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Heel Pain

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Understand your heel pain symptoms with Buoy, including 9 causes and common questions concerning your heel pain.

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Symptoms of heel pain

Heel pain is an uncomfortable condition that can often interfere with daily activities such as walking and exercise.

Symptoms of heel pain can differ in regards to timing of the day, severity, and persistence.

Common characteristics and accompanying symptoms of heel pain

If you're experiencing heel pain, it can likely be described by:

  • Tenderness at the back of the heel
  • Pain localized to the bottom of the foot: This pain probably comes and goes
  • Pain in the heel or middle of foot: This likely worsens with prolonged periods of standing
  • Pain in the back of the heel: This likely worsens with activity or exercise

Once you notice heel pain symptoms, make an appointment with your physician promptly in order to get appropriate treatment and care.

What causes heel pain?

Heel anatomy

The heel may seem like a simple body part, but it actually has many different components.

  • Calcaneus: The heel bone is the largest bone of the foot and supports a significant amount of the body.
  • Achilles tendon: A tendon is a band of connective tissue that connects muscle to bone. The Achilles tendon is one of the thickest tendons in the body and connects the calf muscle to the heel bone.
  • Plantar fascia: This is also a strong band of connective tissue that runs along the bottom of your foot and connects the heel bone to the bones of your toes.
  • Bursa: A bursa is a sac or pouch of fluid that lines bones and joints. It reduces friction and allows the bones to move easily against each other. The heel has a bursa between the Achilles tendon and the calcaneus.
  • Skin: The external layer of the heel is the thick skin surrounding and protecting the heel. Over time it thickens with pressure and use, especially in people who often go barefoot.

Inflammatory causes

Inflammation is often a principal cause of heel pain symptoms. Inflammation is the result of repetitive stress or use. Since the heel and foot are used on such a daily basis, they are easily susceptible to inflammatory heel pain causes.

  • Connective tissue: Inflammation to the plantar fascia (also known as plantar fasciitis) can result in stabbing pain that is worst in the morning after the first few steps of the day. The heel pain usually improves throughout the day but can be triggered after long periods of inactivity such as sitting or standing. See this image for a good visual representation of the plantar fascia. Inflammation of the Achilles tendon often begins as a dull pain in the back of the heel that is most noticeable after running or other sports activities. This condition is called Achilles tendonitis.
  • Bursa: Inflammation of the bursa (bursitis) often begins in the middle, underside of the foot and worsens if you bend your foot up or down.

Structural causes

Problems or deformities of the bones of the heel itself can result in chronic heel pain that may affect the way you walk.

  • Spurs: Heel spurs are actually deposits of calcium that can often look like bony growths coming from the heel. They often appear in the area where the plantar fascia attaches to the calcaneus. They develop over time and are caused by muscle and ligament strain due to repetitive stress from walking, running or jumping. See this image for a visual representation.
  • Bumps: Bursitis and chronic inflammation can result in abnormal bony growths at the back of the heel called posterior calcaneal exostosis. It is common in women and often the result of pressure from shoes that do not fit properly.

This list does not constitute medical advice and may not accurately represent what you have.

Sever disease

Sever's Disease is inflammation of the heel in children due to overuse (typically due to sports). It's caused by the long bones growing faster than the muscles/tendons, creating tension in the Achilles tendon.

You can safely treat this condition on your own. It typically goes away with rest from activity for a bit with a gradual increase back to the previous level. Ice, heal lifts, stretching, and physical therapy are all effective. NSAIDs (Ibuprofen) also works.

Rarity: Rare

Top Symptoms: heel pain, pain in both feet, spontaneous ankle pain, difficulty moving the ankle

Symptoms that always occur with sever disease: heel pain

Symptoms that never occur with sever disease: cut on the foot

Urgency: Self-treatment

Septic arthritis

Septic arthritis is also called infectious arthritis. "Arthritis" simply means inflammation of a joint. In septic arthritis, the inflammation is caused by a bacterial, viral, or fungal infection. The most common agent is Staphylococcus aureus, or staph.

These agents reach the joints either from another infection in the body, or from a traumatic injury that contaminates the wounded joint.

