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 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 heel pain, symptoms usually settle down fairly quickly and even in prolonged cases, heel pain causes are rarely serious.  

What Causes Heel Pain?

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

The most common cause of pain underneath the heel is plantar fasciitis which 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.

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.

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

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

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 bony lump.

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

4. Heel Fractures

Calcaneal fractures 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. 

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 pain at the back of the heel.  

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 pain on the side of your heel 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 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 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, 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 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 heel pain causes problems for around 2-3 months only.

Treatment For Heel Pain Causes

The best treatment for heel pain 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 can help reduce most heel pain causes

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

What Else Can Help?

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. 

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 many foot and ankle heel pain causes.

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Page Last Updated: 01/13/23
Next Review Due: 01/13/25