What is heel pain?

Heel pain is a common foot and ankle problem. Pain may occur underneath the heel or behind it. Many conditions can cause pain in the heels, including:

• Plantar fasciitis.
• Achilles or flexor tendonitis/tendonosis.
• Bone spurs.
• Sever’s disease (mostly in children 8-14 years old).
• Bursitis.
• Stress fractures.
• Inflamed tendons.

It’s important to have a medical evaluation to help you determine the exact cause of your heel pain so that the proper treatment regimen can begin.

Heel pain can make it difficult to walk and participate in daily activities. Most painful heel conditions improve with nonsurgical treatments, but your body needs time to recover.

How common is heel pain?

More than 2 million Americans experience heel pain every year. The problem affects people of all ages and genders.

Where does heel pain develop?

You might experience pain, soreness or tenderness anywhere in the heel. You typically feel heel pain:

• Behind the heel.
• Beneath the heel.
• Within the heel bone itself.

What causes pain behind the heel?

Several problems can cause pain to develop in the back of the heel:

• Achilles tendinitis: The Achilles tendon is a fibrous tissue that connects the calf muscle to the heel bone. It’s the 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 the heel.
• Bursitis: Bursitis occurs when fluid-filled sacs called bursae (plural of bursa) swell. These sacs cushion joints, allowing for fluid movement. You may have a tender, bruise-like feeling in the back of the 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 the heel. Shoes with higher heels, such as 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 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 the heel.

What causes pain beneath the heel?

Problems that cause pain underneath the heel include:

• Bone bruise (contusion): Stepping on a hard, sharp object can bruise the fat padding underneath the heel. You might not see discoloration, but your heel will feel tender when you walk. A stress fracture, as well as Sever’s disease, may cause pain all along the back of the heel on the bottom, side and back of the heel.
• Plantar fasciitis: Plantar fasciitis is by far the leading cause of heel pain. It occurs when the fascia, connective tissue that runs along the bottom (plantar surface) of the foot, tears or stretches. People who run and jump a lot are more likely to develop this painful condition. Treadmills and hard surfaces (such as concrete) for exercise or work are common irritants.
• Heel spurs: Chronic plantar fasciitis can cause a bony growth (heel spur) to form on the 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:

• Are overweight (have obesity).
• Have foot and ankle arthritis, flat feet or high foot 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.

What are the symptoms of heel pain?

Heel pain symptoms vary depending on the cause. In addition to pain, you may experience:

• Bony growth on the heel.
• Discoloration (bruising or redness).
• Stiffness.
• Swelling.
• Tenderness.
• Pain after standing from a resting/sitting position.

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 alignment and joint damage.

Rarely, you may need an MRI or ultrasound. These can show soft tissue problems which X-rays don’t reveal.

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 sedentary. An inactive lifestyle can lead to weight gain. You may also become depressed because you can’t do the things you love.

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

How is heel pain managed or treated?

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

• Injections: Steroid injections can ease pain and swelling. Steroid injections should rarely, if ever, be given for a tendon problem but may certainly help for plantar fasciitis and bursitis.
• Orthotic devices: Over-the-counter or custom-made shoe inserts (orthotics) can take pressure off the 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.
• Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) combined with ice packs ease pain and swelling.
• Physical therapy: Massage, physical therapy and ultrasound therapy can break up soft tissue adhesions. These treatments may reduce pain and inflammation.
• 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 the foot arch or heel.

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

How can I prevent heel pain?

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.

What is the prognosis (outlook) for people who have heel pain?

Heel pain typically goes away with nonsurgical treatments, but recovery takes time. You need to be patient and give your body time to mend. If you return to your usual activities too quickly, it can set back your recovery. In rare situations, you may need surgery.

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