Heel pain

Definition
Heel pain refers to discomfort, tenderness, or aching localized to the underside, back, or sides of the heel. It is one of the most common foot complaints in adults and may be acute (sudden onset) or chronic (long-lasting). The causes range from mechanical stress to inflammatory, degenerative, or systemic conditions.

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Common Causes of Heel Pain

1. Plantar Fasciitis

   • Inflammation or microtears of the plantar fascia, a thick band of connective tissue running along the sole of the foot.

   • Pain is often sharp and worse in the morning or after prolonged rest.

2. Heel Spurs

   • Bony growths (osteophytes) on the underside of the heel bone, often associated with plantar fasciitis.

   • Usually cause pain during weight-bearing activities.

3. Achilles Tendinopathy

   • Overuse or degeneration of the Achilles tendon attaching at the back of the heel.

   • Pain is typically felt at the back of the heel, aggravated by activity.

4. Bursitis

   • Inflammation of the bursa (fluid-filled sac) at the back of the heel.

   • Causes swelling, tenderness, and pain, especially when wearing tight shoes.

5. Stress Fracture of the Heel Bone (Calcaneus)

   • Small cracks due to repetitive stress, commonly seen in athletes or military recruits.

   • Pain worsens with activity, improves with rest.

6. Sever’s Disease (Calcaneal Apophysitis) – more common in children/adolescents

   • Painful inflammation of the growth plate in the heel bone, often due to overuse.

7. Systemic Conditions

   • Rheumatoid arthritis, gout, ankylosing spondylitis, or infections can present with heel pain.

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Risk Factors

• Obesity (increased mechanical load)

• Prolonged standing or walking on hard surfaces

• Poor footwear lacking arch support

• Sports activities involving running and jumping

• Flat feet or high arches

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Symptoms

• Sharp, stabbing, or burning pain in the heel

• Pain worse in the morning or after prolonged inactivity (classic in plantar fasciitis)

• Swelling, redness, or warmth around the heel (in bursitis or infection)

• Tenderness on palpation

• Difficulty walking or bearing weight

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Diagnosis

• Clinical Examination – history of symptoms, physical examination of foot mechanics, palpation of tender areas.

• Imaging

  • X-ray: Detects heel spurs, fractures.

  • Ultrasound/MRI: Useful for plantar fasciitis, tendon injuries, bursitis.

• Blood tests (when systemic disease suspected): rheumatoid factor, uric acid, inflammatory markers.

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Treatment

General Measures

• Rest & Activity Modification – Avoid prolonged standing, running, or jumping.

• Ice therapy – Apply ice packs for 15–20 minutes, 2–3 times daily.

• Footwear correction – Supportive shoes with cushioned soles and orthotic insoles.

• Stretching exercises – Focus on plantar fascia, Achilles tendon, and calf muscles.

• Weight management – Reducing body weight can relieve pressure on the heel.

Medications

• NSAIDs (Non-steroidal anti-inflammatory drugs): Ibuprofen, Naproxen – for pain and inflammation.

• Topical NSAIDs: Diclofenac gel applied locally.

• Corticosteroid injections: Used in refractory plantar fasciitis or bursitis but with caution due to risk of tissue atrophy or rupture.

Physiotherapy

• Ultrasound therapy

• Shockwave therapy (extracorporeal shockwave) for chronic plantar fasciitis

• Taping or splinting to support the heel and arch

Surgical Options (only if conservative measures fail for >6–12 months)

• Plantar fascia release

• Removal of heel spur

• Surgical repair of Achilles tendon pathology

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Precautions & Self-Care

• Avoid walking barefoot on hard surfaces

• Choose shoes with good arch support and shock absorption

• Perform daily stretching of calves and plantar fascia

• Avoid prolonged high-impact sports until symptoms improve

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When to See a Doctor

• Severe pain that persists >2 weeks despite home care

• Heel pain with swelling, redness, or fever (possible infection)

• Inability to bear weight on the foot

• Pain associated with systemic arthritis symptoms

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Drug Interactions & Considerations

• NSAIDs should be used cautiously in patients with hypertension, peptic ulcer disease, renal impairment, or those on anticoagulants.

• Corticosteroid injections may interact with systemic corticosteroids, immunosuppressants, or increase risk of tendon rupture when combined with fluoroquinolone antibiotics.