Heel pain is usually caused by overuse. The most common causes are plantar fasciitis, Achilles tendonitis and arthritis. If you have heel pain that persists, you should see a doctor or physiotherapist.

What causes heel pain?

Plantar fasciitis

Plantar fasciitis is inflammation of the plantar fascia, a piece of strong, thick tissue that runs along the bottom of the foot. It connects the heel bone to the toes, creating the arch of the inner aspect of the foot.

Bruising or overstretching the plantar fascia can cause inflammation and heel pain.

Causes of plantar fasciitis include having flat feet or high-arched feet, wearing non-supportive footwear on hard surfaces, playing sports that place a lot of stress on the heel bone (like running), and being overweight, which puts more load onto the plantar fascia.

People with plantar fasciitis often say the pain is worse when they first get out of bed, or when they walk after they’ve been sitting still for a while. The pain is usually felt in the sole of the foot and the bottom of the heel. It usually eases after a few minutes of walking.

Initial treatment includes stopping the activities that caused the problem, strapping the feet, wearing supportive shoes, stretching and weight loss. Longer-term treatments include exercises to strengthen the calves and small muscles of the foot.

Achilles tendinitis

Achilles tendinitis is another common cause of heel pain. It is inflammation of the Achilles tendon, which runs from the heel to the calf.

It often causes pain behind the heel. It can also cause swelling, warmth and tenderness there. It might hurt to rise to stand on your toes. It can be caused by tight calf muscles and overuse.

Gently stretching the calf might help. You may need to see a physiotherapist and do special exercises if pain persists.

Other causes

Arthritis can also cause pain in the heel. Other common causes of heel pain may be:

• heel bursitis — inflammation of the back of the heel, the bursa (a fibrous sac full of fluid)
• stress fracture — this can be caused by repetitive stress, strenuous exercise, sports or heavy manual work.
• Tarsal tunnel syndrome — a pinched nerve
• heel pad wear and tear
• osteomyelitis — infection of the bone

How is heel pain diagnosed?

A doctor or a physiotherapist is able to diagnose the cause of heel pain by talking to you and examining you.

How is heel pain treated?

Your doctor or physiotherapist may recommend rest and home treatments such as stretching and strengthening your calf muscles if you have plantar fasciitis or Achilles tendinitis.

Other treatments may include:

• applying ice
• anti-inflammatory medicines or painkillers
• night splints or strapping
• supportive footwear or orthotics
• losing any excess weight to reduce the stress on your feet

If you are exercising and feel a sudden pain in the back of the leg, you may have ruptured your Achilles tendon. Seek medical help immediately.

How can heel pain be prevented?

Reducing stress on the feet helps to prevent heel injury and pain. Stretching and a warm-up before exercise can help. If you feel pain in your tendon, you should stop the exercise. Always wear correctly fitted, supportive footwear suitable for your activity.