Heel pain

What is heel pain?

Heel pain is discomfort felt anywhere in or around your heel, from underneath it to the back where it meets your ankle. It's a common problem, most often down to everyday strain rather than anything serious, but occasionally it can point to a fracture or another condition needing medical treatment.

What are the common causes of heel pain?

Most heel pain comes down to repeated strain on the tissues and tendons around your heel, particularly if you're:

• overweight
• spending long stretches standing or walking, especially on hard flooring
• wearing unsupportive, flat or hard-soled shoes
• doing more exercise or activity than you're used to.

Other contributing factors include tight calf muscles or a stiff ankle, high-arched or flat feet, which absorb the shock of walking less well, and a previous injury to the heel.

Less often, heel pain is linked to arthritis affecting the ankle or subtalar joint, or comes as part of a wider condition such as rheumatoid disease or ankylosing spondylitis, where inflammation can develop at the point where a tendon attaches to bone.

Are there different types of heel pain?

Where exactly you feel the pain, and how it started, can indicate the type of heel pain:

• Plantar fasciitis: This is characterised by pain under your heel which is worse with your first steps and eases as you keep moving. It's by far the most common cause. It happens when the band of tissue running under your foot becomes irritated from repeated stress.
• Achilles tendonitis: This is when there is pain towards the back of your heel that also spreads up into your calf and ankle area.
• Bursitis: This is a dull, aching heel that looks red and puffy.
• Injury such as a broken heel or torn Achilles: A sudden, sharp pain accompanied by swelling, an audible pop or snap as it happened, and trouble putting weight on your foot is more likely a break in the heel itself or a torn Achilles tendon, and needs prompt attention rather than home treatment.

How is heel pain diagnosed?

Most of the time, a clinician can diagnose plantar fasciitis and similar problems just from talking to you and examining your foot, without needing a scan. If imaging is used, it's usually an ultrasound to look directly at the affected tissue.

An X-ray sometimes shows a small bony growth called a heel spur, though this tends to be a red herring: spurs show up almost as commonly in people who have never had any heel trouble, so they aren't considered the real culprit, and removing one rarely helps. Blood tests may be arranged if an inflammatory joint condition seems likely.

How is heel pain treated?

For everyday heel pain, self-care usually comes first:

• rest and keep your foot raised when you can – cool the area with something like a chilled, damp cloth or a wrapped ice pack for around 20 minutes, repeating every couple of hours or so
• rolling your foot over a frozen water bottle can reduce plantar fasciitis pain by combining ice therapy with a gentle tissue stretch
• switch to well-cushioned, wide footwear that sits low at the back, and slip in some soft padding or heel cups for extra comfort – also avoid walking bare foot
• do regular gentle stretches for your calf and the sole of your foot, and keep these up even once the pain has settled, since stopping too soon is a common reason it comes back
• take paracetamol, or an anti-inflammatory gel or tablets if needed, checking with a pharmacist first if you're thinking of regular use
• work towards a healthy weight if you're carrying extra pounds, since this reduces the load on your heel.

Give this a few weeks, since heel pain can take many months to settle fully regardless of treatment. If it isn't improving, a GP or podiatrist might suggest a night splint to stop your calf and foot tightening overnight; taping or strapping for extra support; or a course of physiotherapy.

A steroid injection can ease pain in the short term, though it can leave your heel more sore for a few days first, and carries a small risk of thinning the fat pad or weakening the tissue with repeated use.

Surgery to release the tight tissue is rarely needed, and is really only considered once other treatments have been tried for many months without success.

When should you see a doctor?

See a GP if your heel pain is:

• severe
• stopping you from getting on with normal activities
• keeps coming back or is getting worse
• hasn't improved after two weeks of trying the self-care steps above
• comes with tingling or numbness in your foot. It's also worth getting checked promptly if you have diabetes, since foot problems can become more serious more quickly when you suffer from this condition.

Contact NHS 111 without delay if:

• heel pain follows an injury and is severe
• the pain leaves you feeling faint, dizzy or queasy
• your foot or ankle now looks a different shape
• you noticed a snap, grind or pop the moment it happened
• you're unable to walk, rise onto your toes, or manage stairs.

Swelling and bruising tracking up into your calf and ankle is also worth same-day advice as this points towards a fracture or a torn Achilles tendon.