Heel Pain Is a Symptom, Not a Diagnosis
Heel pain is often treated as though it automatically means plantar fasciitis. That condition is common, but pain under the heel, behind the heel, along the side, or deep inside the bone can come from different tissues. Location, timing, sensation, activity, and examination help identify the source.
Pain under the heel
Plantar fasciitis often causes pain near the inner underside of the heel. It may be sharp with the first steps after rest and can return after prolonged standing or activity. A bruised heel pad may feel more central and tender with direct impact. A stress injury can create more focal bone pain that worsens as activity continues.
Pain behind the heel
Achilles tendinitis can cause stiffness and pain where the tendon runs down the back of the ankle or attaches to the heel. A bony prominence called Haglund deformity may rub against the back of a shoe and irritate nearby tissue. Bursitis can also cause tenderness and swelling around the attachment area.
A sudden pop, immediate weakness, or difficulty pushing off raises concern for an Achilles rupture and deserves prompt evaluation.
Burning, tingling, or electric pain
Nerve irritation can create sensations that differ from a typical tendon ache. Tarsal tunnel syndrome involves compression of the posterior tibial nerve near the inside of the ankle and may cause burning or tingling into the heel or sole. Sural nerve irritation can affect the outer heel and ankle.
Why the history matters
- Is pain worst with first steps or after activity?
- Does it occur under, behind, inside, or outside the heel?
- Was there a sudden injury or gradual increase?
- Is the sensation sharp, aching, burning, or numb?
- Do shoes, hills, standing, or barefoot walking change it?
Your podiatrist may assess gait, foot alignment, calf flexibility, tenderness, strength, sensation, and shoe wear. X-rays can evaluate bone and alignment, while MRI or other imaging may be used when a tendon, stress injury, or soft-tissue problem is suspected.
Treatment should match the tissue
Activity modification, stretching, strengthening, footwear, orthotics, immobilization, medication, injections, or shockwave therapy may be used in selected cases. A treatment that helps plantar fascia pain may not be appropriate for a nerve problem or acute tendon tear.
The American Academy of Orthopaedic Surgeons describes both non-surgical and surgical treatment for Achilles tendinitis, with surgery generally considered only after an extended period of non-surgical care that has not relieved pain.
Explore the practice’s overview of heel conditions and note the location and timing of your symptoms before the appointment.
Get a diagnosis that is more specific than heel pain
Kristen Treleven, DPM, AACFAS, provides individualized podiatric care at Foot & Ankle Centers of Frisco, Little Elm, & McKinney. Book a heel pain evaluation or call (972) 712-7773.