Heel Pain

What Is It?

Heel pain is a common symptom that has many possible causes. Although heel pain sometimes is caused by a systemic (body-wide) illness, such as rheumatoid arthritis or gout, it usually is a local condition that affects only the foot. The most common local causes of heel pain include:

• Plantar fasciitis — Plantar fasciitis is a painful inflammation of the plantar fascia, a fibrous band of tissue on the sole of the foot that helps to support the arch. Plantar fasciitis occurs when the plantar fascia is overloaded or overstretched. This causes small tears in the fibers of the fascia, especially where the fascia meets the heel bone. Plantar fasciitis may develop in just about anyone but it is particularly common in the following groups of people: people with diabetes, obese people, pregnant women, runners, volleyball players, tennis players and people who participate in step aerobics or stair climbing. You also can trigger plantar fasciitis by pushing a large appliance or piece of furniture or by wearing worn out or poorly constructed shoes. In athletes, plantar fasciitis may follow a period of intense training, especially in runners who push themselves to run longer distances. People with flat feet have a higher risk of developing plantar fasciitis.
• Heel spur — A heel spur is an abnormal growth of bone at the area where the plantar fascia attaches to the heel bone. It is caused by long-term strain on the plantar fascia and muscles of the foot, especially in obese people, runners or joggers. As in plantar fasciitis, shoes that are worn out, poorly fitting or poorly constructed can aggravate the problem. Heel spurs may not be the cause of heel pain even when seen on an X-ray. In fact, they may develop as a reaction to plantar fasciitis and they can also be found in people without pain or problems in the heel.

• Calcaneal apophysitis — In this condition, the center of the heel bone becomes irritated as a result of a new shoe or increased athletic activity. This pain occurs in the back of the heel, not the bottom. Calcaneal apophysitis is a fairly common cause of heel pain in active, growing children between the ages of 8 and 14. Although almost any boy or girl can be affected, children who participate in sports that require a lot of jumping have the highest risk of developing this condition.
• Bursitis — Bursitis means inflammation of a bursa, a sac that lines many joints and allows tendons and muscles to move easily when the joint is moving. In the heel, bursitis may cause pain at the underside or back of the heel. In some cases, heel bursitis is related to structural problems of the foot that cause an abnormal gait (way of walking). In other cases, wearing shoes with poorly cushioned heels can trigger bursitis.
• Pump bump — This condition, medically known as posterior calcaneal exostosis, is an abnormal bony growth at the back of the heel. It is especially common in young women, in whom it is often related to long-term bursitis caused by pressure from pump shoes.

• Local bruises — Like other parts of the foot, the heel can be bumped and bruised accidentally. Typically, this happens as a "stone bruise," an impact injury caused by stepping on a sharp object while walking barefoot.
• Achilles tendonitis — In most cases, Achilles tendonitis (inflammation of the Achilles tendon) is triggered by overuse, especially by excessive jumping during sports. However, it also can be related to poorly fitting shoes if the upper back portion of a shoe digs into the Achilles tendon at the back of the heel. Less often, it is caused by an inflammatory illness, such as ankylosing spondylitis (also called axial spondylarthritis), reactive arthritis, gout or rheumatoid arthritis.
• Trapped nerve — Compression of a small nerve (a branch of the lateral plantar nerve) can cause pain, numbness or tingling in the heel area. In many cases, this nerve compression is related to a sprain, fracture or varicose (swollen) vein near the heel.

Heel Pain

Many conditions, including plantar fasciitis and Achilles tendinitis, cause heel pain. A sore heel is a common foot and ankle complaint. Rest, orthotics and stretching ease pain over time. If you ignore and don't treat heel pain, you may develop chronic problems that require a longer recovery. Heel pain rarely needs surgery.

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OVERVIEW

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.

When should I call the doctor?

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 doctor?

You may want to ask your healthcare provider:

• What is causing my heel pain?
• What is the best treatment for me?
• What can I do to lower the risk of getting heel pain again?
• What types of symptoms need more urgent evaluation?