Risk factors include existing joint disease or injury; a weakened immune system; and damaged skin. All of these things allow infectious agents to get a foothold.

Symptoms include severe pain in the affected joints, along with redness and swelling. The knees are most often affected but septic arthritis can occur in any joint.

The infection can damage cartilage and bone very quickly, so anyone with these symptoms should see a medical provider as soon as possible.

Diagnosis is made through a sample of the joint fluid; blood tests; and x-ray or CT scan of the joint.

Treatment involves draining the infected fluid from the joint, either with a needle or with surgery, followed by antibiotics.

Septic arthritis is also called infectious arthritis. "Arthritis" simply means inflammation of a joint. In septic arthritis, the inflammation is caused by a bacterial, viral, or fungal infection. The most common agent is Staphylococcus aureus, or staph.

These agents reach the joints either from another infection in the body, or from a traumatic injury that contaminates the wounded joint.

Risk factors include existing joint disease or injury; a weakened immune system; and damaged skin. All of these things allow infectious agents to get a foothold.

Symptoms include severe pain in the affected joints, along with redness and swelling. The knees are most often affected but septic arthritis can occur in any joint.

The infection can damage cartilage and bone very quickly, so anyone with these symptoms should see a medical provider as soon as possible.

Diagnosis is made through a sample of the joint fluid; blood tests; and x-ray or CT scan of the joint.

Treatment involves draining the infected fluid from the joint, either with a needle or with surgery, followed by antibiotics.

Heel pain quiz

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Rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory disorder that affects the lining of the joints, causing them to become thickened and painful. It can also affect other parts of the body such as the heart, lungs, eyes, and circulatory system.

Rheumatoid arthritis is an autoimmune disease, which means the body's immune system turns against itself for unknown reasons.

Most at risk are women from ages 30-60. Other risk factors are family history, smoking, and obesity.

Early symptom include warm, swollen, stiff, painful joints, especially the fingers and toes; fatigue; and fever. Usually, the same joints on both sides of the body are affected.

If untreated, irreversible joint damage and deformity can occur, with other complications. Early diagnosis can allow preventive treatment to begin as soon as possible.

Diagnosis is made through physical examination; blood tests; and x-ray, CT scan, or MRI.

There is no cure for rheumatoid arthritis, but the disease can be managed to improve quality of life. Treatment includes nonsteroidal anti-inflammatory drugs; steroids; anti-rheumatic drugs; physical therapy; and sometimes surgery to repair the joints.

Psoriatic arthritis

Psoriatic arthritis is a complication of psoriasis, which causes the skin to become thickened, red, and scaly. Arthritis may appear before or after the psoriasis appears.

Both conditions are autoimmune diseases, where the body attacks itself, and are thought to be caused by genetic and environmental factors.

Most susceptible are people from 30 to 50 years of age with a family history of the disease and who already have psoriasis.

Symptoms include the joints on one or both sides of the body becoming painful, swollen, and hot; swelling and deformity of the fingers and toes; pitted, flaking fingernails; foot pain in the heels and soles; and joint pain in the low back pain.

It is important to seek treatment, as psoriatic arthritis can permanently damage the joints, eyes, and heart.

Diagnosis is made through physical examination, x-rays, and MRI. Blood tests and joint fluid tests can confirm psoriatic arthritis.

Treatment includes over-the-counter, nonsteroidal anti-inflammatory drugs; anti-rheumatic medication; immunosuppressants; and steroid injections for the joints. Surgery to replace damaged joints may also be tried.

Posterior tibialis tendinopathy

Posterior tibialis tendinopathy

The posterior tibialis tendon attaches the calf muscle to the bones on the underside of the foot. It provides stability and arch support. If this tendon is damaged, the result may be a flat, unstable foot.

Posterior tibialis tendinopathy is most often a sports injury, where the tendon becomes inflamed or torn through overuse or high impact.

Symptoms include pain down the ankle and into the foot, sometimes with swelling. The pain becomes worse with any activity, even standing or walking. When standing, the patient's arch will be collapsed and flat and the front of the foot will point outward. The patient will be unable to stand on the injured foot and raise the heel.

Diagnosis is made through patient history, physical examination, and imaging such as x-ray, CT scan, or MRI.

