Symptom

Heel injury

Heel pain is soreness, tenderness or pain anywhere in your heel, most often underneath it or at the back. It's very common and usually eases with simple self-care, though a few causes need medical treatment.

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What are the common causes of heel injury?

Heel pain is usually caused by repetitive strain rather than a single injury, though a fall or hard landing can also be to blame. Common causes include:

  • Plantar fasciitis: The most common cause, where the band of tissue connecting your heel bone to your toes (the plantar fascia) becomes overstretched or torn, often from running, standing on hard surfaces, a sudden increase in activity, tight calf muscles, unsupportive footwear or being overweight
  • Achilles tendinitis: Overuse inflames the Achilles tendon, which connects your calf muscle to your heel bone – it's more common in runners
  • Heel bursitis: A fluid-filled cushioning sac at the back of your heel becomes inflamed, often from spending a lot of time on your feet, or from a fall or hard landing onto the heel
  • Heel bumps (Haglund's deformity): A bony, firm bump forms on the back of the heel, often made worse by shoes that rub, such as those with a rigid back
  • A fracture: A broken heel bone, usually caused by a fall from a height or landing hard on an uneven surface.

Less common causes include:

  • Tarsal tunnel syndrome: A burning or tingling feeling under the heel, caused by a compressed nerve near the inside of your ankle
  • A stress fracture: A tiny crack in the bone from repetitive stress, more common in runners and people with osteoporosis
  • Chronic inflammation of the heel pad: A dull, worsening ache from a heavy heel strike or a thinning of the fatty padding under the heel
  • Sever's disease: Inflammation where the Achilles tendon attaches to the heel bone, seen in active children roughly between the ages of 8 and 14.

Are there different types of heel injury?

It can help to think about heel pain by where it's felt, since this often points to the cause. Underneath the heel: Usually plantar fasciitis, a bone bruise, a stress fracture, or chronic heel pad inflammation At the back of the heel: Usually Achilles tendinitis, bursitis, or a heel bump To the side of the heel or foot: Less common, and may relate to a stress fracture, a sprain, or a compressed nerve.

How is heel injury diagnosed?

A GP or podiatrist will examine your foot and ask about your pain, your activity levels, your footwear and your medical history. Many causes of heel pain, such as plantar fasciitis, can be diagnosed this way without needing any imaging. If needed, they may arrange:

  • An X-ray: To check for a fracture, arthritis, bone misalignment or a heel spur
  • An ultrasound or MRI scan: Which are rarely needed at first, but can show soft tissue problems that an X-ray cannot.

For suspected tarsal tunnel syndrome, a clinician may tap the nerve just behind your ankle bone. If this brings on your usual burning or tingling feeling, it supports the diagnosis.

How is heel injury treated?

Most heel pain gets better over time with self-care, and surgery is rarely needed.

Self-care

Steps that can help include:

  • resting and raising your heel when you can
  • applying an ice pack, wrapped in a towel, to your heel for up to 20 minutes every 2 to 3 hours
  • wearing wide, comfortable shoes with a low heel and soft sole
  • using soft insoles or heel pads
  • wrapping a bandage around your heel and ankle for support
  • trying regular, gentle stretching exercises
  • taking painkillers such as paracetamol, or ibuprofen as a gel or tablets
  • losing weight if you're overweight.

It's best to avoid walking or standing for long periods, especially barefoot, and to steer clear of high heels or tight, pointed shoes while you recover.

Further treatment

If self-care isn't enough, a podiatrist, physiotherapist or doctor may suggest:

  • Physiotherapy: Including stretching, taping or massage to ease tight tissues and support your foot
  • Orthotics: Over-the-counter or custom-made shoe inserts that take pressure off the painful area
  • A night splint: To keep your foot flexed overnight, which can help with morning pain
  • Steroid injections: To reduce pain and swelling, most often used for plantar fasciitis or bursitis rather than tendon problems
  • A walking boot or cast: For more severe or persistent symptoms, or to allow a fracture to heal
  • Surgery: Rarely needed, but may be considered for chronic plantar fasciitis or a heel bump that hasn't responded to other treatment.

When should I see a doctor?

See a GP if:

  • your heel pain is severe or is stopping you doing normal activities
  • the pain is getting worse or keeps coming back
  • it hasn't improved after 2 weeks of home treatment
  • you have any tingling or loss of sensation in your foot
  • you have diabetes and develop heel pain, as foot problems can be more serious if you have diabetes.

Contact NHS 111 if you:

  • have severe heel pain after an injury
  • feel faint, dizzy or sick from the pain
  • have an ankle or foot that has changed shape or is at an odd angle
  • heard a snap, grinding or popping noise at the time of injury
  • are not able to walk, walk on your tiptoes, or walk up the stairs
  • have swelling and bruising in your calf and ankle.

These last symptoms could be signs of a broken heel bone or broken ankle, so do not try to treat these yourself.

FAQs

  • Is heel pain usually serious?

    No, most heel pain is caused by conditions like plantar fasciitis or Achilles tendinitis, which are uncomfortable but not dangerous and usually improve with self-care. A smaller number of cases, such as a fracture, need medical treatment, so it's worth getting checked if the pain is severe or follows an injury.

  • How long does heel pain usually take to get better?

    It varies by cause, but many people notice an improvement within a few weeks of consistent self-care, such as rest, ice and supportive shoes. If your pain hasn't improved after 2 weeks, it's a good idea to see a GP or podiatrist.

  • What's the difference between plantar fasciitis and Achilles tendinitis?

    Plantar fasciitis causes pain underneath the heel, often worst with your first steps in the morning, and affects the band of tissue that runs along the sole of your foot. Achilles tendinitis causes pain at the back of the heel and affects the tendon connecting your calf muscle to your heel bone.

  • Should I keep exercising if I have heel pain?

    It's usually best to cut back on activities that put repeated stress on your heel, such as running on hard surfaces, until the pain settles. Gentle stretching and low-impact activity are often still fine, and can support your recovery.

  • Do I need an X-ray for heel pain?

    Not usually. Most causes of heel pain, such as plantar fasciitis, can be diagnosed from your symptoms and an examination alone. An X-ray is more likely to be used if a fracture, arthritis or a heel spur is suspected.

  • Can children get heel pain?

    Yes. Sever's disease is a common cause of heel pain in active children, usually between about 8 and 14 years old, caused by inflammation where the Achilles tendon attaches to the heel bone. It's temporary and usually settles with rest and stretching.

Related conditions

Achilles rupture

Achilles tendinopathy

Heel Bone (OS Calcis) Fracture

Heel bone fractures are one of the most common fractures seen by consultants. They often happen as a result of a fall from a height such as a ladder.