Foot Problems Heel Pain

Overview

Heel pain is pain felt under or behind your heel — the back part of your foot that touches the ground. Most of the time it is not a sign of anything serious. It usually comes from tiny repeated strains to the tough tissue and tendons around the heel, rather than from a single injury. The most common type is pain under the heel that is worst with the first steps in the morning. For most people, heel pain settles with simple self-care over weeks to a few months, though it can take patience.

Yes, very common. Most adults will have sore feet at some point, and heel pain is one of the top foot complaints seen in general practice.

It can affect anyone, but it is most common in adults between about 40 and 60. It is also common in people who run or do a lot of sport, people whose jobs involve standing or walking on hard floors all day, people who are carrying extra weight, and people who have just started a new activity or changed their shoes. Children can get a different type of heel pain during growth spurts.

Symptoms

Common symptoms

• Sharp or stabbing pain under the heel, often worst with the first steps in the morning
• Pain that eases as you walk around, then returns after sitting or resting
• Pain that gets worse after exercise rather than during it
• Tenderness when you press the bottom or back of the heel
• Aching or stiffness in the heel and arch of the foot
• Pain that feels better when you wear soft, supportive shoes and worse in flat or thin-soled shoes
• Mild swelling or warmth around the heel

Symptoms in children

• Pain at the back of the heel in children around 8 to 14 years old, often during a growth spurt
• Pain that gets worse with running, jumping or sport and eases with rest
• Limping or walking on tiptoe to avoid pressing the heel
• The heel may look normal, or be slightly swollen and tender to squeeze

Symptoms in older adults

• Thinning of the natural fat pad under the heel, which makes the heel feel bruised and sore on hard floors
• Stiffness in the heel and ankle, especially first thing in the morning
• Heel pain linked to arthritis in nearby joints
• Nerve-type pain such as burning or tingling, which can be linked to diabetes or back problems
• Heel pain combined with poor balance or other long-term health conditions, which needs a careful check

Causes

Main causes

• Irritation of the plantar fascia — the tough band under the foot — often called plantar fasciitis (the name means inflammation of that band)
• Strain or wear of the Achilles tendon, the strong cord at the back of the ankle that attaches to the heel
• Irritation of the small fluid-filled cushion (bursa) behind the heel
• A thinning or bruised fat pad under the heel, which acts as the foot's natural cushion
• A small crack or stress injury in the heel bone, usually from repeated impact
• A trapped or irritated nerve around the heel or ankle
• Arthritis or other joint conditions affecting the foot
• In children, inflammation of the growth area at the back of the heel during a growth spurt

Risk factors

• Standing or walking on hard surfaces for long periods at work
• A sudden increase in walking, running or exercise
• Worn-out, flat or very soft shoes with poor support
• Being overweight, which puts extra load on the heel
• Foot shape — very flat feet or very high arches
• Tight calf muscles or tight Achilles tendons
• Being between 40 and 60 years old
• Diabetes, which can affect the nerves and healing in the feet
• Some types of arthritis

When to see a doctor

See a doctor urgently if:

• A sudden pop or snap at the back of the heel with weakness pushing off
• You cannot bear weight on the foot
• Any open wound, blister or sore on the foot if you have diabetes
• Signs of infection: spreading redness, heat, swelling, fever
• Numbness, coldness or colour change in the foot
• Heel pain that started after a fall or accident

Book a routine appointment if:

• Pain that has not started to improve after about 2 to 3 weeks of self-care
• Pain that is stopping you from walking, working or doing the activities you enjoy
• Pain that keeps waking you at night
• Pain in both heels, or pain with swelling in other joints
• Heel pain in a child that is affecting sport or causing a limp
• You are unsure what is causing the pain or how to manage it

Diagnosis

A doctor or podiatrist will usually start by asking about your pain — when it started, what makes it better or worse, and what you do in a typical day. They will look at how you stand and walk, check the shape of your feet, and press gently on different parts of the heel and foot to find the sore spot. They may also check the strength and tightness of your calf muscles and Achilles tendon. Often this is all that is needed, because the cause is usually clear from the story and examination.

Tests that may be done

• Physical examination of the foot, ankle and lower leg
• Watching you walk to look for changes in how you put your weight down
• An X-ray if a fracture, bone problem or arthritis is suspected
• An ultrasound scan, which can show problems in the tendons and soft tissue
• Blood tests if the doctor thinks inflammation or another condition may be involved
• Rarely, other scans such as MRI if the diagnosis is unclear or pain is not improving

What to expect at your appointment

The appointment is usually quick and painless apart from some tenderness when the doctor presses on the sore area. You may be asked to walk a few steps in bare feet. Most people leave with a clear explanation and a plan for self-care, and are not sent for scans straight away — scans are only useful when the cause is unclear or the usual treatment is not working.

