Heel pain is a common condition that can result from inflammation, tendon problems, or conditions like plantar fasciitis that affect the tissues supporting the heel. It may also develop due to improper footwear, repetitive strain, or injuries that stress the muscles and ligaments in the foot.
Heel pain can cause symptoms such as stiffness, swelling, burning, or discomfort when standing or walking. It may appear gradually over time or suddenly after intense activity, prolonged pressure, or changes in foot structure.
Heel pain can be linked to conditions like heel spurs, bursitis, nerve compression, or even systemic diseases such as gout and spondyloarthritis. Treatment may include rest, stretching, cold compresses, supportive footwear, medications, or targeted therapies depending on the underlying cause.
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What causes heel pain?
Heel pain can be caused by:
1. Changes to foot shape
Changes to foot shape can interfere with walking and gait, leading to foot and heel pain. Changes to foot shape can be noted soon after birth, or they can emerge as a result of inappropriate footwear or sports.
More common conditions that cause heel pain include flat foot, bow leggedness, and knock knees. These conditions are associated with unusual overloading on a joint or bone.
What to do: In these cases, the doctor may prescribe exercises to correct posture, in-soles or even surgery. It is important to consult an orthopedic surgeon or physiotherapist to evaluate the presenting symptoms and devise an optimal treatment plan.
2. Foot trauma
Foot trauma from direct blows, worn-down soles, high heels or intense running can all cause heel pain.
What to do: You should take time to rest your injury. The time dedicated to resting depends on the severity of the injury, and can vary from 2 days to 1 week. If pain persists for longer, you should have the foot assessed by a doctor to rule out a more serious condition. The doctor may prescribe anti-inflammatories or immobilization of the affected foot.
A good tip for a speedy recovery is to apply cold compresses, which will help to reduce inflammation and swelling, as well as comfortable footwear.
3. Plantar fasciitis
Plantar fasciitis is an inflammation of the tissue, or fascia, of the bottom of the foot which is caused by repetitive trauma or injuries. Inflammation can also occur as a result of standing for prolonged periods, being overweight or excess exercising.
Heel pain from plantar fasciitis tends to be more intense in the morning and worsens when starting to walk, until it gradually lessens. Some patients experience swelling in the area and difficulty walking or using shoes.
What to do: You are advised to stretch your calves and feet, to perform strengthening exercising and to massage the affected area. The doctor may also prescribe specific treatment, like corticosteroid injections, radiofrequency ablation or using a splint to sleep.
4. Heel spurs
Heel spurs can emerge due to increased pressure on loading on the bottom of the foot. It is most common in people over 40 years of age, those who are overweight, those with a history of a foot deformity, or those who run intensely.
What to do: Heel spur treatment is usually initiated when there is local swelling, particularly if it presents with plantar fasciitis. The doctor may recommend ice, rest and anti-inflammatories. These interventions are usually sufficient, and surgical removal of the heel spur is rarely necessary.
5. Heel bursitis
A bursa is a small fluid-filled sac that is found between the heel bone and achilles tendon. It can become swollen in some situations, causing pain at the back of the heel that worsens when moving.
What to do: To treat heel bursitis, the doctor may prescribe anti-inflammatories, cold compresses, physiotherapy, stretching and exercise. Read more about bursitis treatment that your doctor may discuss with you.
6. Gout
Gout is an inflammatory disease caused by access uric acid in the blood. Uric acid can start to accumulate in the joints and cause inflammation and intense pain. It is most commonly felt in the big toe, however some patients report heel pain as well, as the feet are the first place for uric acid to start building-up.
What to do: Treatment for gout flare-ups should be guided by the doctor, who may prescribe anti-inflammatories (like naproxen and ibuprofen) or more specific medications that help to regulate uric acid levels. Read more about a gout diet to see which foods you can eat and what you should avoid when treating gout.
7. Haglund’s deformity
Haglund’s deformity is a bony enlargement at the back of the heel that develops due to repeated friction and strain on the Achilles tendon and the retrocalcaneal bursa.
This friction can lead to inflammation of the tendon and bursa, causing heel pain that usually worsens when standing up, taking the first steps, or wearing tight shoes or high heels.
It is more common in people with high arches, runners, individuals who wear stiff or tight shoes, or those with calf strain.
What to do: Treatment usually begins with conservative measures such as wearing comfortable shoes, using insoles or heel pads, applying cold packs, taking doctor-prescribed anti-inflammatory medications, and doing stretching exercises.
If the pain continues, a doctor may evaluate whether surgery is needed to remove the bony prominence or adjust the angle of the heel bone.
8. Sever’s disease
Sever’s disease is inflammation of the growth plate in the heel bone and mainly affects children between 8 and 15 years old who participate in high-impact sports such as running, jumping, gymnastics, or ballet.
The pain is felt at the back of the heel and worsens with running, jumping, or repetitive movements. It may affect one or both feet and usually improves with rest.
What to do: Treatment includes rest, reducing the intensity of physical activity, using heel cups or insoles that raise the heel, and applying cold compresses as advised by a doctor.
Wearing comfortable shoes and avoiding walking barefoot is also recommended, since direct contact with hard surfaces can increase pain.
9. Baxter’s neuropathy
Baxter’s neuropathy occurs when the inferior calcaneal nerve is compressed near the inner side of the heel, causing pain and tingling.
Heel pain may worsen when putting weight on the foot, walking, or wearing tight shoes, and is often accompanied by tingling or a burning sensation.
What to do: Treatment may include rest, wearing comfortable shoes, adjusting physical activity, and taking anti-inflammatory medications as prescribed by a doctor.
If symptoms persist, surgical decompression of the nerve may be considered to relieve pressure and improve symptoms.
10. Spondyloarthritis
Spondyloarthritis is a type of rheumatic condition that affects the areas where tendons and ligaments attach to bones, especially in the heel.
This leads to inflammation where the tendon attaches to the calcaneus (heel bone), causing pain and sometimes visible bone changes on imaging tests.
The pain is usually located on the bottom or back of the heel, near the Achilles tendon, and often affects both feet. It typically occurs in people under 40, is worse in the morning, and improves with movement.
What to do: Treatment focuses on controlling inflammation with anti-inflammatory medications and, if needed, biologic medications such as infliximab, as prescribed by a doctor. Corticosteroid injections may also be used to relieve symptoms in the affected area.
11. Heel fat pad atrophy
Heel fat pad atrophy is the loss or degeneration of the fatty tissue that acts as a natural cushion in the heel. As a result, the impact of walking is transferred more directly to the bone, leading to heel pain.
The pain usually becomes worse when walking, standing on hard surfaces, or wearing shoes with little cushioning.
What to do: Treatment focuses on protecting and replacing the cushioning function of the heel pad by using orthopedic insoles made of shock-absorbing material, wearing shoes with thicker soles, and avoiding high-impact activities on hard surfaces.