Heel Pain Causes & Treatment

Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

Heel Pain Causes, Symptoms, Diagnosis & Treatment

Heel pain causes all kinds of problems affecting day to day activities like walking, running and even sleeping.

The heel bone, aka 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. 

There may be back of heel pain, pain on the side of the heel or pain underneath the heel of the foot depending on the underlying cause.

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. 

With the right treatment for pain in the heel of the foot symptoms usually settle down fairly quickly and even in prolonged cases, heel pain causes are rarely serious.  

Common Heel Pain Causes

There are a number of different heel pain causes each of which are associated with different symptoms. We will start by having a brief look at each one and then go on to find out more about the best treatment for heel pain.

1. Plantar Fasciitis

Plantar Fasciitis is a common cause of foot heel pain

One of the most common heel pain causes is plantar fasciitis. It is the most common cause of pain underneath the heel and affects around 1-in-10 people.

The plantar fascia is a thick band of tissue the runs under the sole of the foot.  

Plantar fasciitis develops when there is excess strain through the plantar fascia from overuse e.g. being on your feet for long periods, muscle weakness and tightness, altered foot biomechanics or obesity. This places strain on the heel where the plantar fascia originates resulting in pain under the heel and into the foot arch.

Plantar fasciitis heel pain causes problems when standing on tip toes or going upstairs and is often worse after periods of prolonged rest e.g. sleeping or watching TV. It may also lead to bump on the bottom of the foot.

You can find out loads more about this common cause of foot heel pain in the Plantar Fasciitis section including causes, treatment and prevention options.

2. Achilles Tendonitis

Achilles tendonitis is characterised by inflammation and/or degeneration of the achilles tendon. Image source http://bit.ly/2B6b6LN

Another common cause of pain in the heel of the foot is Achilles tendonitis

The achilles tendon is a thick tendon which connects the calf muscles to the back of the heel. Achilles tendonitis is a common cause of back of heel pain resulting in discomfort, pain and a lump on the back of the heel.

Repetitive strain on the achilles tendon, usually from muscle weakness, tightness or friction, leads to inflammation and degeneration of the achilles tendon resulting in back of foot pain.

Achilles heel pain causes stiffness and pain in the heel, ankle and calf that tends to be worse after rest. There may be swelling or a painful lump on the back of the heel in the tendon or just above the ankle associated with achilles heel pain.

Achilles tendonitis is one of the slower heel pain causes to recover as the achilles tendon has a poor blood supply which slows healing. The earlier treatment for the back of heel pain starts, the quicker symptoms will settle.

You can find out loads more about the causes, treatment options and prevention strategies of achilles heel pain in the Achilles Tendonitis section.

3. Bone Spurs

Heel bone spurs are a common cause of foot heel pain

Calcaneal bone spurs can develop at the back of the heel or underneath it, and are very common heel pain causes.

Heel bone spurs develop when excess calcium deposits form on the bone in response to repetitive friction. This tends to be from repetitive overuse e.g. running and jumping, muscle weakness and tightness or abnormal heel bone position. 

The two most common types of bone spurs at the heel are:

  • Haglunds Deformity: causes back of heel pain 
  • Inferior Bone Spurs: which develop underneath the heel causing heel arch pain

Bone spur heel pain causes problems when you first get up after resting and it often feels like you are standing on something sharp.  This usually settles to a dull achy foot heel pain once you are moving around. Some people have no pain at all with heel bone spurs but there is usually a noticeable hard heel lump.

You can find out loads more about pain in the heel of the foot due to excess bone growth in Heel Bone Spurs section including causes, symptoms and treatment options.

4. Heel Fractures

Calcaneal fractures are a serious cause foot heel pain

One of the most potentially serious heel pain causes is a fracture or break in the heel bone. 

Heel fractures may be caused by:

  • Repetitive Overloading: of the heel, e.g. jumping, running, causing stress fractures,
  • Injuries: e.g. a fall from a height landing feet first.

Calcaneal fractures typically result in severe heel pain which can make it difficult to take any weight through the foot and are usually associated with significant foot swelling.

You can find out more about fractured heel pain causes, symptoms and treatment options in the Stress Fractures section.

5. Retrocalcaneal Bursitis

Heel Pain Causes: Retrocalcaneal Bursitis - causes, symptoms, diagnosis and treatment

One of the most common heel pain causes associated with swelling at the back of the heel is retrocalcanel bursitis.

Also known as heel bursitis, this is where there is inflammation of the small sac at the back of the heel that protects the achilles tendon. If the bursa swells enough, you will notice a soft heel lump on the back of the calcaneus.

Repetitive pressure or friction on the bursa causes it to swell and achilles heel pain causes difficulty walking and running. Retrocalcaneal bursitis is usually caused by calf tightness, weakness or a sudden increase in activity levels. 

Retrocalcaneal bursitis is one of the common heel pain causes in sporty adolescents, particularly when the are going through a growth spurt, as my son recently experienced!

Find out about how bursitis causes back of heel pain and how to treat it in the retrocalcaneal bursitis section.

6. Os Trigonum Syndrome

Os Trigonum is one of the more rare causes of heel pain

Os trigonum syndrome is one of the rarer heel pain causes, and tends to affect ballet dancers and athletes.

An os trigonum is a small extra bone fragment in the foot that only around 5-10% of people have. Often it goes completely unnoticed but if it gets stuck in the ankle joint it can irritate the surrounding soft tissues causing back of heel pain. 

