Heel Pain

Overview

Heel pain is a common complaint with numerous etiologies. Plantar fasciitis is the most frequent cause, but calcaneal stress fractures, fat pad atrophy, retrocalcaneal bursitis, and tarsal tunnel syndrome must also be considered. Accurate diagnosis based on the location, timing, and character of pain guides appropriate treatment. Most causes of heel pain respond to conservative management.

Symptoms

• Pain localized to the bottom, back, or sides of the heel
• Morning pain with the first steps after rest
• Pain that improves with activity and worsens after prolonged standing
• Tenderness on palpation at specific locations depending on the cause
• Swelling or redness in some inflammatory conditions

Causes

• Plantar fasciitis from repetitive microtears of the plantar fascia
• Calcaneal stress fractures from repetitive impact loading
• Fat pad atrophy reducing natural cushioning under the heel bone
• Retrocalcaneal bursitis or Achilles tendinopathy at the posterior heel

Risk factors

• Sudden increases in weight-bearing activity
• Prolonged standing on hard surfaces
• Obesity increasing heel loading
• Tight calf muscles and reduced ankle dorsiflexion
• Wearing unsupportive footwear

Diagnosis

Location of tenderness helps differentiate causes: medial heel tenderness suggests plantar fasciitis, posterior heel tenderness suggests bursitis or Achilles involvement, and diffuse tenderness may suggest stress fracture. X-rays may reveal bone spurs or fractures. MRI is used when diagnosis is uncertain or pathology is suspected on imaging.

Treatment & management

Treatment varies by cause but generally includes rest, ice, appropriate stretching and strengthening exercises, supportive footwear, orthotic inserts, and anti-inflammatory medications. Physical therapy is often beneficial. Specific treatments depend on the underlying diagnosis.

Management is individualized and discussed with benefits, limitations, and follow-up.

Prevention & self-care

Wearing supportive footwear with adequate cushioning, maintaining healthy weight, stretching the calf and plantar fascia regularly, gradually increasing activity levels, and using orthotic inserts when biomechanical risk factors are present.

When to seek medical attention

• Heel pain that persists beyond two weeks despite self-care measures
• Severe pain that limits weight-bearing or walking
• Heel pain following a specific injury or trauma
• Signs of infection including redness, warmth, swelling, or fever
• Heel pain with numbness or tingling in the foot

Frequently asked questions