Pain In Her Heels

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Many conditions, including plantar fasciitis and Achilles tendinitis, cause heel pain. A sore heel is a common foot and ankle complaint. Rest, orthotics and stretching ease pain over time. If you ignore and don't treat heel pain, you may develop chronic problems that require a longer recovery. Heel pain rarely needs surgery.
Heel pain is a common foot and ankle problem. Pain may occur underneath the heel or behind it. Many conditions can cause pain in the heels, including:
It’s important to have a medical evaluation to help you determine the exact cause of your heel pain so that the proper treatment regimen can begin.
Heel pain can make it difficult to walk and participate in daily activities. Most painful heel conditions improve with nonsurgical treatments, but your body needs time to recover.
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More than 2 million Americans experience heel pain every year. The problem affects people of all ages and genders.
You might experience pain, soreness or tenderness anywhere in the heel. You typically feel heel pain:
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Several problems can cause pain to develop in the back of the heel:
Problems that cause pain underneath the heel include:
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Anything that puts a lot of pressure and strain on your foot can cause heel pain. The way you walk (foot mechanics) and your foot's shape (foot structure) are also factors.
You may be more likely to develop heel pain if you:
Heel pain symptoms vary depending on the cause. In addition to pain, you may experience:
Your healthcare provider will assess your symptoms and perform a physical exam. You may also get X-rays to check for arthritis, bone fractures, bone alignment and joint damage.
Rarely, you may need an MRI or ultrasound. These can show soft tissue problems which X-rays don’t reveal.
Heel pain can interfere with your ability to get around, work, exercise and complete daily tasks. When it hurts to move, you can become sedentary. An inactive lifestyle can lead to weight gain. You may also become depressed because you can’t do the things you love.
Untreated Achilles tendonitis can cause the tendon to break down (tendinosis). In time, the Achilles tendon can tear or rupture. This problem may require surgery.
Most problems that cause heel pain get better over time with nonsurgical treatments. Therapies focus on easing pain and inflammation, improving foot flexibility and minimizing stress and strain on the heel. These treatments include:
It’s rare to need surgery to treat most causes of heel pain.
To prevent heel pain or keep pain from returning, it’s important to keep your foot and heel tendons flexible. You should stretch regularly and wear properly fitted, supportive shoes. Runners are especially prone to heel pain. You can prevent running injuries by covering fewer miles and running on softer surfaces.
Heel pain typically goes away with nonsurgical treatments, but recovery takes time. You need to be patient and give your body time to mend. If you return to your usual activities too quickly, it can set back your recovery. In rare situations, you may need surgery.
You should call your healthcare provider if you experience:
You may want to ask your healthcare provider:
Heel pain often improves over time with nonsurgical treatments. Your healthcare provider can determine what’s causing the pain. Your provider can also show you stretching exercises and recommend orthotics and other methods if needed. Many people try to ignore heel pain and continue with activities that make the problem worse. But it’s essential to give your body time to recover. Otherwise, you may develop chronic heel pain that sidelines you for an extended time. The longer you have heel pain the harder it is to effectively treat, so it’s important to get evaluated.
Last reviewed by a Cleveland Clinic medical professional on 04/09/2021.
American Academy of Orthopaedic Surgeons. Arthritis of the Foot and Ankle. Accessed 4/12/2021.
American Academy of Orthopaedic Surgeons. Heel Pain. Accessed 4/12/2021.
American College of Foot and Ankle Surgeons. Heel Pain: Plantar Fasciitis. Accessed 4/12/2021.
American Orthopaedic Foot and Ankle Society. Heel Pain. Accessed 4/12/2021.
American Podiatric Medical Association. Heel Pain. Accessed 4/12/2021.
Priscilla T, Bytomski J. Diagnosis of Heel Pain. American Family Physician. 2011;84(8):909-16. Accessed 4/12/2021.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
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Causes of Heel Pain and Treatment Options
Verywell Health's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Ⓒ 2021 About, Inc. (Dotdash) — All rights reserved
Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery.
Medically reviewed by Stuart Hershman, MD on February 09, 2020
Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction.
Heel pain is an extremely common complaint, and there are many potential causes, ranging from conditions that affect the actual heel bone, like a bruise or stress fracture, to conditions that affect structures near it, like plantar fasciitis or Achilles tendonitis. The pain can be throbbing and simply annoying, stabbing and debilitating, or something in between depending on what's behind it and the severity of your case.
Your heel bone—called the calcaneus—lies at the back of the foot beneath the ankle. Along with surrounding tissues and another small bone called the talus, your heel bone works to provide balance and side-to-side movement of the back of the foot.
But because the anatomy of your foot is rather complex, your family doctor, podiatrist, or orthopedist will consider issues related to bones, soft tissues, nerves, and skin that comprise your entire foot and ankle when working to find the reason behind your discomfort.