Os trigonum syndrome is usually caused by repetitive plantarflexion (foot pointing downwards) or an ankle injury, resulting in a deep, dull back of heel pain.  

Find out more about the causes, symptoms and treatment options in the Os Trigonum Syndrome section.

7. Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome: Pain on side of heel, tingling and numbness

If your have side of heel pain with associated tingling and numbness in the foot, it is probably due to tarsal tunnel syndrome.

Tarsal Tunnel Syndrome develops when there is irritation of the tibial nerve where it passes through a narrow gap on the inner side of the foot known as the tarsal tunnel. Anything which reduces the size of the tunnel such as swelling, cysts, ganglions, arthritis, benign tumours or flat feet, places pressure on the tibial nerve.

Tarsal tunnel syndrome side of heel pain causes altered sensation on the inner side of the foot such as numbness, pins and needles and hot and cold sensations. Tarsal tunnel heel pain causes problems in one foot rather than both and symptoms are typically worse at night. 

You can find out more about the causes, symptoms and treatment options for pain on the side of the heel in the Tarsal Tunnel Syndrome section.

8. Sever’s Disease

Severs Disease: the most common of heel pain causes in children. Copyright:  Nevit Dilmen

Sever’s Disease is the most common of all children's heel pain causes. With Sever's disease there is inflammation of the growth plate at the back of the heel.

This may be caused by a growth spurt where the heel bone grows faster than the surrounding muscles and ligaments, standing for long periods or overuse from participating in lots of sporting activities like running and jumping.

Sever's disease heel pain causes problems at the back of the heel or underneath it. There may be inflammation and tenderness, foot heel pain when walking and ankle stiffness. Symptoms of sever's disease are typically worse with activity and improve with rest. Often, Sever's disease foot heel pain causes symptoms in both feet at the same time.

Treatment for Sever's disease usually involves strengthening and stretching exercises, rest, orthotics, medication. With correct treatment the foot heel pain causes problems for around 2-3 months only.

Other Possible Causes

There are a some other conditions that can cause heel pain that extends into the foot:

  • Ankle Sprain: over-stretching or tearing of one of the ankle ligaments
  • Cuboid Syndrome: a common cause of ongoing pain on the outside of the heel after twisting your ankle
  • Peroneal Tendonitis: inflammation of the peroneal tendon causing outer foot pain on the outside of the heel
  • Posterior Tibial Tendonitis: inflammation of the posterior tibial tendon is a common inner side of heel pain cause

If there is any tingling, pins and needles or numbness in the heel, then it is likely to be linked to some nerve damage.

Heel Pain Treatment

The best heel pain treatment will depend on the underlying cause but will usually involve a combination of:

  • Heel Stretches: one of the best ways to reduce back of heel pain is to do heel stretches targeting the calf muscles and plantar fascia
  • Strengthening Exercises: treatment for heel pain usually involves strengthening the calf and glute muscles
  • Rest: from aggravating activities to reduce the friction and irritation on the heel bone
  • Ice: regularly applying ice can help reduce back of foot pain and inflammation
  • Orthotics: Wearing special inserts in your shoes such as gel heel cups can help reduce most heel pain causes

You can find for more specific treatment advice using the links to the different heel pain causes above.

Pain In Heel Recovery

Most heel pain causes are not serious and will settle down with a combination of appropriate rest and stretching and strengthening exercises with 6-12 weeks.  Visit the calf workout section for a variety of exercises that are the basis of long term recovery from many foot and ankle heel pain causes.

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 foot pain diagnosis so do consult your doctor. 

What Causes My Heel Pain?

There are lots of different heel pain causes which each lead to pain in slightly different areas of the foot

Back of heel pain is usually from achilles tendonitis, heel bone spurs, heel bursitis or os trigonum

Side of heel pain may be caused by tendonitis, tarsal tunnel syndrome or cuboid syndrome

Heel and arch pain in the foot is most commonly caused by plantar fasciitis but may also be due to muscle cramps or plantar fibromatosis

Outside heel pain may be caused by cuboid syndrome or peroneal tendonitis

Inner side of heel pain is often due to posterior tibial tendonitis or tarsal tunnel syndrome

Foot and heel pain may be caused by a fracture, heel spur, plantar fasciitis or nerve pain

A lump on the back of the heel may be caused by bone spurs (hard lump) or bursitis (soft lump)

A lump on the bottom of the heel is usually due to plantar fibroma or inferior bone spurs

Side heel pain after running is usually caused by tendonitis or tarsal tunnel syndrome

Heel Pain Causes Summary

Heel pain is a common problem and there are lots of possible heel pain causes. In most cases, foot heel pain comes on gradually due to overuse and repetitive friction.

The most common causes of heel pain are achilles tendonitis (back of heel pain), plantar fasciitis (heel and arch pain in the foot), bone spurs (hard lumps at the back or bottom of the heel) and bursitis (soft lump on heel of foot).

Heel pain may also be associated with other problems such as heel lumps and altered sensation.

Heel pain treatment usually involves a combination or rest, ice, medication and exercises. The best heel pain exercises involve a combination of heel stretches and strengthening exercises. Most heel pain causes will settle down within 6-12 weeks with the right treatment.

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Page Last Updated: 05/09/23
Next Review Due: 05/09/25