Heel pain can really slow you down. You feel frustrated when you do not know the cause. This guide helps you understand different types of heel pain. Use our Heel Pain Diagnosis Chart to quickly find potential causes. This chart uses your symptoms and pain location. Remember, this information is for you to learn. Always see a doctor for a full heel pain diagnosis and treatment.
Key Takeaways
- Knowing where your heel hurts helps identify the problem. Pain at the bottom of your foot often means plantar fasciitis or heel spurs. Pain at the back of your foot can be Achilles tendinitis or bursitis.
- Plantar fasciitis is a common cause of heel pain. It causes sharp pain, especially with your first steps in the morning. Many things can increase your risk, like tight ankles or being overweight.
- You can get quick relief for heel pain. Rest your foot and use ice. Wear supportive shoes and stretch your calf muscles. Over-the-counter pain medicine can also help.
- See a doctor if your heel pain lasts for weeks. Get medical help right away for severe pain, swelling, or if you cannot walk. A doctor can give you a correct diagnosis and treatment plan.
Heel Pain
You can start to understand your heel pain by looking closely at your symptoms. Foot pain charts are helpful tools. They guide you in identifying what might cause your discomfort. This first step in your heel pain diagnosis helps you talk to your doctor.
Pinpointing Pain Location
Knowing exactly where your heel hurts helps a lot. Is the pain at the bottom of your foot? Does it feel like it is at the back of your heel? Pain and stiffness in the bottom of the heel are common.
This heel pain can feel dull or sharp. The bottom of your foot may also ache or burn. This pain often feels worse with your first steps in the morning. It also intensifies after you stand or sit for a while. Climbing stairs can make the pain worse. Intense activity, like walking, running, or jumping sports, can increase your pain.
Common Symptoms
Many people experience similar symptoms with heel pain. You might feel sharp or intense pain when you first get out of bed. People often describe this as ‘stabbing’ pain. This pain may ease a little as you move. You might also notice intense pain when you first stand up after sitting for a long time.
This pain might loosen up with walking, but it often comes back. Sometimes, the pain feels better after you ‘warm up’ with movement. However, the pain often returns stronger after longer periods of standing, walking, or exercise. You might also have tight calf muscles. This tightness can add stress to your foot. You may also feel tenderness when you press along the arch or heel area.
Heel Pain Diagnosis: Bottom of Foot
Pain on the underside of your heel often points to specific conditions. You can learn about these common causes here.
Plantar Fasciitis
Plantar fasciitis is a very common cause of heel pain. It happens when the plantar fascia, a thick band of tissue on the bottom of your foot, becomes inflamed or develops tiny tears. This tissue runs from your heel bone to your toes. It supports the arch of your foot.
You will likely feel a sharp, stabbing pain. This pain is often worst with your first steps in the morning. It can also hurt after you sit for a long time. The pain might lessen as you move around, but it often returns after long periods of standing or exercise.
Many people experience this condition. About 1 in 10 people will get plantar fasciitis. Around 2 million individuals in the U.S. seek treatment for it each year. Studies show that 0.85% of U.S. adults reported a diagnosis with pain in the past month.
Several things can increase your risk for plantar fasciitis:
- Limited ankle movement.
- Obesity.
- Spending a lot of time on your feet.
- Running, especially long distances or increasing your mileage too quickly.
- Foot mechanics like flat feet or high arches.
- Working on your feet for long hours.
- Getting older, especially between 30 and 60 years old.
- Weak foot muscles.
- A tight Achilles tendon. About 4 out of 5 people with plantar fasciitis also have a tight Achilles tendon.
- Different leg lengths.
- Sudden weight gain.
Heel Spurs
A heel spur is a bony growth on your heel bone. It often forms where the plantar fascia connects to the bone. Heel spurs and plantar fasciitis are related but different. Plantar fasciitis is inflammation of the tissue. A heel spur can develop as your body tries to react to the stress and inflammation from plantar fasciitis.
Most people with heel spurs do not feel pain from them. Doctors often find them on X-rays. If a heel spur does cause pain, it feels similar to plantar fasciitis pain. You might feel it directly under your heel.
The pain usually comes from the damaged plantar fascia, not the spur itself. Both conditions share similar risk factors like athletic stress, obesity, and tight calf muscles. They also often respond to similar treatments.
Fat Pad Atrophy
Your heel has a natural fatty cushion. This cushion protects your heel bone when you walk or stand. Fat pad atrophy means this fatty cushion thins out or wears away.
You might feel a deep, bruise-like pain in the middle of your heel. This pain happens when you walk, stand, or run. Pressing firmly on the middle of your heel can also cause this pain.
The pain gets worse with long periods of standing or walking. It also hurts more during high-impact activities or when you walk barefoot on hard surfaces. You might feel like you are walking on a hard or uneven surface, or even a marble. You might also notice your heel fat pad looks thinner. You can sometimes feel your heel bone through the fat pad with your fingers. Men generally have thicker heel fat pads than women.
