What Causes Heel Pain? Symptoms, and Treatment

Heel pain is relatively common, and it’s likely you’ve experienced some type of heel or foot pain before. It’s especially prevalent in runners and athletes that do a lot of running and jumping.

Doing a lot of running, wearing the wrong shoes, and having tight muscles can all cause heel pain.

Usually, we break heel pain into two categories: pain behind the heel and pain under the heel.

In this article, I’ll talk about the different causes of heel pain, what causes this kind of pain, and how to deal with it.

I’ll also discuss risk factors that make you more likely to have heel pain and strategies to prevent it.

Causes of Pain Behind the Heel 

There are a handful of different activities and conditions that can cause pain behind the heel. 

Achilles tendinitis

Tendinitis is inflammation and pain in a tendon, and Achilles tendinitis happens in your Achilles tendon.

This is the thick band of tissue that runs along the back of your heel and ankle.

Typically, Achilles tendinitis is an overuse injury. Too much running and jumping can aggravate the tendon and if you don’t rest enough, it can get inflamed.

Wearing poorly fitting shoes that dig into the back of your heel can make it worse.

In rare cases, Achilles tendinitis can be caused by underlying conditions like ankylosing spondylitis, gout, or rheumatoid arthritis.

Bursitis

Bursitis is inflammation in a bursa, which is a small sac of fluid that cushions the joints.

There are two bursae at the back of your heel, right where the Achilles tendon meets the bone.

If you do too much running, jumping, or wear ill-fitting shoes, you can aggravate them, causing bursitis.

You might feel pain on the bottom or back of your heel. It may be swollen, and the pain could get worse as the day goes on.

Haglund’s deformity

Haglund’s deformity is a bony, protruding lump on the back of the heel.

It happens when there is constant pressure and rubbing.

If you wear shoes that are too tight or very stiff, you are more likely to develop a bump—the condition is even called “pump bump” because it affects people who wear high heels.

Some people are genetically predisposed to Haglund’s deformity.

Having high arches, tight Achilles tendons, and a tendency to walk on the outsides of your feet all increase your risk.

Although the bump itself isn’t an issue, it can cause problems if it rubs against your Achilles tendon.

This can cause bursitis, which we discussed above, and is very painful.

Sever’s disease (calcaneal apophysitis)

Sever’s disease, or calcaneal apophysitis, is common in active children aged 5–11 years old.

It happens when the growth plate in the heel gets inflamed from overuse. Usually, it affects kids who are very active or play sports that involve a lot of running and jumping.

It’s especially common in children who are over-pronators, which means their feet point slightly inwards. 

This condition is usually temporary.

Once the muscles and tendons catch up to the heel bone’s growth, the pain should resolve. Resting and reducing the amount of jumping affected people do each day can help.

Causes of Pain Beneath the Heel

As with pain behind the heel, there are various reasons for pain beneath the heel. 

Bone bruise (contusion)

If you’ve walked around barefoot, you may have an injury called a bone bruise, which is sometimes called a stone bruise.

This happens when you accidentally step on a sharp or hard object.

It injures the fat pad covering your heel bone, making it sore, painful, and swollen.

Plantar fasciitis 

This condition is very common in runners.

It happens when the thick band of tissue that runs from your heel bone to your toes gets inflamed from overuse. 

Usually, you’ll feel pain directly under your heel.

It’s typically worst first thing in the morning. If you continue to run and ignore the pain, it’ll get worse over time.

Plantar fasciitis is more common in people who are obese, pregnant, or have diabetes.

It is also prevalent in people who do sports that involve a lot of running and jumping. 

Heel spurs

Heel spurs can happen as a complication of plantar fasciitis. If your plantar fasciitis goes on for a long period of time, your body can form a calcium deposit at the base of your heel.

This is called a heel spur.

Usually, the best way to deal with a heel spur is to rest and stretch the area.

Symptoms

The symptoms of heel pain depend on its cause.

This section lists common symptoms of the conditions discussed above.

However, it’s important to note that symptoms can vary from person to person, and if you have ongoing heel pain, you should see a doctor for a diagnosis.

Common symptoms of heel pain may include: 

• Pain
• Tenderness
• Stiffness
• Swelling
• Redness

Risks

Certain people are more likely to develop heel pain. In particular, athletes and people who do a lot of running and jumping have an especially high risk.

People who are at an increased risk for heel pain include those who are:

• Over 65 years of age
• Overweight or obese
• Pregnant
• Very active 
• Active growing children
• Inflexible
• Over-pronators

Diagnosis

If your heel pain does not improve after a few weeks of rest and home care, you should call your doctor or provider. They can evaluate your symptoms and diagnose the problem.

It’s a good idea to contact a doctor or provider if:

• Your pain is getting worse
• Your pain is sharp and severe
• You cannot put weight on your foot
• Your foot is red and swollen

Your provider will ask you questions about when your pain started, what it feels like, and what makes it better and worse. They will examine your foot and gently feel for swelling and deformities.

Additionally, they might ask you to walk and perform physical tests. 

If they think it’s needed, your provider may also order imaging tests like x-rays, CT scans, and ultrasounds.

Prevention

It can be difficult to prevent heel pain, and sometimes it can come on suddenly.

This can be very frustrating for active people and athletes who are reluctant to take time off from training.

Choosing the right footwear and focusing on proper form can reduce your chance of injury.

If you do lots of running and jumping, you should try to increase your training load gradually instead of all at once.

You should also always stretch and warm up before strenuous activity and cool down after to decrease the risk of injury or pain. 

People who are overweight or obese may also benefit from losing excess weight. 

Treatment

The specific treatment for heel pain depends on its cause.

However, as most of the conditions we discussed are overuse injuries, the general treatment protocol is similar. 

If you are experiencing heel pain, you can try:

• Resting
• Taking time off from your training regimen
• Icing the affected area
• Taking over-the-counter (OTC) pain relievers
• Wearing comfortable, supportive shoes
• Wearing insoles
• Using crutches

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