Heel Pain: Causes, Diagnosis and Treatment

Heel pain has many causes. Here we will focus on the common ones. Pain can involve both the heels but more often involves one side.

Before reading on it would be good to first understand the anatomy of the foot (skip this if you already done so).

The following diseases and conditions can cause pain in the heel.

  • plantar facscitis (degenerative and inflammatory condition of plantar fascia in the foot)
  • osteoarthritis
  • rheumatoid arthritis
  • Reiter syndrome
  • ankylosing spondylitis
  • infection in patients of diabetes mellitus
  • after fractures of the heel
  • presence of a large calcaneal spur

Other factors that may contribute to the development of heel pain include

  • over weight
  • occupations requiring to stand for long durations (waiters, construction workers, factory workers, security guards)
  • use of shoes with hard and stiff soles
  • degeneration of the heel pad in old age

Symptoms include

  • the usual patient is between 40 to 60 years of age with symptoms exclusively in one foot
  • pain in the heel that is more on standing. in the morning after a night's sleep or after a short period of rest
  • after a few steps the pain decreases
  • patients describe the pain as piercing in nature like a pin or thorn
  • a dull ache is present in the heel after standing or walking for a few hours which is relieved by sitting or lying down

On clinical examination tenderness is present over the the heel; more towards the sole.

Findings of diabetes, psoriasis, rheumatoid arthritis, Reiters syndrome or ankylosing spondylitis may be seen.

Diagnosis is mainly by history and clinical examination. Your doctor may still order a few investigations to rule out other conditions. These include

  • x ray of the heel
  • bone scan
  • MRI scan
  • electromyography
  • blood investigation for diabetes, psoriasis, rheumatoid arthritis, Reiters syndrome or ankylosing spondylitis

Treatment can be operative or non-operative.

Non-operative treatment is successful in 99% of patients and includes

  • anti-inflammatory and analgesic medication
  • use of soft flexible shoes with good arch support
  • use of rubber or foam heel cushions in the shoes
  • stretching exercises of the calf and foot muscles
  • use of a night splint to keep your foot and calf muscles stretched (relieves early morning pain)
  • injection of steroid into the heel
  • intervals of rest during periods of long standing
  • shifting of weight towards the fore foot during prolonged standing
  • treatment for diabetes, psoriasis, rheumatoid arthritis, Reiters syndrome or ankylosing spondylitis is given when these diseases are present

Operative treatment consists of releasing the plantar fascia and removing a calcaneal spur if present. It is indicated when all non-operative treatment methods have been exhausted and the heel is still painful.

Frequently Asked Questions

Will I have complete relief from pain after surgery?

Chances of complete relief are good (75%). Few patients have persistent pain even after surgery.

What are the causes of persistent symptoms after surgery?

Persistent symptoms can be due to wrong diagnosis or post-operative infection.

I hope the information provided was helpful. If you have any query about heel pain you can ask me at the contact me page.

This page was last updated on 23th June 2009.

Other causes of foot pain...

Hallux Rigidus

Mallet Toe

Hammer Toe


Flat Foot



Sesamoid Fracture

Tarsal Tunnel Syndrome

Talus Fracture

Calcaneus Fracture

Foot Infection

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