Heel Pain: Back of Foot
When you feel pain at the back of your foot, specific conditions often cause it. This section details these common issues.
Achilles Tendinitis
When you feel pain at the back of your foot, Achilles tendinitis might be the cause. This condition involves inflammation or degeneration of your Achilles tendon. This strong band of tissue connects your calf muscles to your heel bone. You might experience pain and stiffness, especially in the morning or after activity. Athletes often face this issue.
For example, the overall injury rate for Achilles tendon injuries in collegiate athletes was 2.17 per 100,000 athlete-exposures. Males had a higher injury rate compared to females. In men’s collegiate sports, basketball, soccer, and football showed the highest rates. For women, gymnastics, basketball, and soccer also had high rates. Elite male runners have a cumulative lifetime incidence of Achilles tendinopathy over 50%.
Runners face a risk ten times higher than inactive people. Basketball athletes have an incidence rate of 7.7%. Professional football players showed an incidence of 11.6% over an 11-year period. The overall pooled prevalence of Achilles tendonitis in athletes was 0.06.
Overuse is a common reason for Achilles tendonitis. Activities like jumping and running can cause it. Starting a new activity or increasing its intensity can also lead to this problem. Extending your training duration, climbing stairs, or hill climbing also contribute.
Poor physical conditioning, improper shoes, or training on unsuitable surfaces can also cause it. Improper stretching exercises also play a role. This overuse causes tiny damage to the tendon. The tendon does not heal properly, leading to its breakdown. Excessive and repetitive strain is linked to this issue. Athletes like runners, gymnasts, cyclists, and volleyball players often experience Achilles tendinosis. Even a low saddle height for cyclists can be a factor.
Bursitis
Bursitis causes pain at the back of your heel. A bursa is a small, fluid-filled sac. It cushions your bones, tendons, and muscles around your joints. When this bursa becomes inflamed, you have bursitis. You might feel pain at the back of your foot, especially when you run uphill.
Rising on your toes can increase the pain. You will also notice tenderness and swelling at the back of your foot. Activities that load your calf muscles make the pain worse. You might feel primary bursa pain in your foot.
This pain can feel like throbbing under pressure. You may also experience stiffness in your foot. Sometimes, you hear a cracking sound when you flex your foot. Your shoes might feel uncomfortable. You could also have pain in your calf muscles when you walk or run. Swelling and redness on the skin around your heel are also possible.
Many things can cause bursitis. Starting a new, intense sport or workout program can trigger it. Increasing activity levels too quickly without proper conditioning is another cause. Wearing unsupportive shoes for walking, running, or workouts also contributes.
A family or personal history of arthritis can increase your risk. Standing for long periods or walking long distances can also lead to it. Repetitive activity or overuse, like in sports with running or jumping, is common. Improper footwear, such as poor support or a stiff heel counter, also plays a role. A sudden increase in activity level without proper conditioning can cause it.
Foot deformities, like high arches or flat feet, alter your gait and contribute. Trauma or a direct impact to your heel area can also cause it. Medical conditions such as rheumatoid arthritis, gout, or infections are also factors. Prolonged pressure on the bursae, repetitive motion, or trauma are common causes.
Rheumatoid arthritis, osteoarthritis, gout, systemic lupus erythematosus, and scleroderma can also contribute. Running in tight-fitting shoes or high heels can restrict movement in your foot and cause inflammation.
Overtraining, adding mileage too quickly, or not warming up properly can also lead to bursitis. Running uphill frequently is another cause. Inflammatory joint diseases like rheumatoid arthritis, gout, psoriatic arthritis, and ankylosing spondylitis can also contribute. Less common causes include infection or Haglund deformity.
Haglund’s Deformity
Haglund’s Deformity is a bony enlargement on the back of your heel. People sometimes call it ‘pump bump.’ This bump can irritate the soft tissues around your foot. You will notice heel pain. You can see and feel a bump on the back of your heel.
Swelling and skin discoloration around the bump are also common. You might see signs of inflammation like warmth, redness, and tenderness over the back of your heel. This condition often results from wearing certain types of shoes. Shoes with a firm, rigid back can cause Haglund’s Deformity.