A note from Cleveland Clinic

Heel pain often improves over time with nonsurgical treatments. Your healthcare provider can determine what’s causing the pain. Your provider can also show you stretching exercises and recommend orthotics and other methods if needed. Many people try to ignore heel pain and continue with activities that make the problem worse. But it’s essential to give your body time to recover. Otherwise, you may develop chronic heel pain that sidelines you for an extended time. The longer you have heel pain the harder it is to effectively treat, so it’s important to get evaluated.

What Causes Heel Pain?

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Overview

Your foot and ankle are made up of 26 bones, 33 joints, and more than 100 tendons. The heel is the largest bone in your foot.

If you overuse or injure your heel, you may experience heel pain. This can range from mild to disabling. It’s possible you’ll need to have a doctor or podiatrist diagnose the cause if simple home remedies don’t ease the pain.

What are common causes of heel pain?

There are several common causes of heel pain.

• Plantar fasciitis. Plantar fasciitis occurs when too much pressure on your feet damages the plantar fascia ligament, causing pain and stiffness. Find out what causes this condition and possible treatment options.
• Sprains and strains. Sprains and strains are injuries to the body, often resulting from physical activity. These injuries are common and can range from minor to severe, depending on the incident. Learn more about sprains and strains.
• Fracture. A fracture is a broken bone. This condition is considered a medical emergency. Urgent care may be required. Know what symptoms to look for and who’s at risk.
• Achilles tendonitis. Achilles tendonitis occurs when the tendon that attaches the calf muscles to the heel becomes painful or inflamed due to overuse injuries. Find out how this condition is diagnosed and treated.
• Bursitis. Bursae are fluid-filled sacs found about your joints. They surround the areas where tendons, skin, and muscle tissues meet bones.
• Ankylosing spondylitis. This form of arthritis primarily affects your spine. It causes severe inflammation of the vertebrae that might eventually lead to chronic pain and disability. Read more about ankylosing spondylitis.
• Osteochondroses. These disorders directly affect the growth of bones in children and adolescents. Learn more about the different types of osteochondroses.
• Reactive arthritis. An infection in the body triggers this is a type of arthritis. Find out more about its causes, symptoms, and possible treatments.

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When should you contact your doctor?

If you develop heel pain, you may first try some home remedies, such as rest, to ease your symptoms. If your heel pain doesn’t get better within two to three weeks, you should make an appointment with your doctor.

You should call your doctor immediately if you experience the following:

• Your pain is severe.
• The pain starts suddenly.
• You have redness in your heel.
• You have swelling in your heel.
• You can’t walk because of the pain in your heel.

How can heel pain be treated?

If you develop heel pain, you can try these methods at home to ease your discomfort:

• Rest as much as possible.
• Apply ice to the heel for 10 to 15 minutes twice a day.
• Take over-the-counter pain medications.
• Wear shoes that fit properly.
• Wear a night splint, a special device that stretches the foot while you sleep.
• Use heel lifts or shoe inserts to reduce pain.

If these home care strategies don’t ease your pain, you need to see your doctor. They’ll perform a physical exam and ask you about your symptoms and when they began. Your doctor may also take an X-ray to determine the cause of your heel pain. Once your doctor knows what’s causing your pain, they’ll be able to provide you with the appropriate treatment.

In many cases, your doctor may prescribe physical therapy. This can help to strengthen the muscles and tendons in your foot, which helps to prevent further injury. If your pain is severe, your doctor may provide you with anti-inflammatory medications. These medications can be injected into the foot or taken by mouth.

Your doctor may also recommend that you support your foot as much as possible - either by taping the foot or by using special footwear devices.

In very rare cases, your doctor may recommend surgery to correct the problem, but heel surgery often requires a long recovery time and may not always relieve your foot pain.

What are the complications of heel pain?

Heel pain can be disabling and affect your daily movements. It may also change the way that you walk. If this happens, you may be more likely to lose your balance and fall, making you more prone to other injuries.

How can you prevent heel pain?

It may not be possible to prevent all cases of heel pain, yet there are some easy steps that you can take to avoid injury to the heel and prevent pain:

• Wear shoes that fit properly and support the foot.
• Wear the right shoes for physical activity.
• Stretch your muscles before exercising.
• Pace yourself during physical activity.
• Maintain a healthy diet.
• Rest when you feel tired or when your muscles ache.
• Maintain a healthy weight.