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 (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. 

Heel 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. 

Common Heel Pain Causes

Here, we will look at an overview of the most common foot and ankle heel pain causes, symptoms and treatment options for each. You can find out more about each by visiting the relevant sections.

Plantar Fasciitis

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

Plantar Fasciitis is a common cause of foot heel pain
  • What Is Plantar Fasciitis: Damage and inflammation of the plantar fascia, a band of tissue underneath the foot

  • 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

  • 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

Achilles tendonitis is the most common cause of pain at the back of the heel.

Achilles tendonitis is characterised by inflammation and/or degeneration of the achilles tendon. Image source http://bit.ly/2B6b6LN
  • What Is Achilles Tendonitis: 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 or just above the ankle

  • 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

Bone Spurs

Calcaneal bone spurs can occur both underneath and at the back of the heel.  They are very common foot and ankle heel pain causes.

Heel bone spurs are a common cause of heel pain
  • What Are Heel Bone Spurs: 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

  • 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.

Heel Fractures

  • What Are Heel Fractures: Single or multiple breaks/cracks in the heel bone
Calcaneal fractures cause foot heel pain
  • 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.

Retrocalcaneal Bursitis

  • What Is Bursitis: Retrocalcaneal bursitis is inflammation of a small fluid filled sac (bursa) that sits between the heel bone and Achilles tendon
Heel Pain Causes: Retrocalcaneal Bursitis - causes, symptoms, diagnosis and treatment
  • 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

  • Treatment: Rest, ice, medication, calf exercises, injections

Find out more about the causes, symptoms, treatment options and prevention strategies in the retrocalcaneal bursitis section

Os Trigonum Syndrome

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

  • What Is Os Trigonum: Irritation of the soft tissues at the back of the heel
Os Trigonum is one of the more rare causes of heel pain
  • 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.

Tarsal Tunnel Syndrome

  • What Is Tarsal Tunnel Syndrome: 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.

Find out more about the causes, symptoms, diagnosis and treatment in the Tarsal Tunnel Syndrome section.

Sever’s Disease

Sever’s Disease is the most common of all childrens heel pain causes

Severs Disease: the most common of heel pain causes in children. Copyright:  Nevit Dilmen
  • What Is Sever's Disease: 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.

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 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: 10/03/21
Next Review Due: 10/03/23