Considering this, it's probably no surprise that there are many potential causes of your heel pain that may be suspected. While deciding which applies to you is best left to your doctor, knowing more about them can help you prepare for that conversation.
The two most common causes of heel pain are plantar fasciitis and Achilles tendonitis.1
Plantar fasciitis refers to irritation and inflammation of the tight tissue band that forms the arch of the foot and connects your heel bone to the base of your toes. The severe, stabbing, or throbbing pain of plantar fasciitis is felt on the bottom of the heel and occurs upon weight-bearing after rest, such as when taking your first steps in the morning or when standing up after prolonged sitting.2
If plantar fasciitis persists for a long time, a heel spur—a bony protrusion—may form where the fascia connects to your heel bone.2 Rarely, the plantar fascia may tear (rupture). The pain of plantar fascia rupture is severe, sharp, and sudden, and there may be swelling and bruising present as well.
Achilles tendonitis refers to inflammation of the Achilles tendon—a large, cord-like tendon that attaches to the back of your heel bone.
The tightening or burning pain of Achilles tendonitis is located at the part of the tendon that is slightly above the heel bone. Mild swelling around the tendon and morning stiffness in the heel and calf are also often experienced.
Achilles tendonitis most commonly develops from overuse (e.g., running too much and/or not warming up your calf muscles).3 Bone spurs from wearing poor-fitting shoes or arthritis may also lead to Achilles tendonitis.
Rarely, the Achilles tendon ruptures; this typically occurs as a result of engaging in a vigorous type of physical activity where the foot pivots suddenly (as in basketball or tennis). Besides severe heel pain, some people report hearing a "pop" or "snap" when the tendon tears.4
Other causes of heel pain must also be considered, even if you've experienced this discomfort and gotten one of the above diagnoses before:
Tarsal tunnel syndrome is a nerve condition in which a large nerve in the back of the foot becomes pinched.5 Tarsal tunnel pain, described as aching or burning, may be felt in the heel but is more common in the bottom of the foot and near the toes. Similar to carpal tunnel syndrome in the hand, numbness and tingling may be present, and the pain is often worse at night.
Stress fractures of the foot and heel commonly occur in athletes or long distance runners who increase their running mileage over a short period of time. Repeated stress on the heel bone eventually leads to a break.6
Other factors that increase a person's chance of developing a stress fracture include:
A stress fracture causes significant pain that intensifies with activity and improves with rest. In addition to pain, swelling may be present, along with tenderness felt in the area of the bone break.
A heel pad bruise causes a sharp pain over the bottom of the heel.7 It may occur after trauma (e.g., landing from a high fall or stepping on a stone) or excessive weight-bearing exercises (e.g., running long distances in poorly cushioned shoes).
In older adults, the cushioning fat of your heel pad may atrophy or breakdown. Unlike plantar fasciitis, the pain of fat pad atrophy is absent in the morning but worsens with activity during the day.8
Heel pad syndrome is due to thinning of this fat pad that results from trauma, such as the consistent pounding of the foot in marathon runners or pressure put on the foot due to obesity. This causes a deep, aching pain felt in the middle of the heel that worsens with weight-bearing activity.
Haglund's Syndrome (With or Without Bursitis)
Haglund's syndrome, also referred to as "pump bump," occurs when a bony prominence at the back of the heel rubs against rigid shoes.9
It's unclear why some people develop this bony bump, but experts suspect it may be due to a tight Achilles tendon, high arch of the foot, wearing tight or poorly fitted shoes, and/or heredity.
The pain of Haglund's syndrome is felt at the back of the heel and may be associated with limping and signs of inflammation like swelling, warmth, and redness.10 As the soft tissue surrounding the bony bump at the back of the heel gets irritated, bursitis may develop.
There are two types of heel bursitis:
Retrocalcaneal bursitis causes pain deep in the back of the heel, while calcaneal bursitis pain is felt on top of to the side of your Achilles tendon.
The sinus tarsi, referred to as "the eye of the foot," refers to the space on the outside of the foot between the ankle and heel bone. This space, while small, contains several ligaments, as well as fatty tissue, tendons, nerves, and blood vessels.
Rolling out your ankle often triggers this syndrome, which may lead to pain with weight-bearing activities, a sensation of ankle looseness, and difficulty walking on uneven surfaces, like grass or gravel.12
These heel diagnoses are rare, but worth keeping in the back of your mind:
Piezogenic papules are painful, yellow or flesh-colored heel bumps that represent fat from deep within the skin pushing through the heel capsule (called fat herniation). The papules are benign and only cause pain in less than 10 percent of cases.13
The cause is unknown, although experts suspect the papules may result from a hard heel strike during walking. Interestingly, they are a characteristic skin finding in people with the connective tissue disease Ehlers-Danlos syndrome.13
Rarely, an infection of the heel bone (called osteomyelitis) may cause pain—although, unlike most other sources of heel pain, the pain from an infection of the heel bone is usually constant. A fever may also be present.14
A tumor in the heel bone may cause pain, usually reported as deep, boring, and worse at night.15
If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, seek medical attention.
