The most common cause of pain in the back of the heel isplantar fasciitis.
Pain that comes from behind or beneath the heel is more likely to be a case of Achilles tendonitis.
It can also be resulting from injury to nerves that service the ankle or foot.
Illustration by Alexandra Gordon for Verywell Health
The heel bone lies at the back of the foot beneath the ankle.
It usually affects one foot, allowing you to bear weight on the other.
BMI is a dated, flawed measure.
It does not take into account factors such asbody composition, ethnicity, sex, race, and age.
Achilles tendonitis causes tightening or burning pain in the tendon just over the heel.
Mild swelling and morning stiffness of the heel and calf are also common.
Achilles tendonitis is usually due to overuse, such as from long-distance running.
In rare cases, theAchilles tendon can rupture.
Besides severe heel pain, some people report hearing a popping or snapping sound when the tendon tears.
Sever Disease
Sever disease is the most common cause of heel pain in children and adolescents.
It can be worse during a growth spurt.
The injury involves bone swelling or inflammation, often due to playing sports like soccer or basketball.
Conservative treatment (rest, icing, pain medication) is usually successful.
These tendons can rupture, dislocate, or stretch in ways that cause tendonitis.
It’s common for peroneal tendonitis to occur due to overuse injuries.
Damage to the peroneal nerve also can cause symptoms, including numbness, tingling, and pain.
Some people experience a foot drop with this injury, leading to gait (walking) changes and weakness.
It can also happen with excessive weight-bearing exercises.
Repeated stress on the heel bone eventually causes a break.
A stress fracture causes significant heel pain that worsens with activity and improves with rest.
In addition to pain, swelling and tenderness may be experienced at the fracture site.
This is referred to as fat pad atrophy, with wear on the heel causing pain.
This typically occurs in people who wearrigid or poorly fitted shoes.
The pain can cause limping accompanied by swelling, warmth, and redness.
As the soft tissue surrounding the bony bump gets irritated, a condition calledbursitismay develop.
Bursitis is the inflammation of a fluid-filled sac between joints, called the bursa.
There may also be a sensation of ankle looseness andheel pain when walkingon uneven surfaces.
Rare Causes of Heel Pain
Rare causes of heel pain include:
1.
People diagnosed with diabetes face a higher risk.
So do other factors, like the activities that lead to heel pain.
In certain cases, imaging studies and blood tests may be needed.
Medical History
A detailed medical history is often the most important part of diagnosing heel pain.
They may also move (manipulate) your foot and ankle to see if and where it causes pain.
There are other conditions that can mimic plantar fasciitis, Achilles tendonitis, and other causes of heel pain.
These include:
Treating Heel Pain
Treatment depends entirely on the cause of your heel pain.
A common approach is theR.I.C.E.
For example, take a few days off from jogging or avoid prolonged standing or walking.
Place a thin towel between the ice pack and your skin to avoid frostbite.
The tape should not be applied too tightly and can stay in place for up to a week.
Compression
Compression or wrapping the injury site is an important treatment step.
It helps to immobilize the site and support the heel with pressure.
Avoid wrapping too tightly, though.
Many Achilles tendon ruptures are treated by placing the limb in a cast with the toes pointed down.
These are performed in the morning and evening as part of a physical therapy treatment plan.
For Achilles tendonitis, you may be referred to aphysical therapistfor a form of therapy called theAlfredson protocol.
This involves strengthening the Achilles tendon with eccentric exercises that contract the tendon while stretching the supporting muscles.
These typically involve over-the-counter NSAIDs like Advil (ibuprofen) and Aleve (naproxen).
Sometimes,cortisonea steroid that reduces inflammationmay be injected into the heel to temporarily ease the pain.
Another procedure called agastrocnemius resectionsurgically lengthens the calf muscle to relieve plantar fasciitis pain.
Be sure to listen to your body, because pain is never normal.
If there is heel pain you cannot explain, back off a little and see if it improves.
If it recurs or gets worse, see a healthcare provider.
When and how the pain occurs also will help you to understand its cause.
Once your healthcare provider makes a diagnosis, they can discuss treatment options with you.
In many cases, conservative treatment options including rest or the use of shoe orthotics can bring relief.
Physical therapy and, rarely, surgery also may be needed.
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Johns Hopkins Medicine.Plantar fasciitis.
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Johns Hopkins Medicine.Peroneal nerve injury.
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American Academy of Orthopedic Surgeons.Heel pain.