Treatment involves rest, over-the-counter pain relievers, orthotics (shoe pads,) braces, and sometimes steroid injections into the damaged tendon. Surgery can be tried, but tends to be complex and cannot always restore the tendon completely.

Rarity: Ultra rare

Top Symptoms: swollen foot, pain in one foot, limping, pain in one ankle, spontaneous ankle pain

Symptoms that never occur with posterior tibialis tendinopathy: recent cutting accident

Urgency: Primary care doctor

Plantar fasciitis

Plantar fasciitis is a condition where the thick band of tissue that runs across the bottom of the foot becomes inflamed. This is a common problem in runners, people who are overweight, and those who wear shoes with inadequate support. When the thick band of tissue (fascia) becomes inflamed, it can cause heel pain.

You can safely treat this condition on your own with over-the-counter pain killers (Advil, Motrin), as well as shoe inserts (orthotics) to help distribute pressure to the feet more evenly. If pain does not begin to subside, seek consultation with a physical therapist.

Chronic idiopathic peripheral neuropathy

Peripheral neuropathy refers to the feeling of numbness, tingling, and pins-and-needles sensation in the feet. Idiopathic means the cause is not known, and chronic means the condition is ongoing without getting better or worse.

The condition is most often found in people over age 60. Idiopathic neuropathy has no known cause.

Symptoms include uncomfortable numbness and tingling in the feet; difficulty standing or walking due to pain and lack of normal sensitivity; and weakness and cramping in the muscles of the feet and ankles.

Peripheral neuropathy can greatly interfere with quality of life, so a medical provider should be seen in order to treat the symptoms and reduce the discomfort.

Diagnosis is made through physical examination; blood tests to rule out other conditions; and neurologic and muscle studies such as electromyography.

Treatment involves over-the-counter pain relievers; prescription pain relievers to manage more severe pain; physical therapy and safety measures to compensate for loss of sensation in the feet; and therapeutic footwear to help with balance and walking.

Rarity: Rare

Top Symptoms: distal numbness, muscle aches, joint stiffness, numbness on both sides of body, loss of muscle mass

Urgency: Primary care doctor

Ankle arthritis

Arthritis simply means inflammation of the joints. Because the feet and ankles have many small joints and carry the weight of the body, they are often the first place that arthritis appears.

Ankle arthritis is caused by a breakdown in the protective cartilage at the end of each joint, so that the bones begin to wear against each other and the joint becomes stiff and painful. This breakdown may be due to simple wear and tear; an injury; or from rheumatoid arthritis, an autoimmune condition which causes the body to break down its own cartilage.

Symptoms include swelling, warmth, and redness in the joint, and pain with movement or with pressure on the joint.

Diagnosis is made through patient history, physical examination, and imaging such as x-rays, CT scan, or MRI.

There is no cure for arthritis, but treatment is important because the symptoms can be managed to prevent further damage, ease pain, and improve quality of life. Treatment involves physical therapy, pain-relieving medications, and sometimes surgery to help repair damaged joints.

Rarity: Uncommon

Top Symptoms: swollen ankle, swollen foot, joint stiffness, pain in one ankle, ankle stiffness

Urgency: Self-treatment

Achilles tendonitis

Non-insertional Achilles tendinitis is an inflammation of the center section of the Achilles tendon. It runs down the back of the ankle and connects the calf muscle to the heel bone.

Overuse, especially without proper conditioning, causes the small fibers of the tendon to become weakened, torn, and broken down. The tendon becomes thickened, swollen, and sometimes calcified in an attempt to protect itself.

Non-insertional Achilles tendinitis is most common in younger people, especially those in training for sports or the military.

Symptoms include stiffness, pain, and firm, tough swelling at the back of the ankle up above the heel; pain that is worse after exercising; and difficulty flexing or rotating the ankle.

Tendons do not heal very well, so treatment is important to ease the symptoms and repair as much of the damage as possible.

Diagnosis is made through physical examination and x-rays.

Treatment involves rest, ice, nonsteroidal anti-inflammatory drugs, and physical therapy. Specialized shoes and inserts can help take the pressure off of the injured tendon. Surgery is sometimes tried.

