Heel Pain

Heel pain is one of the most common reasons adults come into a podiatry office, and it is also one of the most commonly misdiagnosed. Plantar fasciitis has become a household name, so when that first sharp twinge appears after getting out of bed, most people reach straight for that label. The problem is that tendons, bursae, nerves, bone and the fat pad under the heel can all produce pain in the same small area, and the treatment that helps one of them can do nothing at all for another.

Where it hurts tells you a lot

Before anything else, notice exactly where the pain sits and when it is worst. Those two details narrow things down more than any other clue.

• Under the heel, worst on the first steps in the morning. The classic pattern for plantar fasciitis.
• At the back of the heel, worse going uphill or rising onto your toes. Points toward the Achilles tendon rather than the fascia.
• A deep, bruised ache across the center of the heel, worse on hard floors. Often the fat pad that cushions the heel thinning out.
• Burning, tingling, or pain that spreads toward the toes. Suggests a nerve rather than soft tissue.
• A spot you can pinpoint with one fingertip that is worsening week by week. Worth looking at sooner rather than later.
• A child or teenager with heel pain during a growth spurt. Usually involves the growth plate, and is treated differently from adult heel pain.

Plantar fasciitis

Plantar fasciitis is inflammation and microtearing where the thick band of tissue along the bottom of the foot meets the heel bone. Most people describe a sharp, stabbing pain near the inside edge of the heel, worst with the first steps after sleep or after a long stretch of sitting. It often eases after a few minutes of walking, then comes back after prolonged standing or a long walk.

Overpronation is a common contributor. As the foot rolls inward while walking, the arch lengthens and the fascia comes under extra tension, and over time that produces inflammation.

Heel spurs, and the part most people have backwards

This is the single biggest misunderstanding we see, so it is worth being direct about it.

A heel spur is a small calcium deposit that forms on the heel bone. Spurs often occur alongside plantar fasciitis, because the ongoing pull on the heel bone prompts it to lay down extra calcium to protect itself. The spur is usually the result of the problem, not the cause of it.

That distinction changes what treatment should be aimed at. Plenty of people have a spur visible on an X-ray and no pain whatsoever, and plenty of people have significant heel pain with no spur at all. Treating the underlying inflammation and the mechanics behind it is what relieves the pain.

Do heel spurs go away on their own?

The bony growth itself does not dissolve on its own. The pain associated with it very often does settle with conservative treatment, and that is the part that matters to you day to day. Simply waiting it out without changing anything tends not to work, because whatever caused the strain in the first place is still there.

What is the fastest way to heal a heel spur?

There is no overnight fix, and anything promising one is worth treating with suspicion. What genuinely shortens the process is addressing the cause early: supporting the arch, stretching the calf and the fascia, reducing the activity that aggravates it, and settling the inflammation. The longer the underlying mechanics go unaddressed, the longer recovery takes.

Is surgery needed to remove a heel spur?

Rarely. Because the spur is usually a consequence rather than the source of the pain, removing it is not the first answer. Conservative treatment resolves the large majority of cases, and surgery is considered only after a properly run course of conservative care has not worked.

Other causes worth knowing about

Several conditions produce pain in the same area and are routinely mistaken for plantar fasciitis:

• Achilles tendinopathy. Aching or stiffness at the back of the heel or up the tendon, worse with hill walking, running, or rising onto the toes.
• Heel bursitis. Inflammation of the small fluid-filled sacs near the heel.
• Nerve entrapment. Burning, tingling or numbness rather than a sharp mechanical pain.
• Calcaneal stress fracture. Focal bone tenderness that gets worse over weeks.
• Fat pad atrophy. A deep, bruised pain across the weight-bearing center of the heel, worse on hard surfaces and better in cushioned shoes.
• Sever’s disease. A growth plate condition affecting children roughly 8 to 15 during growth spurts, which needs activity modification rather than the treatments used for adult heel pain.

For the longer breakdown of how these are told apart, see our detailed guide to the different causes of heel pain. If the patient is a child or teenager, our guide to heel pain in young athletes covers it in more depth.

How heel pain is treated

Treatment starts with the least invasive option likely to work, and only escalates if it does not.

• Supportive footwear and activity changes, to take load off the painful tissue
• Stretching for the calf and the plantar fascia
• Ice and anti-inflammatory measures. Please check with your physician before taking any medication.
• Custom orthotic devices, to correct the mechanics driving the problem rather than just easing the symptom
• Extracorporeal shock wave therapy for persistent cases that have not responded to conservative care
• Surgery, considered only when conservative treatment has been properly tried without success

When heel pain needs more than rest

Most heel pain settles with sensible conservative care. Come in sooner rather than later if:

• the pain is getting worse over days or weeks rather than better
• there is bone tenderness you can pinpoint with one finger
• there is visible swelling or a lump
• you have numbness or tingling radiating toward the toes
• the pain stops you walking normally, or wakes you at night

Insurance and what it costs

Heel pain is treated as a medical problem rather than an elective one, so evaluation and treatment are generally covered. Cherrywood Foot Care participates with a wide range of plans. You can check whether yours is accepted on our participating insurance list, or call the office and we will check it for you.

Heel pain FAQ

Is all heel pain plantar fasciitis?

No. Plantar fasciitis is the most familiar cause, but tendons, bursae, nerves, bone and the fat pad of the heel can all produce pain in the same area. Several of these conditions are routinely mistaken for plantar fasciitis.

Why does my heel hurt most on the first steps in the morning?

The fascia tightens while you sleep, and the first steps stretch it abruptly. That pattern, sharp pain near the inside edge of the heel that eases after a few minutes of walking, is the classic sign of plantar fasciitis.

Do heel spurs go away on their own?

The bony growth itself does not dissolve on its own, but the pain associated with it very often settles with conservative treatment. Waiting without changing anything tends not to help, because the strain that caused it is still present.

What is the fastest way to heal a heel spur?

There is no overnight fix. Recovery is shortest when the cause is addressed early: supporting the arch, stretching the calf and fascia, reducing the aggravating activity, and settling the inflammation.

Is surgery needed to remove a heel spur?

Rarely. The spur is usually a consequence rather than the cause of the pain, so conservative treatment resolves the large majority of cases. Surgery is considered only after conservative care has been properly tried without success.

Will my insurance cover heel pain treatment?

Heel pain is treated as a medical problem rather than an elective one, so evaluation and treatment are generally covered. Cherrywood Foot Care participates with a wide range of plans, and you can check yours on our participating insurance list or by calling the office.

When should I see a podiatrist about heel pain?

Sooner rather than later if the pain is worsening over days or weeks, you have focal bone tenderness, visible swelling or a lump, numbness or tingling radiating toward the toes, or pain that stops you walking normally or wakes you at night.