Heel pain

What is heel pain, and how common is it?

Heel pain is pain at or around the heel, often underneath or at the back¹. It's very common². It can start when the heel is overused, for example with dancing or running¹.

In adults the most common cause is plantar fasciitis (also called plantar fasciopathy), which involves the plantar fascia, the band of tissue under your foot³. About 10% of adults are said to have plantar heel pain at some point in their lives⁴.

The typical pattern is pain that builds gradually under the heel, is sharpest on your first steps out of bed, and gets worse later in the day or after long periods of standing or walking⁵. It's usually in one heel, though some people have both affected⁶.

What can cause heel pain?

Plantar fasciitis is the most common cause, and it can last a long time or keep coming back⁷. Other causes include:

• Achilles tendinopathy (a sore Achilles tendon): pain at the back of the heel that is worse on tiptoe, sometimes with swelling or a bony bump⁸.
• Sever's disease: a common cause in active, growing children¹⁹.
• Other heel problems: a heel bump, nerve irritation (heel neuritis) or bursitis (an inflamed cushion of fluid)². Arthritis can also be behind it¹.

A heel spur (a small bony point) can show up on an X-ray, but spurs are also found in people with no heel pain. A spur is unlikely to be the cause of your pain¹⁰.

Back pain with numbness or pain running down the leg, or symptoms elsewhere in your body, point away from the usual plantar fasciitis picture⁶. Mention them to your podiatrist.

How is the cause found?

Mostly by talking and examining, rather than by scans². A podiatrist will ask when the pain began, what sets it off, what eases it and how it affects walking, work or sport⁸. They'll look at how you walk, your foot alignment, and any swelling, tenderness or stiffness⁸.

If your story and examination fit plantar fasciitis, a scan usually isn't needed⁶. An X-ray is advised after an injury, if the pain seems out of proportion, or if it isn't responding to treatment, to rule out other causes⁶. Ultrasound can help confirm plantar fasciitis but isn't required⁶.

Before an appointment, it helps to write down where the pain is, when it's worst and what eases it.

What helps first?

Start with things you can do yourself, along with a clear explanation of what's going on⁴:

• Ease back from what sets the pain off, such as running or long periods of standing⁸¹¹.
• Stretch your calf and the sole of your foot. Calf stretches, with or without sole stretches, can reduce pain⁶.
• Wear supportive, cushioned shoes with good arch support rather than flat or slip-on shoes⁸¹¹.
• Ask about taping, insoles or heel raises. Taping can reduce pain⁶, and a podiatrist or physiotherapist can advise on the rest⁸.
• Ice and pain relief. Ice massage is one option⁶, and a pharmacist can advise on pain relief such as paracetamol. Don't use ice over numb skin or an open wound, and stop if pain, swelling or skin soreness increases.
• Weight management is part of first-line care where it's appropriate, and your GP can help⁸.

What helps if that isn't enough?

Go back to your podiatrist, physiotherapist or GP to review the diagnosis and plan before considering injections or surgery. Shockwave therapy and steroid injections are sometimes used as second-line options⁷.

A steroid injection may lower heel pain slightly, but only for under a month. Rare harms such as a plantar fascia rupture (a tear in the band under your foot) and infection have been reported¹². One guideline says injections shouldn't be used first or second, because the benefits don't outweigh the risks⁴. If you're offered one, ask about the expected benefit, how long it lasts and the risks.

Surgery is the last option, after other treatments have failed².

Will it get better, and how can I stop it coming back?

Almost all people respond to non-surgical treatment². How long it takes isn't clear yet, so give each step time.

Plantar fasciitis is linked with limited ankle movement, carrying extra weight and work that keeps you on your feet³. These are links, so changing them isn't certain to stop it returning. It makes sense to keep up the stretching and footwear that helped, and to talk to your GP about gradual weight management if that's relevant. If the pain returns or doesn't go away, see a health professional early.