Heel pain is one of the most common foot problems, and plantar fasciitis is its most frequent cause. Most heel pain improves without surgery, though healing often takes months.
Some heel pain needs prompt care. MedlinePlus advises contacting a provider for sudden, severe foot pain; an injury after which you can’t put weight on the foot; a red or swollen joint, an open sore or a fever; or any foot pain if you have diabetes or poor blood flow. The American Academy of Orthopaedic Surgeons (AAOS) says a sudden pop at the back of the calf or heel may mean the Achilles tendon has torn; see a doctor right away.
In the video above, Southwest Foot & Ankle Center, the Lewisville, Texas, practice of podiatrist and foot and ankle surgeon Dr. Reza Mobarak, introduces heel pain. The information below comes from the patient-education sources listed at the end of this article.
Plantar fasciitis: the most common cause
The plantar fascia is a thick band of tissue that runs along the sole from the heel to the toes and supports the arch. Too much strain can cause tiny tears, and the tissue becomes irritated and inflamed.
Typical signs include:
- pain under the heel, and sometimes in the arch
- pain that’s worst with the first steps in the morning or after sitting, then eases after a few minutes of walking
- pain after long periods on your feet, or after exercise rather than during it
Risk factors include flat feet or high arches, tight calves or a tight Achilles tendon, extra body weight, long hours standing on hard floors, high-impact activities such as running, a sudden jump in activity, and shoes with poor arch support.
Other causes to know
Not all heel pain is plantar fasciitis.
- Achilles tendinitis. Overusing the tendon that joins the calf to the heel bone can cause pain and stiffness at the back of the heel or just above it, often worse in the morning and with activity.
- Heel spurs. These bony growths under the heel bone show up on X-ray. Cleveland Clinic says about 15% of people have one, and most don’t hurt. AAOS notes that spurs don’t cause plantar fasciitis pain.
- Stress fracture. A tiny crack in the bone from repeated strain, such as a sudden increase in exercise. The pain usually builds over time and worsens with weight-bearing. AAOS says a heel stress fracture can mimic plantar fasciitis, and that ignoring one can let the bone break completely.
- Nerve problems. Less common, nerve pain tends to burn, tingle or feel electric, and can cause numbness. In tarsal tunnel syndrome, a nerve is pinched on the inside of the ankle; left untreated, it can cause permanent nerve damage.
- Other causes include bursitis, a bony bump at the back of the heel (Haglund’s deformity), a bone bruise and arthritis. In children around ages 8 to 14, a common cause is Sever’s disease, an irritated growth plate at the back of the heel.
A doctor will ask about your symptoms and examine your foot. X-rays can help rule out fractures and arthritis.
Home care
- Rest and switch activities. Cut back on what hurts. Cycling or swimming can take the place of running.
- Stretch. AAOS describes stretching the calves and plantar fascia as the best way to relieve the pain.
- Ice the sore heel for short sessions a few times a day, with a thin towel between the ice and your skin.
- Wear supportive shoes with good arch support and cushioning, avoid going barefoot, and replace shoes with worn-down heels or soles.
- Ask about pain relievers. Over-the-counter anti-inflammatory medicines can ease pain and swelling; check with your doctor before starting one.
- Manage your weight. Losing extra weight can take pressure off the heel.
Treatments a podiatrist may use
A podiatrist (doctor of podiatric medicine, or DPM) treats problems of the foot, ankle and lower leg, including with surgery. If pain continues after several weeks of home care, a foot and ankle specialist may suggest:
- padding, taping or strapping
- over-the-counter or custom orthotics (shoe inserts)
- a night splint that keeps the foot stretched overnight to ease morning pain
- physical therapy
- a removable walking cast or boot for a few weeks
- a corticosteroid injection in some cases, though AAOS notes these shots can weaken the plantar fascia and lead to a tear
- shockwave therapy or platelet-rich plasma (PRP) injections, newer options with mixed or limited evidence
Surgery is rarely needed. AAOS says it is generally saved for people who haven’t improved after 12 months of thorough nonsurgical care. Options include partly releasing the plantar fascia or lengthening a tight calf muscle.
How long recovery takes
AAOS reports that more than 90% of people with plantar fasciitis improve within 10 months of starting simple treatments; MedlinePlus says most improve within 6 to 18 months. Because the underlying causes can remain, the American College of Foot and Ankle Surgeons (ACFAS) calls supportive shoes, stretching and custom orthotics the core of long-term care.
When to see a doctor
Make an appointment if heel pain:
- doesn’t improve after a few weeks of rest and home care
- makes walking or daily activities hard
- comes with redness, swelling or warmth that doesn’t go away
- burns, tingles or comes with numbness
Get care right away for the warning signs at the top of this article.
Questions to ask your doctor
- What do you think is causing my heel pain, and do I need an X-ray?
- Which stretches should I do, and how often?
- What shoes or inserts should I use, and which activities should I cut back on?
- Would a night splint, physical therapy or an injection help me?
- How long should recovery take, and what’s next if I’m not getting better?
- How can I keep heel pain from coming back?
Dr. Mobarak is a podiatrist and foot and ankle surgeon at Southwest Foot & Ankle Center in Lewisville, Texas. See Dr. Mobarak’s Best Docs Network profile for more about the practice.
Sources
- Cleveland Clinic. Heel Pain.
- Cleveland Clinic. Heel Spurs.
- Cleveland Clinic. Tarsal Tunnel Syndrome.
- Cleveland Clinic. What Is a Podiatrist?.
- American Academy of Orthopaedic Surgeons, OrthoInfo. Plantar Fasciitis and Bone Spurs.
- American Academy of Orthopaedic Surgeons, OrthoInfo. Achilles Tendinitis.
- American Academy of Orthopaedic Surgeons, OrthoInfo. Stress Fractures of the Foot and Ankle.
- American College of Foot and Ankle Surgeons, Foot Health Facts. Plantar Fasciitis.
- American College of Foot and Ankle Surgeons, Foot Health Facts. Heel Pain.
- American College of Foot and Ankle Surgeons, Foot Health Facts. Tarsal Tunnel Syndrome.
- American Podiatric Medical Association. Heel Pain.
- American Academy of Family Physicians, familydoctor.org. Plantar Fasciitis.
- MedlinePlus (U.S. National Library of Medicine). Plantar fasciitis.
- MedlinePlus (U.S. National Library of Medicine). Foot pain.
This article is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
