That sharp, stabbing heel pain in the morning? The throbbing ache that returns after activity and lingers for days? Or perhaps a new, painful bump has appeared on the back of your heel? You’re not alone in wondering, “Why Do My Heels Ache?”
It’s easy to dismiss occasional foot discomfort, especially when you’re on your feet so much. However, persistent or recurring heel pain is your body’s way of signaling that something needs attention and healing. Understanding the reasons behind your heel pain is the first step towards finding effective relief and getting back on your feet comfortably.
Let’s explore the most common culprits behind heel pain and guide you on when it’s time to seek professional help.
Plantar Fasciitis: The Number One Reason for Heel Pain
[alt]: A diagram illustrating the plantar fascia, a thick band of tissue running along the bottom of the foot from the heel to the toes, highlighting its location and connection to the heel bone.
Plantar fasciitis is frequently the answer to the question, “why do my heels ache?”. This condition arises from inflammation or micro-tears in the plantar fascia, a robust ligament stretching along the bottom of your foot, connecting your heel to your toes. Think of it as the shock absorber of your foot’s arch. Repetitive strain, excessive pressure on the arch, or sudden increases in activity are often the triggers for plantar fasciitis.
What Does Plantar Fasciitis Heel Pain Feel Like?
Plantar fasciitis pain can be unpredictable, flaring up at various times. You might experience heel pain during exercise, immediately after a workout, or after prolonged periods of standing or walking. If your heels ache after walking or any form of physical activity, the pain is often described as a sharp, stabbing sensation, primarily felt in the arch of your foot or directly beneath your heel. This is a clear indication that the plantar fascia is irritated and inflamed due to overuse, signaling the need for rest and proper care.
A hallmark symptom of plantar fasciitis, and a key reason for asking “why do my heels ache in the morning?”, is intense pain after periods of rest, especially first thing in the morning. While you sleep, the plantar fascia tends to tighten. Upon taking your first steps, this tightened ligament is suddenly stretched, causing that characteristic sharp, shooting pain. This “morning heel pain” is a strong indicator of plantar fasciitis. Similarly, you might experience heel pain after sitting for extended periods for the same reason – the plantar fascia tightens during inactivity and then protests upon movement.
The silver lining is that rest, although initially painful upon movement, is actually beneficial for healing. As you move around and the tissue stretches, the pain typically lessens, at least temporarily.
Diagnosing and Treating Plantar Fasciitis
If you suspect plantar fasciitis is behind your heel pain, a podiatrist, a medical doctor specializing in foot and ankle conditions, can provide an accurate diagnosis. Fortunately, plantar fasciitis is often effectively managed with at-home treatments for plantar fasciitis. These include:
- Supportive Footwear: Investing in shoes with good arch support and cushioning is crucial. Avoid flat shoes or going barefoot, even indoors, as this adds extra stress to the plantar fascia. Supportive slippers are a good alternative for home wear.
- Rest: Reducing activities that aggravate the pain is essential to allow the plantar fascia to heal.
- Hot and Cold Therapy: Alternating ice and heat can help reduce inflammation and pain. Ice is typically recommended for acute pain, while heat can soothe stiffness.
- Targeted Stretches and Exercises: Specific stretches, like calf stretches and plantar fascia stretches, along with exercises to strengthen the foot and ankle muscles, are key to long-term relief.
If home treatments aren’t sufficient, or if your heel pain worsens and impacts your daily life, a podiatrist might recommend further interventions, such as cortisone injections to reduce inflammation. In rare, severe cases where conservative treatments fail, surgery may be considered as a last resort.
Other Common Causes of Heel Pain
While plantar fasciitis is the most frequent answer to “why do my heels ache?”, several other conditions can also cause heel discomfort.
Achilles Tendonitis: Pain Behind the Heel
[alt]: An anatomical illustration showcasing the Achilles tendon located at the back of the ankle, connecting the calf muscles to the heel bone, highlighting its position relative to the heel.