High heels are particularly common culprits. Any type of shoe with firm, rigid backs can increase the risk. This includes men’s dress shoes and ice skates. High heels and pumps, especially those with rigid backs or narrow heel counters, increase pressure and friction. This irritation on the back of your heel leads to the bony enlargement.
| Condition | Common Pain Location | Key Symptoms / Description | Worse With | Helpful Clues | Initial Management |
|---|---|---|---|---|---|
| Plantar Fasciitis | Bottom of heel, especially inner side | Sharp pain with first steps in the morning | Standing, walking after rest | Pain improves after moving around | Stretching, ice, arch support, NSAIDs |
| Achilles Tendonitis | Back of heel above heel bone | Tenderness and stiffness in Achilles tendon | Climbing stairs, running, uphill walking | Pain decreases when warmed up | Calf stretching, heel lifts, rest, NSAIDs |
| Heel Bursitis (Retrocalcaneal) | Deep pain at back of heel | Swelling or redness around Achilles insertion | Pressure from shoes | Pain when squeezing sides of heel | Softer shoes, heel lifts, ice, reduce irritation |
| Heel Spur | Under plantar fascia/heel bone | Often occurs along with plantar fasciitis | Standing or walking | Can be seen on X-ray | Same treatment as plantar fasciitis |
| Stress Fracture (Calcaneus) | Deep, persistent heel pain | Pain after activity, becomes constant | Running and impact activity | Pain when pressing heel from both sides | Rest, avoid impact, medical evaluation |
| Tarsal Tunnel Syndrome | Inner ankle/heel and sometimes foot arch | Burning, tingling, or numbness | Standing or walking long periods | Positive Tinel’s sign near inner ankle | Reduce compression, orthotics, nerve evaluation |
| Sever’s Disease (Kids / Teens) | Back or bottom of heel | Seen in growing children, active sports | Running and jumping | Age 8–14, tight calves, growth spurt | Heel cushions, rest, stretching |
Other Heel Pain Causes
Sometimes, your heel pain comes from less common but still important issues. You should know about these other potential causes.
Stress Fractures
A stress fracture is a tiny crack in a bone. It often happens from repeated stress, not a single injury. You might feel a deep ache or tenderness in your heel. This pain often gets worse with activity and better with rest.
Stress fractures in your foot commonly occur in the long bones, like the metatarsals, and in your heel bone, which is called the calcaneus. These calcaneal fracture often appear behind or below the subtalar joint. Other common sites include the navicular bone.
Many things can increase your risk for a stress fracture. Starting a new sport or increasing your activity level too quickly can cause it.
Changing training surfaces, like moving from a track to hard concrete, also contributes. Poor equipment, like worn-out shoes, can be a factor. High-impact sports such as running, basketball, and gymnastics put you at higher risk. Health conditions like osteoporosis, bunions, high arches, flat feet, or a vitamin D deficiency also make you more prone to these fractures.
Nerve Entrapment
Nerve entrapment means a nerve gets compressed or squeezed. This can cause heel pain that feels different from other types. You might feel burning, tingling, numbness, or cramping.
This pain often spreads and gets worse with activity, improving with rest. The main plantar nerve, also known as the calcaneal nerve, can become entrapped. Baxter’s nerve, a branch of the lateral plantar nerve, is also a common nerve entrapped in your heel region. If your sural nerve is affected, you might feel burning and heightened skin sensitivity on the side of your heel and foot.
Systemic Conditions
Sometimes, your heel pain is a symptom of a larger body-wide condition. These are called systemic conditions. They can cause inflammation throughout your body, including your heel.
Examples include rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and gout. These conditions can lead to chronic heel pain. Rarely, infections like gonorrhea or tuberculosis can also cause heel pain. If you have a heel pain diagnosis that doesn’t fit typical patterns, your doctor might look for these systemic causes.
Next Steps for Heel Pain
You have explored different types of heel pain. Now, you need to know what to do next. This section gives you actionable advice. It helps you find relief and understand when to seek professional help.
Immediate Relief
You can take steps to ease your heel pain right away. Rest your foot. Apply ice to the painful area for 15-20 minutes several times a day. You can also use compression and elevate your foot.
Wear supportive tennis shoes. Use over-the-counter inserts like Powersteps or Superfeet. These offer cushioning and support. Reduce calf tightness through proper stretching. This helps alleviate stress on your foot. You can also use a heel lift, such as a firm Adjust A Lift. This temporarily relaxes your calf muscle and reduces inflammation.
When to See a Doctor
You should see a doctor for a proper diagnosis if your heel pain continues for more than a few weeks. This is true even if you have tried home remedies. Seek medical attention immediately if you experience severe pain and swelling. This is especially important if it appears suddenly near your heel.
You also need to see a doctor if you cannot bend your foot downward or stand on your toes. Inability to bear weight on your foot is another serious sign. Watch for heel pain with fever, numbness, or tingling. Redness and swelling around your heel also warrant a visit. Intense pain after an injury, like a fall, could mean a fracture.
Some symptoms are red flags. Persistent, progressive pain that does not improve with rest or therapy needs attention. Night pain or pain at rest can signal more serious issues. Swelling or a palpable mass in your heel region also requires medical review. If you have a history of cancer or systemic symptoms like unexplained weight loss, see your doctor. Your doctor will provide a definitive diagnosis.