Heel pain quiz

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Take heel pain quiz

Heel pain treatments and relief

At-home treatment

If you are experiencing heel pain, try the method below in order to relieve symptoms:

  • Rest: Limit weight-bearing on the heel as much as possible.
  • Ice: Put an ice pack on your heel every 15 minutes in order to reduce swelling or reduce heel pain.
  • Compress: Wrap your heel with a wrap or protective brace that supports both the heel and ankle.
  • Elevate: Raise your heel above the level of your heart to reduce swelling and give your foot a break.

When to see a doctor

However, if you continue to experience heel pain despite home remedies, see your physician for appropriate care.

  • Pain medications: Non-steroidal anti-inflammatory drugs, or NSAIDs, like ibuprofen (Advil, Motrin) can help relieve heel pain.
  • Physical therapy: Your physician may prescribe stretching exercises or a physical therapy/rehabilitation program to help you restore strength and stability to your heel.
  • Surgery: If the treatments and methods above do not work, your physician may suggest surgery to repair the structures contributing to your heel pain symptoms.

Prevention

Heel pain symptoms can be prevented with simple lifestyle changes such as:

  • Maintaining a healthy weight
  • Wearing comfortable shoes: Shoes should support and cushion the heel
  • Stretching and warming up: Both before exercise and sports
  • Massaging the soles of the feet or using an ice pack: Especially after prolonged sports activity or a long day of work

Heel pain FAQs

Why do I have heel pain in the morning?

Heel pain in the morning is a common sign of plantar fasciitis — an inflammation of the thick protective membrane just underneath the skin of the foot. Plantar fasciitis is likely caused by increased pressure placed on the foot by such actions as prolonged standing, jumping, flat feet, and reduced flexing of the ankle upward.

Is heel pain a symptom of diabetes?

Yes, heel pain can be a symptom of diabetes following the development of a "Charcot joint," which is a joint that is damaged after uncontrolled diabetes damages the nerves of the foot — causing joint collapse. A Charcot joint, however, is caused by a lack of ability to sense pressure when standing and results in an ability to perceive when one is placing too much pressure on a particular part of the foot.

Why do I have heel pain when standing or walking?

You may have heel pain for a variety of reasons, including plantar fasciitis or Achilles tendinitis. Differentiating between these two causes can be done based on location and the history of trauma or injury to the affected heel. Heel pain in the back of the heel is usually attributed to Achilles tendinitis, while plantar fasciitis is usually along the bottom of the heel.

Do certain shoes cause heel pain more than others?

Heel pain can be caused by high heels, especially when worn by young women whose heel bones are still developing. Heel pain may also be caused by shoes with inadequate padding, causing stress fractures of the heel bone or the small bones of the foot.

What causes heel pain when pressure is applied?

Heel pain when pressure is applied can be a sign of a stress fracture of the heel, which can be caused by repeatedly landing on the heel when jumping or running. The actual sensation of pain is often caused by sensitization of the nerves supplying that stretch of heel, coupled with pressure from either touch or standing.

Questions your doctor may ask about heel pain

  • Have you ever been told you have flat feet?
  • Has a bunion formed on your foot?
  • What is your body mass?
  • How would you explain the cause of your foot pain?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

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Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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References

  1. Heel Pain. American Academy of Orthopedic Surgeons: OrthoInfo. Reviewed Oct. 2017. OrthoInfo Link
  2. Whitney KA. Achilles Tendon Bursitis. Merck Manual Consumer Version. Reviewed March 2018. Merck Manuals Consumer Version Link
  3. Plantar Fasciitis. American Orthopedic Foot & Ankle Society: FootCareMD. AOFAS Link
  4. Mazzone MF, Mccue T. Common Conditions of the Achilles Tendon. Am Fam Physician. 2002 May 1;65(9):1805-1811. AAFP Link
  5. Vaishya R, Agarwal AK, Azizi AT, Vijay V. Haglund's Syndrome: A Commonly Seen Mysterious Condition. Cureus. 2016;8(10):e820. Published Oct. 7, 2016. NCBI Link
  6. Rogers LC, Frykberg RG, Armstrong DG, et al. The Charcot foot in diabetes. Diabetes Care. 2011;34(9):2123-9. NCBI Link