Heel pain

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 4, 2016
StartSymptomsHeel pain

Heel pain can be felt directly under the heel as well as behind the heel bone or calcaneus and is a commonly observed symptom of foot injury.


Definition & Facts

Heel pain pain can be sharp and knife-like or feel similar to a tearing sensation along the bottom of the heel. As time goes on, this pain may spread all the way up to the back of the leg. Many people who report heel pain first notice it when putting weight on the foot while getting out of bed in the morning or standing up after sitting for a long period of time.


When the pain is located under the heel, plantar fasciitis is often the cause. This is inflammation of the plantar fascia which is the ligament that runs under the foot from the bottom of the heel to the base of the toes.

Motions that make the foot flatten out more than it should can cause this ligament to stretch excessively, resulting in small tears occurring at the point where the ligament attaches to the heel bone. The excessive tension on the ligament as the plantar fascia pulls away from its position on the heel bone is what triggers heel pain in this case. Footwear that causes constant over-flattening of the foot will in many cases cause the development of plantar fasciitis.

Another cause of heel pain is heel bursitis which is inflammation located on the back of the heel bone where a bursa or fluid sac is located. This is caused by awkward landings, pressure from poorly fitting footwear, or hard landings on the heels. In many cases, the pain is felt deep inside or towards the back of the heel. Having flat feet can also exacerbate the problem.

Another cause of heel pain can be Achilles tendinitis resulting from microscopic tears within the Achilles tendon. When the pain is located behind the heel, Achilles tendinitis is usually the cause.

Gout can also cause heel pain, which is a condition stemming from the buildup of uric acid in the blood. When levels become too high, this acid can form crystals which cut into and cause pain in and around the joints.

Rheumatoid arthritis (RA), a chronic and progressive disease that is caused by an abnormal autoimmune response, can cause inflammation in the joints and the heel.

When to see a doctor

Individuals who experience severe pain, swelling, numbness, tingling, and inability to walk normally should call a physician immediately.

Treatment & Therapy

Heel pain can be treated in stages and include stretching the calf muscle is important, taking anti-inflammatory medicines and experimenting with over-the-counter heel cushions and arch supports. A second stage of treatment could consist of more calf muscle stretches, injection of cortisone, and orthopedic foot taping in order to support the arch.

If the heel pain returns, the use of a functional foot orthotic may be recommended. These are special devices fitted by podiatrists and placed into shoes as an arch support and can prevent abnormal pronation of the foot and the subtalar joint.

Prevention & Prophylaxis

The following may help prevent heel pain: maintaining a healthy weight, eating a healthy and balanced diet, and wearing appropriate footwear. Shoes with low to medium heels and heel cushions can support the arches and heels of the feet, while shoes without heels or shoes that are flat should be avoided.

In addition, walking barefoot on hard ground should be avoided and if a physical activity such as running is undertaken, athletic shoes should be replaced at regular intervals. Stretching after every athletic session is crucial to avoiding injury.