities. It’s important to see your healthcare provider to help you determine the exact cause of pain in the heel of your foot. Most heel conditions improve with nonsurgical treatments, but your body will need time to recover.

What causes heel pain?

Heel pain causes range from mild to severe, depending on the location of the pain. You may experience sudden heel pain without injury or pain that develops over time. Several problems are located at the back of the heel:

• Achilles tendinitis: Your Achilles tendon is a fibrous tissue that connects your calf muscle to your heel bone. It’s your body’s longest and strongest tendon. Runners and basketball players are more prone to Achilles tendinitis. This overuse injury inflames the tendon. Tendonitis causes pain, swelling and stiffness in the back of your heel.
• Bursitis: Bursitis occurs when fluid-filled sacs called bursae (plural of bursa) swell. These sacs cushion your joints, allowing for fluid movement. You may have a tender, bruise-like feeling in the back of your heel. Bursitis typically occurs after you spend a lot of time on your feet.
• Haglund’s deformity: Chronic inflammation and irritation can cause an enlarged, bony bump (called a pump bump) to form in the back of your heel. Shoes with higher heels, like pumps, can make the bump and pain worse.
• Sever’s disease (calcaneal apophysitis): Sever’s disease is a frequent cause of heel pain in active children between the ages of 8 and 14. Kids who participate in activities that require a lot of running and jumping are more prone to this problem. The increased athletic activity irritates the growth plate in the back of their heels.

Why is the bottom of my heel hurting?

Problems that cause bottom-of-heel pain include:

• Bone bruise (contusion): Stepping on a hard, sharp object can bruise the fat padding underneath your heel. You might not see discoloration, but your heel will feel tender when you walk and sometimes at rest.
• Stress fracture: A stress fracture may cause pain all along the bottom, side and back of your heel.
• Plantar fasciitis: Plantar fasciitis is the most common cause of heel pain. It occurs when the fascia — connective tissue that runs along the bottom (plantar surface) of your foot — tears or stretches and becomes inflamed. People who run and jump a lot are more likely to develop this painful condition. Treadmills and hard surfaces (like concrete) for exercise or work are common irritants.
• Heel spurs: Chronic plantar fasciitis can cause a bony growth (heel spur) to form on your heel bone. Heel spurs aren’t usually painful, although some people have pain.

What are the risk factors for heel pain?

Anything that puts a lot of pressure and strain on your foot can cause heel pain. The way you walk (foot mechanics) and your foot’s shape (foot structure) are also factors.

You may be more likely to develop heel pain if you:

• Have overweight or obesity.
• Have foot and ankle arthritis, flat feet or high arches.
• Run or jump a lot in sports or for exercise.
• Spend a lot of time standing, especially on concrete floors.
• Wear improperly fitted shoes without arch support and/or cushion.

How is heel pain diagnosed?

Your healthcare provider will assess your symptoms and perform a physical exam. You may also get X-rays to check for arthritis, bone fractures, bone misalignment and joint damage.

Rarely will you initially need an MRI (magnetic resonance imaging) or ultrasound. These can show soft tissue problems that X-rays don’t reveal.

How do I get rid of the pain in my heel?

Most problems that cause heel pain get better over time with nonsurgical treatments. Heel pain treatment focuses on easing pain and inflammation, improving foot flexibility and minimizing stress and strain on your heel. These treatments include:

• Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) combined with ice packs can ease pain and swelling.
• Stretching exercises: Your healthcare provider can show you how to do heel stretching exercises for tight tendons and muscles.
• Taping: You can use athletic or medical tape to support your foot arch or heel.
• Physical therapy: Massage, physical therapy and ultrasound therapy can break up scar tissue (adhesions). These treatments may reduce inflammation and provide heel pain relief.
• Orthotic devices: Over-the-counter (OTC) or custom-made shoe inserts (orthotics) can take pressure off your heel. Some people find relief by wearing a splint at night, especially if they get morning pain. A walking boot may be necessary for more severe symptoms. You may also need to switch to more supportive shoes for everyday wear and exercise.
• Injections: Steroid injections can ease pain and swelling. Your provider will rarely recommend steroid injections for a tendon problem but they may help for plantar fasciitis and bursitis.
• Immobilization: Should the pain be chronic, not responding to treatment, you’ll need casting or a walking boot.

It’s rare to need surgery to treat most causes of heel pain.

What are the complications of heel pain?

Heel pain can interfere with your ability to get around, work, exercise and complete daily tasks. When it hurts to move, you can become inactive (sedentary), which can lead to weight gain. You may also develop depression because you can’t do the things you love.

Untreated Achilles tendonitis can cause the tendon to break down (tendinosis). In time, your Achilles tendon can tear or rupture. This problem may require surgery.

Can heel pain be prevented?

To prevent heel pain or keep pain from returning, it’s important to keep your foot and heel tendons flexible. You should stretch regularly and wear properly fitted, supportive shoes. Runners are especially prone to heel pain. You can prevent running injuries by covering fewer miles and running on softer surfaces.

When should heel pain be treated by a healthcare provider?

You should call your healthcare provider if you experience:

• Pain that doesn’t improve in a few weeks with rest or pain relievers.
• Pain that makes walking or movement difficult.
• Severe foot or heel swelling, inflammation or stiffness.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

• What’s causing my heel pain?
• What’s the best treatment for me?
• What can I do to lower the risk of getting heel pain again?
• What complications should I look out for?