Heel pain causes all kinds of problems affecting day to day activities like walking, running and even sleeping. Foot and ankle heel pain is a common problem. The heel bone (calcaneus) is the largest bone in the foot absorbing most of the impact when we are walking and running so it is no wonder we are so prone to sore heels.
Pain is usually felt at the back of the heel or underneath it and can really affect daily life. It usually settles down fairly quickly, but even in prolonged cases, heel pain causes are rarely serious. In most cases sore heels develop gradually over time but occasionally they can be the result of an injury. Often, heel pain causes secondary problems too, as we walk differently
to try and reduce the pain.
Here, we will look at the most common foot and ankle heel pain causes, symptoms and treatment options for each.
The plantar fascia is a thick band of tissue on the sole of the foot. Damage to it is the most common of all foot heel pain causes affecting 1-in-10 people
What Is It: Damage and inflammation of the plantar fascia
Causes: Overuse (e.g. being on your feet for long periods), muscle weakness and tightness, altered foot biomechanics, obesity
Symptoms: Pain and tenderness under the heel which is worse after rest, when standing on tiptoes or going up stairs. There is often a specific spot which is particularly painful when touched
Associated Problems: The formation of a heel bone spur
Treatment Options: Rest, exercises, injections, orthotics and occasionally surgery
Find out more about this common cause of foot heel pain in the Plantar Fasciitis section including more information on diagnosis, treatment and prevention.
Achilles tendonitis is the most common cause of pain at the back of the heel.
What Is It: Inflammation or degeneration of the Achilles tendon which connects the calf muscles to the heel bone
Causes: Repetitive strain on the tendon usually from muscle weakness and/or tightness, altered foot biomechanics or friction from heel bone spurs
Symptoms: Back of heel pain, worse after rest and first thing in the morning. Ankle and calf stiffness. Swelling and/or tender lump in the tendon at the back of the heel (1) or just above the ankle (2) - see diagram
Associated Problems: Calcaneal bursitis – inflammation of the fluid-filled sac that sits between the Achilles tendon and heel bone
Treatment: Rest, exercises, orthotic insoles for your shoes, injections, medication
To find out more about this condition, including how to treat it and prevent it from coming back again, visit the Achilles Tendonitis section
Calcaneal bone spurs can occur both underneath and at the back of the heel. They are very common foot and ankle heel pain causes.
What Is It: Bony lumps that stick out formed by excessive calcium deposits on the bone. They can occur both at the back of the heel (eg Haglunds Deformity) or underneath the heel (inferior bone spur)
Causes: repetitive overuse e.g. running and jumping, muscle weakness and tightness, abnormal heel bone position
Symptoms: Pain in heel when first get up after resting which feels like standing on something sharp. Usually settles to a dull achy foot heel pain. Some people have no pain at all with heel bone spurs but there is usually a noticeable bony lump
Associated Problems: Bone spurs are often linked with plantar fasciitis and Achilles tendonitis.
Treatment: Stretching and strengthening exercises, shoe orthotics and surgery.
Find out more about the causes, symptoms and treatment options in the Heel Bone Spurs section.
What Is It: Single or multiple breaks/cracks in the heel bone
Causes: Repetitive overloading of the heel e.g. jumping, running causing stress fractures or a fall from a height landing feet first
Symptoms: pain made worse by pressure through the heel and swelling. Fractured heel pain causes you to walk differently
Treatment: Stress fractures of the heel are normally treated with medication and PRICE (protect, rest, ice, compression and elevation) but more serious fractures may require surgery.
Find out more about fractured heel pain causes, symptoms and treatment options in the Stress Fractures in the foot section.
What Is It: Retrocalcaneal bursitis is inflammation of a small fluid filled sac (bursa) that sits between the heel bone and Achilles tendon
Causes: Repetitive friction on the bursa usually caused by muscle tightness and weakness or a sudden increase in activity levels
Symptoms: Back of heel pain especially when walking, running and standing on tiptoes. Tender to touch. Swelling, redness and warmth at the back of the heel
Associated Problems: Commonly associated with Achilles Tendonitis
Treatment: Rest, ice, medication, calf exercises, injections
This is one of the rarer heel pain causes, and tends to affect ballet dancers and athletes.
What Is It: Irritation of the soft tissues at the back of the heel
Causes: An small extra bone, known as an Os Trigonum, gets stuck in the ankle joint and irritates the surrounding soft tissues. Usually caused by repeated plantarflexion (foot pointing downwards) or an ankle injury
Symptoms: Deep, dull pain at the back of the heel. Worse with plantarflexion, eases with rest
Treatment: Rest, ice, steroid injection and occasionally surgery
Find out more about the causes, symptoms and treatment options in the Os Trigonum Syndrome section.
What Is It: Compression of the tibial nerve as it passes through the tarsal tunnel on the inner side of the ankle
Causes: Anything reducing the space in the tarsal tunnel such as swelling, cysts, ganglions, arthritis, benign tumours or flat feet
Symptoms: Foot heel pain which can spread up the calf. Numbness and pins and needles on the inner side of the foot and heel, hot and cold feelings in the foot. Worse at night. Usually only affects one foot.
Treatment: Rest, anti-inflammatory medication, exercises, shoe orthotics, steroid injections, surgery.
Sever’s Disease is the most common of all childrens heel pain causes
What Is It: Inflammation of the growth plate of the heel
Causes: Growth spurt where the heel bone grows faster than the surrounding muscles and ligaments, standing for long periods, overuse from participating in lots of sporting activities like running and jumping
Symptoms: Pain in heel usually at the back or underneath the heel. Inflammation and tenderness, pain when walking, ankle stiffness. Symptoms are worse with activity and improve with rest. Often affects both feet at the same time
Treatment: Strengthening and stretching exercises, rest, orthotics, medication. Symptoms usually settle within 2 months.
Often, heel pain causes us to walk slightly differently, to reduce the pressure on the foot, which can cause problems further up the body, particularly the knee, hip and back. It is important to get an accurate diagnosis so do consult your doctor.
Most heel pain causes are not serious and will settle down with a combination of appropriate rest and stretching and strengthening exercises. Visit the calf workout section for a variety of exercises that are the basis of long term recovery from foot and ankle heel pain.
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