What Causes Heel Pain—And How Can You Find Relief?
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Medically reviewed by Oluseun Olufade, MD
Heel pain causes a throbbing, aching, burning, or stabbing sensation in the back or bottom of the foot. This type of pain is a common complaint for people of all ages and activity levels. In fact, heel pain makes up over two million visits to the doctor's office each year in the U.S.
Your heel pain may often worsen with weight-bearing activities like standing or walking, which can limit mobility and affect your daily activities. While dismissing heel pain as a minor annoyance may be tempting, seeking medical attention can help relieve your symptoms and prevent long-term complications, like bone spurs or foot deformities.
Types of Heel Pain
The heel bone (known as the calcaneus) is the largest bone in the foot and sits at the back of the foot below your ankle. This bone serves as an anchor for important soft tissue structures in your foot, including the:
Achilles tendon: A very thick tissue that runs down the calf muscle in the lower leg and attaches to the back of the heel
Plantar fascia: The long ligament that runs along the foot's sole from the heel to the toes, forming the arch of the foot
The heel bone, Achilles tendon, and plantar fascia are the foundation of your feet. They support your body weight and provide shock absorption when you're moving. Heel pain occurs when these supporting connective tissues or the heel bone become injured or inflamed.
Generally, heel pain occurs either at the back of the heel where the Achilles tendon meets the heel bone, or at the bottom of the heel where the plantar fascia connects to the heel bone. This pain may cause stiffness, burning, aching, or tenderness. The pain may also feel dull, sharp, stabbing, or tingling.
Heel pain can be acute (develops suddenly and lasts for a short time) or chronic (lasts for three months or longer). Acute heel pain usually stems from an injury or overuse, which causes inflammation in the heel bone. Sometimes, untreated acute pain can progress to chronic pain. Chronic pain may occur due to an unhealed injury, chronic overuse or irritation, or an underlying condition like arthritis.
Symptoms of Heel Pain
The symptoms of heel pain can vary depending on the cause of your pain and which part of your heel is affected. The exact type of pain you're experiencing can also differ from person to person. Some people may feel a throbbing, dull ache while others have sharp or stabbing pains. The discomfort can either be constant, come and go, or worsen during certain activities, like walking or standing, or during certain times of the day, such as the morning.
If you think you're experiencing heel pain, be on the lookout for the following symptoms:
Swelling or redness
A bump or lump on the bottom of the heel
Stiffness or tightness, especially after periods of inactivity
Pain that starts at the heel and radiates (spreads) to other areas of the foot or leg
Numbness or tingling
Difficulty standing, walking, or running
Worsening pain after physical activity or prolonged standing
Potential Causes of Heel Pain
There are many possible causes of heel pain, including injury to the heel bone or surrounding supportive tissues, overuse, or biomechanical factors (e.g., gait or walking speed) that put too much stress on your heels.
Plantar Fasciitis
Plantar fasciitis is the inflammation of the plantar fascia—the band of connective tissue that forms the arch of your foot and connects the heel bone to your toes. The plantar fascia absorbs the stress and strain you place on your feet when running, walking, or jumping. Too much stress on the plantar fascia can irritate, damage, or tear the tissues, leading to inflammation and swelling.
When you have plantar fasciitis, you may experience sharp, stabbing pains, or a dull ache. The pain often worsens in the mornings or after periods of inactivity and may feel tight and stiff. Walking may help temporarily relieve the pain, but the discomfort may return at night or after long periods of activity.
People with tight calf muscles, flat feet, or obesity are more likely to experience plantar fasciitis. The condition is also common in people who engage in repetitive high-impact activities, such as dancing or running, stand on hard surfaces for prolonged periods (e.g., teachers or factory workers), or wear unsupportive footwear.
Heel Spurs
A heel spur is a bony growth that forms on the bottom of the heel bone, where the plantar fascia connects to the heel bone. Long-term strain and inflammation of the plantar fascia can cause the growth of heel spurs, which occur in about 70% of people with plantar fasciitis. Activities that put a lot of stress and strain on your feet (e.g., jogging), ill-fitting or unsupportive footwear, obesity, and flat feet can all increase your risk of developing a heel spur—and lead to aches and pains.