Here are some definite signs that you should be evaluated by a doctor:
Most heel conditions can be diagnosed with a medical history and physical examination alone. In certain cases, though, additional tests like imaging studies and/or blood tests are warranted.
A detailed medical history is often the crux for diagnosing heel pain. With that, it's sensible to come prepared to your doctor's appointment with answers to these basic questions:
During your physical exam, your doctor will inspect and press on ("palpate") various areas of your foot, including your heel, as well as your ankle, calf, and lower leg. By doing this, she can check for areas of focal tenderness, swelling, bruising, rash, or deformity. She will also likely evaluate your gait, as well as move your foot and ankle around to see if that elicits pain.
While blood tests are not commonly ordered for the diagnosis of heel pain, your doctor may order one or more laboratory studies if she suspects or wants to rule out a particular condition. A C-reactive protein (CRP) test is the most commonly ordered to rule out an infection.
An X-ray of the heel may be ordered to diagnose certain conditions like a stress fracture of the heel, Haglund's syndrome, heel spur, or bone tumor. Less commonly, other imaging tests are used. For instance, magnetic resonance imaging (MRI) may be used to diagnose a soft-tissue injury or an infection.16
While it is reasonable to think that heel pain must stem from your heel, this is not always the case. Sometimes pain is referred to the heel, as in certain neurological conditions.
Irritation of a nerve in the lower back (called radiculopathy) may cause pain of the calf muscle that moves down the leg into the heel. In addition, peripheral neuropathies associated with diabetes, alcohol abuse, or a vitamin deficiency can cause diffuse foot and heel pain.17
Besides a neurological exam, an MRI or nerve conduction studies may be ordered to diagnose nerve problems.
Skin problems, like an infection of the hindfoot or ankle (cellulitis), plantar wart, diabetic ulcers, or fungal foot infection (e.g., chronic athlete's foot) can cause discomfort in the heel or sole of the foot.18 A medical history and physical exam are usually sufficient to diagnose a skin problem of the heel, although blood tests or a biopsy of the affected area may be needed.
Whole-body inflammatory diseases like sarcoidosis, rheumatoid arthritis, or reactive arthritis may cause heel pain.19 Oftentimes, other symptoms are present with these systemic diseases, such as fever, rash, and joint pain and inflammation. Laboratory and imaging studies are also used to diagnose systemic diseases.
Treatment depends entirely on the root cause of your heel pain. If you are unsure of your diagnosis, or how severe your condition is, be sure to seek medical advice before beginning any treatment plan.
Some common treatments are listed here—but keep in mind, not all of these are appropriate for every condition.
For more acute causes of heel pain, such as a heel bruise, avoiding the precipitating activity—for example, take a few days off jogging or prolonged standing/walking—may be all you need to feel better. In other instances, resting can help to eliminate the most severe pain until you are able to see your doctor or a podiatrist.
For most sources of heel pain, applying an ice pack over the heel for 20-minute intervals up to four times daily can help diminish swelling and soothe your pain. Be sure to place a thin towel between the ice pack and the skin of your heel.
Taping the foot with sports tape or hypoallergenic tape is useful for certain heel diagnoses like plantar fasciitis, heel pad bruise, and heel pad syndrome.20
For plantar fasciitis, your doctor may recommend a taping technique involving four strips of tape that get applied around the foot and heel. The tape should not be applied too tightly and can stay in place for one week.
Many acute Achilles tendon ruptures are treated by placing the limb in a cast with the foot in equinus (toes pointing down).
Exercises and stretches are designed to relax the tissues that surround the heel bone. Some simple exercises, performed in the morning and evening, often help patients feel better quickly.
For Achilles tendonitis, your doctor may refer you to a physical therapist who uses a specialized exercise program called the Alfredson protocol, which focuses on eccentric loading of your Achilles tendon.21
Depending on the cause of your heel pain, various foot supports may be recommended by your doctor.22
For instance, for plantar fasciitis, your doctor may recommend wearing splints at night to keep your foot straight. Moreover, wearing sturdy, comfortable shoes (ones with a good arch and heel support) and/or wearing special shoe inserts (e.g., gel pad inserts or heel cups) may also be helpful for easing the pain of plantar fasciitis.
Likewise, heel wedges or shoe orthotics may be recommended for the treatment of Achilles tendonitis. For Haglund's syndrome, your doctor may recommend alteri
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