Heel pain is one of the commonest foot complaints in an orthopaedic OPD. In adults the usual cause is plantar fasciitis, where the thick band of tissue under the foot (the plantar fascia) becomes painful at the point where it attaches to the heel bone. Other structures around the heel can hurt in much the same way, so where the pain sits and when it comes on both matter.
Plantar fasciitis: what the pain is like
- A sharp or stabbing pain under the heel, often towards the inner side.
- Worst with the first steps after getting out of bed or after sitting for a long time. It eases once the foot warms up and often returns by evening after a day on your feet.
- Tender when you press on the underside of the heel, usually in one foot.
Despite the name, the tissue is often worn rather than simply inflamed, so anti-inflammatory tablets alone rarely settle it. It is seen more often with long hours of standing, a sudden rise in walking or running, a tight calf and unsupportive footwear.
Other causes of heel pain
- Heel fat pad irritation: a bruise-like ache in the centre of the heel, worse on hard floors.
- Achilles tendon trouble: pain and stiffness at the back of the heel, sometimes with a bony bump that rubs against the shoe.
- Stress fracture of the heel bone: pain that builds with walking after a sudden jump in activity, and is tender when the heel is squeezed from both sides.
- Nerve irritation (tarsal tunnel): burning, tingling or numbness along the inner heel or sole.
- Inflammatory arthritis or gout: pain in both heels with morning stiffness, or a hot, swollen heel.
A heel spur is usually not the cause
An X-ray often shows a small bony spur under the heel. Many people with spurs have no pain, and the pain usually comes from the fascia rather than the spur, so treatment is aimed at the fascia.
How heel pain is assessed
The doctor checks the exact point of tenderness, calf and ankle flexibility, your walk, footwear and activity, and whether you have diabetes. An X-ray excludes a fracture or arthritis. Ultrasound, MRI or blood tests are kept for pain that does not fit the usual pattern.
Treatment without surgery
Most heel pain is managed without an operation, and this works better when followed steadily for weeks to months.
- Plantar fascia and calf stretches, done daily, including before the first steps in the morning.
- Cushioned, supportive footwear, with heel cushions or an orthotic insole where advised. Avoid walking barefoot on hard floors.
- Cutting back on running, jumping and prolonged standing, while keeping up gentle activity.
- Weight reduction where relevant, a night splint or taping, physiotherapy for calf and foot strengthening, and a short course of pain relief as advised by your doctor.
- For pain that has not settled after several months, shockwave therapy is offered, and options with limited evidence, such as a PRP injection, may be discussed. A local steroid injection can give short-term relief but is used sparingly, as repeated injections can weaken the fascia.
When is surgery considered?
Surgery is rarely needed and is discussed case by case. It is considered only when the diagnosis is clear and a long period of well-followed non-surgical treatment, usually about 6 to 12 months, has not helped. Risks of any operation include persistent pain, nerve irritation and wound infection, and they are explained beforehand.
When to see a doctor
- You cannot put weight on the heel, or the pain began after a fall or injury.
- The heel is swollen, red or warm, or you have a fever.
- There is numbness, tingling or burning in the heel or sole.
- It has not improved after a few weeks of self-care.
With diabetes, a heel sore or blister should be seen within a day. See diabetic foot treatment in Surat.
How to book
Dr. Aman Khanna sees foot and heel problems at Mahavir Health Campus, Ring Road, Athwa Gate, Surat, Monday to Saturday, 4 to 6 PM. To book, use WhatsApp at +91 89808 22922 or the clinic and hours page. WhatsApp is for booking only; the heel is examined at the visit.