Heel Pain: Common Causes

What Are the Most Common Causes of Heel Pain?

Heel pain can have different causes, and each case requires an individualised approach. The most common causes include:

1. Plantar Fasciitis

This is the most common cause of pain in the underside of the heel. It is caused by inflammation of the plantar fascia, a thick band of connective tissue that connects the sole of the foot to the heel. The pain is usually more severe in the morning, during the first steps, and decreases as the day progresses. In some cases, a heel spur may also be present, which is a bony protrusion that causes chronic irritation of the plantar fascia.

2. Achilles Tendinitis

This is inflammation of the Achilles tendon at the back of the heel. It often affects athletes or individuals who suddenly increase their level of physical activity. It is associated with severe pain during push-off, stiffness and sometimes redness or swelling in the area.

3. Tarsal Tunnel Syndrome

This is a neurological condition in which the tibial nerve becomes compressed within the tarsal tunnel. Heel pain is often accompanied by numbness, burning or an “electric shock” sensation in the sole of the foot.

4. Injuries and Trauma

Ankle sprain, a fall from a height or prolonged overuse may cause injury to the ligaments and soft tissues around the heel. The pain is often accompanied by local swelling and tenderness on pressure.

5. Other Causes

• Poor support from footwear
• Foot deformities, such as flat feet or valgus deformity
• Rheumatological conditions, such as spondyloarthritis or psoriatic arthritis
• Stress injuries (stress fractures) in athletes

Which Symptoms Require Medical Assessment?

If heel pain:

• Persists for more than 2 weeks, despite rest
• Is accompanied by swelling, redness or warmth in the area
• Significantly affects walking or balance
• Wakes the patient during the night

then immediate assessment by a specialised orthopaedic surgeon is recommended.

Treatment of Heel Pain

Treatment depends on the cause and severity of the condition. In most cases, conservative treatment is sufficient:

1. Rest and Activity Modification

Avoid high-impact activities (such as running or jumping) and allow the body time to recover.

2. Ice Therapy

Apply ice to the heel for 15-20 minutes, 2-3 times a day, to relieve inflammation.

3. Anti-inflammatory Medication

Non-steroidal anti-inflammatory drugs can reduce pain and inflammation.

4. Physiotherapy

Specific stretching exercises (for the Achilles tendon and plantar fascia), strengthening of the foot muscles and therapeutic exercise for rehabilitation.

5. Special Orthopaedic Footwear

Customised footwear provides support and proper pressure distribution across the heel, significantly improving walking.

6. Injection Therapies

In some cases, cortisone injections or biological agents (PRP) may be administered to reduce inflammation and promote healing.

7. Surgical Treatment

Surgery is rarely required, but it may be necessary in cases of a heel spur causing severe functional impairment or extensive Achilles tendinopathy that does not respond to conservative treatment.

Prevention of Heel Pain

To reduce the likelihood of developing heel pain:

• Wear appropriate footwear with adequate shock absorption.
• Do not neglect stretching before and after exercise.
• Maintain a healthy body weight to reduce pressure on the feet.
• Incorporate a variety of low-impact exercises, such as swimming or cycling, to minimise strain.

Read also: Ankle Pain Without Injury, The Most Common Running Injuries and Knee Surgery: Frequently Asked Questions. More answers in the frequently asked questions.