Here we explain the common causes of heel pain, including under the heal and at the back of the heel. We also outline other conditions with symptoms of pain under the heel, which shoulder not be missed.
Is your pain under the heel or at the back of the heel?
Pain under the heel
Pain under the heel is usually (but not always) gradual onset and related to overuse. The following injuries are common causes of pain under the heel:
Probably the most common cause of pain under the heel is Plantar fasciitis. A combination of treatment approaches is best including plantar fasciitis taping, heel pads, cushioning insoles, orthotic inserts, stretching exercises, a night splint, plantar fasciitis massage and more. Symptoms include:
- Pain under the heel which is worse first thing in the mornings.
- As your foot warms up, pain eases, only for it to return later in the day.
- Pain may also radiate into the arch of your foot.
More on Plantar Fasciitis
Bruised heel, also known as fat pad contusion is another common heel injury with symptoms similar to plantar fasciitis including:
- Gradual onset pain under the heel. However, a bruised heel may also occur from an acute and severe impact such aslanding from a height on your heels.
- Pain becomes worse with use, but eases with rest.
- Pain does NOT radiate into the arch of your foot as it does with plantar fasciitis.
Rest is the key to recovery and a bruised heel taping technique can help by protecting the soft tissues under the heel.
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A heel spur is a bony growth on the heel which can occur alongside plantar fasciitis and has identical symptoms. However, it is a separate injury and a heel spur can occur without any symptoms, likewise, plantar fasciitis can occur without the presence of a heel spur. Symptoms consist of:
- Pain under the heel
- Pain radiates into the arch of your foot. A foot Xray will be needed to confirm the diagnosis.
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Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is caused by pressure on the posterior tibial nerve as it passes on the inside of the ankle. Symptoms include:
- Burning pain in the heel that can radiate into the arch of your foot.
- The sole of the foot may feel numb or have pins and needles.
Treatment involves rest and identifying the underlying cause of the condition. Most are treated with cold therapy, physical therapy, and biomechanical assessment, however, injections and surgery are required in some cases.
More on Tarsal Tunnel Syndrome
Calcaneal Stress Fracture
Less common than a bruised heel, a stress fracture is a hairline fracture in the big heel bone (calcaneus). Symptoms include:
- Heel pain which occurs gradually over time.
- Pain gets worse with weight-bearing activities like running or jumping.
- Often a stress fracture cannot be seen on an X-ray until it has started to heel which occurs following a significant period of rest.
A stress fracture is an overuse injury commonly seen in soldiers, roadrunners and dancers.
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A calcaneal fracture can be caused by a fall or jumping from a great height. Sudden heel pain at the time of impact.
- Severe pain, swelling and bruising are the main symptoms.
- This is a serious heel injury and needs urgent medical care.
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Lateral Plantar Nerve Entrapment
Lateral plantar nerve entrapment in pinching or compression of a nerve in the foot. Symptoms include:
- Pain which radiates into the lower, inside of your heel and inner ankle.
- Numbness in the heel is not normally a symptom plantar nerve entrapment.
- Patients with poor foot biomechanics are more susceptible to this injury. Athletes who overpronate where the foot rolls in or flattens will increase the likelihood of causing the nerve to be compressed.
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Medial calcaneal nerve entrapment
Medial calcaneal nerve entrapment, often called ‘Baxter’s nerve’ has similar symptoms to that of tarsal tunnel syndrome. It is caused by compression of a nerve in the foot. Symptoms consit of:
- Pain which radiates from the inside, out towards the centre of the heel.
- You may feel a burning pain below the medial malleolus (bony bit on the inside of the ankle).
- Pain may also radiate under the sole and into the arch of the foot.
- Activities such as running will usually aggravate the condition.
- You may have tenderness when pressing in over the medial malleolus.
- A positive sign for tinels test will be seen on examination.
Pain at the back of the heel
The following injuries are common causes of pain at the back of the heel:
This largely affects children aged 8-15 years old, especially if they do a lot of sport. Symptoms consist of:
- Pain and tenderness at the back of the heel which gets worse with exercise.
- Sometimes a lump is seen at the back of the heel.
- Squeezing the sides of the back of the heel will feel particularly tender.
Sever’s disease is often linked to a growth spurt when the muscles and tendons can’t keep up with the bone changes.
More on Sever’s Disease
Insertional Achilles Tendonitis
Insertional Achilles Tendonitis causes pain at the back of the heel at the point where the Achilles tendon inserts into the heel bone. The injury is similar to Sever’s disease in children but affects adults. The main symptoms are:
- Pain at the back of the heel
- Sometimes a lump develops where the Achilles tendon inserts into the calcaneus or heel bone.
More on Insertional Achilles tendonitis
Achilles bursitis, also known as Retrocalcaneal bursitis is a common cause of pain at the back of the heel in athletes, particularly runners.
- There will be tenderness and swelling at the back of the heel.
- Swelling will feel ‘spongy’ when pressing it at the sides.
More on Achilles Bursitis
Heel pain – not to be missed!
The following are not common causes, however may cause heel pain symptoms and should not be overlooked.
- Bone and tissue tumours, like osteoid osteoma, are rare and are less likely than the above injuries to be causing the pain. If the pain is persistent, however, medical advice should be sought.
- After a knee or ankle injury, regional complex pain syndrome may cause pain in the heel.
- Spondyloarthropathies are joint diseases that may cause pain in various body parts, including the foot.
- Lemont H, Ammirati KM, Ulsen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003;93(3):234-37
- Riddle DL, Pulisic M, Pidcoe P et al. Risk factors for plantar fasciitis: a matched case-control study.J Bone Joint Surg Br 2003;85-A(5):872-7
- Gonnade N1, Bajpayee A2 et al Regenerative efficacy of therapeutic quality platelet-rich plasma injections versus phonophoresis with kinesiotaping for the treatment of chronic plantar fasciitis: A prospective randomized pilot study. Asian J Transfus Sci. 2018 Jul-Dec;12(2):105-111
- Malahias MA, Cantiller EB, Kadu VV, Müller S. The clinical outcome of endoscopic plantarfascia release: A current concept review. Foot Ankle Surg. 2018 Dec 23. pii: S1268-7731(18)30233-9
- Spears IR, Miller-Young JE, Sharma J et al. The potential influence of the heel counter on internal stress during static standing: a combined finite element and positional MRI investigation. J Biomech 2007;40(12):2774–80.
- Ramponi DR, Baker C. Sever’s Disease (Calcaneal Apophysitis) Adv Emerg Nurs J. 2019 Jan/Mar;41(1):1