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Causes

Heel pain is most often the result of overuse. However, it may be caused by an injury.

Your heel may become tender or swollen from:

• Shoes with poor support or shock absorption
• Running on hard surfaces, such as concrete
• Running too often
• Tightness in your calf muscle or the Achilles tendon
• Sudden inward or outward turning of your heel
• Landing hard or awkwardly on your heel

Conditions that may cause heel pain include:

• Swelling and pain in the Achilles tendon
• Swelling of the fluid-filled sac (bursa) at the back of the heel bone under the Achilles tendon (bursitis)
• Bone spurs in the heel
• Swelling of the thick band of tissue on the bottom of your foot (plantar fasciitis)
• Fracture of the heel bone that is related to landing very hard on your heel from a fall (calcaneus fracture)

Home Care

The following steps may help relieve your heel pain:

• Use crutches to take weight off your feet.
• Rest as much as possible for at least a week.
• Apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes. Ice more often in the first few days.
• Take acetaminophen or ibuprofen for the pain.
• Wear well-fitted, comfortable, and supportive shoes.
• Use a heel cup, felt pads in the heel area, or shoe insert.
• Wear night splints.

Your health care provider may recommend other treatments, depending on the cause of your heel pain.

Maintaining flexible and strong muscles in your calves, ankles, and feet can help prevent some types of heel pain. Always stretch and warm-up before exercising.

Wear comfortable and well-fitting shoes with good arch support and cushioning. Make sure there is enough room for your toes.

When to Contact a Medical Professional

Contact your provider if your heel pain does not get better after 2 to 3 weeks of home treatment. Also contact them if:

• Your pain is getting worse despite home treatment.
• Your pain is sudden and severe.
• You have redness or swelling of your heel.
• You cannot put weight on your foot, even after resting.

What to Expect at Your Office Visit

Your provider will perform a physical exam and ask questions about your medical history and symptoms, such as:

• Have you had this type of heel pain before?
• When did your pain begin?
• Do you have pain upon your first steps in the morning or after your first steps after rest?
• Is the pain dull and aching or sharp and stabbing?
• Is it worse after exercise?
• Is it worse when standing?
• Did you fall or twist your ankle recently?
• Are you a runner? If so, how far and how often do you run?
• Do you walk or stand for long periods of time?
• What kind of shoes do you wear?
• Do you have any other symptoms?

Your provider may order a foot x-ray. You may need to see a physical therapist to learn exercises to stretch and strengthen your foot. Your provider may recommend a night splint to help stretch your foot or place you in a boot to rest your foot. At times, further imaging, like CT scan or MRI may be needed. Surgery may be recommended in some cases.

References

Grear BJ. Disorders of tendons and fascia and adolescent and adult pes planus. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 83.

Kadakia AR, Aiyer AA. Heel pain and plantar fasciitis: hindfoot conditions. In: Miller MD, Thompson SR, eds. DeLee Drez & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 120.

McGee DL. Podiatric procedures. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 51.

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