The most frequent causes of heel pain are not single injuries, such as a fall or twist, but repetitive or excessive heel pounding.

Tenderness and swelling may be present.

Plantar fasciitis, which is an inflammation of the ligament that is attached to the front of the heel bone and runs forward along the bottom of the foot, can be caused by:

• Feet that flatten and roll inward when walking or running
• Shoes with poor arch support
• Stiff-soled shoes
• Quick turns that put stress on the ligaments
• Too much distance running

Heel bursitis (inflammation of the back of the heel) can be caused by landing hard or awkwardly on the heel, or by pressure from shoes.

Achilles tendonitis, which occurs when the calf muscles repeatedly contract suddenly or with much force, can be caused by:

• Shortening of and lack of flexibility in the calf muscle
• Shoes with inadequate stability or shock absorption
• Sudden inward or outward turning of the heel when hitting the ground
• Running on hard surfaces, such as concrete

• Plantar fasciitis
• Bursitis
• Achilles tendonitis
• Bony spur

For plantar fasciitis, when the pain is usually on the bottom of the foot about 1 to 2 inches from the back edge of the heel:

• Rest as much as possible for at least a week.
• Use over-the-counter analgesics for pain relief, if needed.
• Wear proper-fitting shoes.
• Avoid shoes with excessively low heels.
• A heel cup, felt pads in the heel area, or an orthotic device may help.
• The most important thing to do is refrain from the activity that caused the problem and allow the injury to heal. Be patient; this problem can take a year or more to go away.

For bursitis, when the pain and swelling is just above the back of the heel or on the bottom of the heel near the back edge):

• Rest as much as possible for at least a week.
• Use over-the-counter analgesics for pain relief, if needed.
• Wear new shoes or stretch your old shoes to avoid rubbing against the heel.
• Pressure from the bump may be relieved by applying moleskin to the affected area.

For Achilles tendonitis, when the pain and tenderness is in the Achilles tendon, usually about 2 to 3 inches above the bottom edge of the heel:

• Avoid exercise and apply ice twice a day to the tendon.
• Use over-the-counter analgesics for pain relief and to reduce inflammation.
• Following a week or more of rest, proper stretching is the most important treatment.

If the pain is getting worse despite home treatment, or if there is little progress after a month of home treatment, contact your health care provider.

Your health care provider will obtain your medical history and will perform a physical examination.

Medical history questions documenting heel pain may include the following:

• Time pattern
  • Is this the first time that you have had this type of heel pain?
  • When did the pain begin?
  • If the pain is long term, at what age did pain begin?
  • How long does each episode of pain last?
• Associated complaints: Is there enlargement of the bone?
• Location
  • Is the pain in the joint?
  • Is it in the back of the heel (posterior)?
  • Is the pain on the bottom of the foot about 1 to 2 inches from the back edge of the heel?
  • Is the pain just above the back of the heel or on the bottom of the heel near the back edge?
  • Is the pain only on one side (unilateral)?
  • Is it in the tendon at the back of the heel (Achilles tendon)?
• Quality
  • Is the pain dull and aching?
  • Is the pain sharp and stabbing?
• Aggravating factors
  • Is it worse after you exercise?
  • Is it worse when you are standing?
  • Have you had a fall recently?
  • Have you twisted your foot recently?
  • Are you a runner?
    • How far do you run?
    • How often do you run?
    • Where do you run?
  • Do you walk or stand on your feet often?
  • What kind of shoes do you wear?
• Other
  • What other symptoms are present?
  • Is the heel swollen?

The physical examination will include a detailed examination of the foot and leg.

Diagnostic tests that may be performed include a foot X-ray (extremity X-ray), focusing on the heel.

If either plantar fasciitis or bursitis is diagnosed and if shoe changes and the use of orthotics have not been successful, cortisone injections may be tried. Surgery is a last resort and is seldom necessary.

If Achilles tendonitis is diagnosed, an oral anti-inflammatory medicine may be prescribed. Heel lifts may be used. In particularly unresponsive cases, a walking cast may be helpful. Surgery is not usually necessary.