Achilles Tendonitis
Achilles tendonitis is the inflammation of the Achilles tendon—the large tendon that runs down the back of the leg, connecting the calf muscle to your heel bone. You use your Achilles tendon when walking, climbing stairs, jumping, and running. Repetitive activities that put a lot of strain or stress on the Achilles tendon or a sudden increase in the intensity of activity can lead to Achilles tendonitis. Achilles tendonitis is most common in young athletes, people with tight calf muscles or flat feet, and those who wear unsupportive footwear.
Most people experience Achilles tendonitis pain at the back of the heel. But, this pain can often spread to the back of your leg when you walk or engage in other physical activities. With this condition, it's also common to experience heel stiffness or swelling in the mornings. You may also have trouble standing on your tip-toes or finding shoes that rest comfortably on the back of your heel.
Bursitis
Heel bursitis is the inflammation of the bursa, which is a fluid-filled sac that cushions and reduces friction between joints, muscles, or ligaments and the heel bone. Friction from poorly fitting or uncomfortable footwear can irritate the bursa, and increase your risk of inflammation. Heel bursitis is also common in people with inflammatory arthritis (such as gout or rheumatoid arthritis).
Two types of bursitis can affect your heels:
Inferior calcaneal bursitis: Develops on the bottom of the heel, where the plantar fascia attaches to the heel bone. The pain can feel throbbing and worsens when your heel first touches the ground when you're walking or running.
Retrocalcaneal bursitis: Occurs on the back of the heel, where the Achilles tendon connects to the heel bone. This type of bursitis can cause pain while walking, swelling, stiffness, or limited mobility (ability to move).
Less Common Causes
Although less common, heel pain can also occur due to the following reasons:
Heel pad atrophy: Your heel pad is a fatty tissue pad on the bottom of your heel that provides cushioning and protection for the heel bone. This pad absorbs about 80% of the impact of your body weight with each step you take. Over time, the heel pad breaks down and becomes thinner, leading to an aching, bruise-like pain in the middle of the heel that tends to worsen throughout the day. Heel pad atrophy is most common in older adults, marathon runners, and people with obesity.
Heel bruise: A blow or injury to the heel bone (e.g., stepping on a hard object like a stone) can cause bruising. A heel bruise may appear swollen and can cause sharp pain when putting weight on your heel.
Nerve pain: Burning, numbness, and tingling in the heel may be a sign of compression of the Baxter nerve, which is located where the heel meets the foot's arch. Injury, overuse, and flat feet can lead to the compression of the Baxter nerve. Some studies suggest that nerve compression may be responsible for up to 20% of chronic heel pain cases.
Sever's disease: Most common in active children between the ages of 8 to 12, Sever's disease is the inflammation of the growth plate in the heel bone. Symptoms of this condition include mild swelling, pain, and tenderness at the bottom of the foot that worsens with activity.
When to Contact a Healthcare Provider
While heel pain may resolve on its own with rest and at-home care, it's important to see a healthcare provider if you experience any of the following symptoms:
Pain that persists for two weeks or longer
Worsening pain despite rest
Sudden or severe pain
Difficulty putting weight on your heel
Limited mobility
The Diagnostic Process
To determine the cause of your heel pain, your healthcare provider will begin by reviewing your medical history and asking about your symptoms. They may ask:
Which part of your heel hurts?
What does pain feel like?
How long does your pain last?
Does the pain go away after rest?
Do you have a history of heel or foot injuries?
How active are you throughout the day?
What do you do for work?
Which self-care measures have you tried at home to manage the pain?
Your healthcare provider will also perform a physical exam, which may include:
Examining your heel to look for signs of inflammation, redness, and swelling
Touch your heel to feel for areas of tenderness or warmth
Moving your foot, heel, and ankle to check for stiffness or limits in your range of motion
Observing your gait and movement by watching how you walk and stand
Assessing the position of your feet and posture
Your healthcare provider can also order diagnostic imaging tests, such as a foot X-ray or ultrasound, to look for abnormalities like heel spurs or problems with the soft tissues (e.g., Achilles tendon).