Treatment

Most heel pain settles with time and simple steps you can take at home. The aim is to reduce the load on the sore area while keeping the foot and leg strong and mobile. Treatment usually starts with rest from the activities that hurt, better footwear and gentle stretching. If that is not enough, a physiotherapist or podiatrist can help with a more tailored programme. Surgery is only considered in a small number of cases after many months of other treatment.

Self-care at home

• Rest from the activities that make the pain worse, and swap to low-impact movement such as swimming or cycling
• Wrap an ice pack in a cloth and hold it on the sore area for up to 15 to 20 minutes, a few times a day
• Wear shoes with a cushioned sole and good arch support — avoid walking barefoot on hard floors, and avoid worn-out or very flat shoes
• Try heel cups or soft insoles from a pharmacy to take pressure off the heel
• Gently stretch your calf and the sole of your foot, especially before your first steps in the morning
• Build activity back up slowly rather than all at once
• If you are carrying extra weight, losing some can reduce the load on your heels — ask your doctor or pharmacist for support with this
• Keep a simple note of what makes the pain better or worse so you can see progress

Medical treatments

If self-care is not enough, your doctor may refer you to a physiotherapist or podiatrist. They can teach you specific strengthening and stretching exercises, advise on footwear and insoles made for your feet, and suggest taping or a night splint that gently stretches the tissue while you sleep. Some specialists offer other approaches such as shock wave therapy or an injection into the sore area to calm inflammation. These are only used in certain cases and are not right for everyone, so your clinician will explain the benefits and risks. Your doctor may also review other conditions, such as diabetes or arthritis, that could be adding to the problem. Always ask your doctor or pharmacist before starting any medicine, including pain relief bought over the counter.

When is surgery considered?

Surgery is rarely needed for heel pain. It may be discussed if the pain has lasted many months, other treatments have not helped, and the diagnosis is clear. It is a decision to make carefully with a specialist, because recovery takes time and surgery carries risks. Most people get better without it.

Living with this condition

Heel pain can be frustrating because it affects something you do all day — walking. Plan your day so you are not on your feet for long stretches without a rest, and keep a pair of supportive shoes by the bed so you are not walking barefoot on hard floors first thing. Going slowly and steadily with activity is usually better than bursts of doing a lot when you feel better.

Lifestyle tips

• Choose shoes with a firm back, a cushioned sole and some arch support for everyday wear
• Break up long periods of standing or walking with short rests and gentle stretches
• Warm up gently before exercise and build up new activities gradually
• Keep your calf muscles and feet flexible with simple daily stretches
• If you are carrying extra weight, aim for gradual, realistic changes rather than crash diets
• Check your feet regularly if you have diabetes, and look after any cuts or blisters

Diet and exercise

There is no special diet for heel pain, but eating a balanced diet and staying active at a healthy weight takes strain off your feet. Choose movement that does not pound the heel while you recover — swimming, cycling, and gentle strength work are good options. As the pain settles, add walking and standing back slowly. Strong calf and foot muscles protect the heel in the long run, so gentle strengthening is part of getting better, not just something to do afterwards.

Mental health and emotional wellbeing

Ongoing pain can wear you down, affect sleep, and make everyday plans harder. It is normal to feel frustrated or low when something as simple as walking hurts. Tell your doctor if the pain is affecting your mood or sleep — support is available, and talking about it helps. If you are struggling with your mental health, please reach out to a local mental health service or crisis line in your country, or speak to your doctor.

Prevention

You cannot always prevent heel pain, but you can lower the odds. Good shoes, gradual increases in activity, keeping your calf muscles flexible, and staying at a healthy weight all help protect your heels. If you have had heel pain before, build these habits into your routine rather than waiting for it to return.

Screening programmes

There is no routine screening test for heel pain. If you have diabetes, regular foot checks with your healthcare team are important, because nerve damage and poor healing can make foot problems harder to notice.

Complications

If left untreated

• Pain that lasts for months and makes walking, working or exercise difficult
• Changes in how you walk, which can put strain on your knees, hips or back
• Weakness or tightness in the calf and foot muscles from avoiding movement
• In a small number of cases, a tear in the plantar fascia or Achilles tendon
• Skin problems or falls if you are limping or unsteady
• In people with diabetes, a small wound or blister that goes unnoticed and becomes serious

Long-term outlook

The good news is that heel pain usually gets better. Many people notice a clear improvement within a few weeks of starting self-care, and most are much better within a few months, even if progress feels slow at times. Some people have flare-ups now and then, especially when they suddenly do more than usual. If your pain is not improving, or keeps coming back, speak to your doctor or a physiotherapist — there is almost always something more that can be tried, and surgery is rarely needed.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.