Heel pain usually comes from conditions like Plantar Fasciitis, Bruised Heel, or Achilles Bursitis. We’ll explore the main reasons for pain at the back and bottom of the heel. We’ll also highlight other often-ignored issues that can cause major heel discomfort.
Medically reviewed by Dr Chaminda Goonetilleke, 20th Jan. 2022
Primary Causes of Heel Pain
Plantar Fasciitis
This condition primarily causes pain at the base of your foot. Symptoms typically manifest gradually and tend to be most severe upon waking or after prolonged periods of inactivity, and may extend into your foot’s arch. The discomfort usually eases as your foot warms up, but it tends to recur later.
Bruised Heel or Fat Pad Contusion
This common heel injury results from overuse or impact, such as landing hard on your heels. It manifests as a gradual onset pain under the heel, worsening with increased walking or running.
Achilles Bursitis or Retrocalcaneal Bursitis
This is a frequent source of pain at the heel’s back, particularly in athletes like runners. Symptoms include a tender, ‘spongy’ feeling of swelling at the heel’s back.
Sever’s Disease
Affecting children aged 8-15 years who engage in frequent sports activities, this disease often associates with a growth spurt. Symptoms include exercise-aggravated pain and tenderness at the heel’s back. Sometimes, you may notice a lump at the heel’s back.
Secondary Causes of Heel Pain
Calcaneal Stress Fracture
This hairline fracture of the calcaneus (heel bone) is common in soldiers, roadrunners, and dancers. The symptoms are similar to a fat pad contusion with heel pain, which gets worse with weight-bearing activities.
Medial Calcaneal Nerve Entrapment (Baxter’s Nerve)
This condition mirrors the symptoms of tarsal tunnel syndrome, arising from nerve compression in the foot. It results in pain radiating from the inside towards the heel’s centre, with a possible burning sensation in the ankle’s inside or tenderness when pressing in.
Lateral Plantar Nerve Entrapment (Baxter’s Nerve)
Similar symptoms to Plantar fasciitis and Tarsal tunnel syndrome can appear with this condition. These include pain over the inside of the ankle and heel, especially when pressing along your foot and ankle’s inside. The pain may also radiate into the middle three toes.
Tarsal Tunnel Syndrome
Pressure on the posterior tibial nerve, as it passes the ankle’s inside can cause burning pain, numbness, or pins and needles in the heel, which can extend into the arch of your foot.
Insertional Achilles Tendonitis
This condition causes pain in the heel’s back, specifically where the Achilles tendon inserts into the heel bone. It is akin to Sever’s disease in children but affects adults.
Heel Spur
This bony growth on the heel can accompany plantar fasciitis, with identical symptoms. However, it can also occur without any symptoms, and an X-ray confirms the diagnosis.
Calcaneal Fracture
This fracture of the heel bone usually results from a fall or a high jump. Symptoms include severe heel pain, swelling, and bruising. This serious heel injury necessitates immediate medical attention.
Rare But Significant Causes of Heel Pain
Bone and Tissue Tumors
Rare conditions like osteoid osteoma are less likely to cause pain than the injuries above. However, persistent pain warrants medical attention.
Regional Complex Pain Syndrome
This may cause heel pain following a knee or ankle injury.
Spondyloarthropathies
These joint diseases can cause pain in various body parts, including the foot.