How To Treat Heel Pain
Fortunately, there are several treatments that can improve heel pain. Treatment for heel pain varies, depending on the cause of your pain and the severity of your symptoms.
Non-Surgical Approaches
In most cases, non-surgical treatments are enough to relieve heel pain and promote healing. Your healthcare provider may recommend:
Resting your body and limiting high-impact exercises
Trying low-impact activities like swimming or cycling
Applying ice packs to your heels for 20 minutes at a time, several times a day to relieve inflammation
Taking over-the-counter pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen)
Wearing over-the-counter orthotics (e.g., heel pads or heel cup inserts) in your shoes
Buying shoes with good arch support and cushioning
Using a splint while you sleep at night can stretch the plantar fascia or Achilles tendon to reduce stiffness
Placing kinesiology tape (KT) across your food to provide arch support to your heels
Starting physical therapy to learn stretches and exercises that improve flexibility and pain
Surgical Treatments
In cases of severe heel pain or when non-surgical treatments do not provide adequate relief, your healthcare provider may recommend surgery. Depending on the cause of your heel pain, this may include:
Plantar fasciotomy: A minimally invasive procedure that makes a small incision (cut) into your heel to make more tiny cuts into your plantar fascia ligament to relieve tension and pain.
Achilles tendonitis surgery: In severe cases of Achilles tendonitis, surgery may be necessary to remove the damaged areas of the tendon. If you have a heel spur, your surgeon will remove the spur during this procedure.
Complementary and Alternative Medicine (CAM)
CAM treatments are not a substitute for conventional medical treatments, but some alternative therapies can help relieve heel pain. These include:
Shockwave therapy: Uses high-energy sound waves to stimulate tissue repair and relieve chronic heel pain. Repeated treatments may be necessary for optimal results.
Acupuncture: A Traditional Chinese Medicine (TCM) practice that involves inserting thin needles at specific points on the body to stimulate healing and pain relief. One to two months of acupuncture therapy may relieve heel pain significantly.
Platelet-rich plasma therapy: Platelet-rich plasma (PRP) therapy involves injecting concentrated platelets from your blood into the affected heel to stimulate tissue repair and reduce pain.
How to Prevent Heel Pain
Taking proactive steps can help protect the health of your feet and reduce your risk of experiencing heel pain. Here are some tips for maintaining pain-free heels:
Proper footwear: Wear well-fitting, supportive shoes with good cushioning and shock-absorbent soles
Manage obesity: Excess weight puts extra pressure on your feet and heels, so maintaining your weight through a balanced diet and regular exercise can lower your risk of heel pain
Warm-up and cool down: Incorporate gentle stretches before and after your workouts to limit injury during exercise
Listen to your body: Increase the intensity of exercise gradually, don't push yourself too hard while working out, and take rest days to allow your body a chance to repair and recover
Living with Heel Pain
While heel pain often resolves with rest and proper treatment, chronic heel pain that persists for months or longer can make daily life challenging.
Here are some strategies for managing chronic pain:
Follow your treatment plan: Adhering to your healthcare provider's recommendations for self-care measures, medication, physical therapy, and lifestyle changes can help manage heel pain and lower the risk of complications
Try various pain management techniques: Experiment with different pain management and relaxation techniques, such as meditation, breathing exercises, or visualization techniques
Maintain activity level: Try low-impact activities like swimming, cycling, or stretching to help maintain fitness and avoid stiffness while minimizing heel pain
Prioritize rest and recovery: Listen to your body and take rest breaks during the day when you need them
Stretch: Make daily foot and ankle stretching a part of your daily routine to help prevent pain from worsening and improve your range of motion
A Quick Review
If you have heel pain, early intervention is key. Contact a healthcare provider for heel pain that is persistent, severe, or worsening. Treatment options, like rest, ice therapy, physical therapy, and medications, can help reduce pain and improve your quality of life. If you're living with chronic heel pain, following your treatment plan and prioritizing your foot health can help you stay comfortable and active.
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