If your pain is located above your heel, specifically in the back of your ankle, and intensifies during and after activity, Achilles tendonitis could be the cause. Achilles tendonitis is the inflammation of the Achilles tendon, the large tendon connecting your calf muscles to your heel bone. Overuse, particularly a sudden increase in the intensity or frequency of exercise, is the primary culprit. Runners are particularly susceptible to this condition.
Achilles tendonitis typically starts with a mild ache that worsens with continued activity. You might notice stiffness or tenderness after periods of rest or after exercise. Interestingly, mild activity or stretching often provides temporary relief as the tendon warms up.
Similar to other overuse injuries, rest is paramount for Achilles tendonitis. Modifying or avoiding activities that strain the tendon is crucial for healing. In cases involving tears in the Achilles tendon, surgery might be necessary.
A podiatrist can accurately diagnose Achilles tendonitis and recommend treatments such as physical therapy, supportive wraps, braces, or splints to reduce strain and promote healing.
Haglund’s Deformity: The “Pump Bump”
[alt]: A close-up image of the back of a heel showing a Haglund’s deformity, a bony bump, clearly visible and slightly red, at the point where the Achilles tendon inserts into the heel bone.
Haglund’s deformity is characterized by a bony protrusion on the back of the heel. Often referred to as “pump bump,” it’s prevalent among individuals who wear high heels, but any footwear with a rigid heel back, including men’s dress shoes and ice skates, can irritate the area.
Besides the visible and often painful bump, symptoms of Haglund’s deformity include:
- Pain at the back of the heel where the Achilles tendon attaches.
- Swelling in the back of the heel.
- Redness and inflammation of the skin on the back of the heel.
Switching to supportive shoes with soft heel backs is crucial for alleviating pain. Over-the-counter anti-inflammatory medications and icing the heel can also provide relief. Consulting a podiatrist is advisable, especially as Haglund’s deformity can sometimes lead to another painful condition called bursitis.
Heel Bursitis: Inflammation at the Back of the Heel
Heel bursitis is another common reason for pain at the back of the heel, often overlapping with symptoms of Haglund’s deformity or Achilles tendonitis. Bursitis refers to the inflammation of a bursa, a small, fluid-filled sac that acts as a cushion and lubricant between tissues, reducing friction in areas prone to rubbing. There are two main types of heel bursitis:
- Subcalcaneal Bursitis (Calcaneal Bursitis): This affects the bursa located between the Achilles tendon and the skin at the back of the heel. It’s frequently linked to Haglund’s deformity and is often triggered by ill-fitting shoes that rub against the back of the heel. High heels and improperly fitted athletic shoes are common culprits. Symptoms include pain, redness, and swelling on the heel, making shoe wear uncomfortable.
- Retrocalcaneal Bursitis: This type involves the bursa situated between the heel bone and the Achilles tendon, just above the Achilles tendon’s insertion point on the heel bone. It results from repeated irritation and can be associated with both Achilles tendonitis and Haglund’s deformity. It’s also common in individuals with posterior calcaneal bone spurs. Pain and swelling are typically more severe where the Achilles tendon meets the heel bone.
Treatment for both types of heel bursitis mirrors that of other heel conditions: rest, anti-inflammatory medications, and heat or ice application. Avoiding activities that exacerbate the pain and wearing comfortable, supportive shoes are essential. If the pain persists, or if the heel becomes hot to the touch, seeking professional advice from a podiatrist is recommended.
Heel Fracture: Sudden or Gradual Pain
A heel fracture, a break in the calcaneus (heel bone), can also be a cause of heel pain. Fractures can occur suddenly due to trauma or develop gradually from overuse.
Traumatic Calcaneus Fracture
[alt]: An X-ray image of a fractured calcaneus (heel bone), clearly showing the break in the bone structure, indicative of a heel fracture resulting from trauma.
A sudden, intense pain in the heel following a traumatic event, such as a fall from height, a jump, or a car accident, strongly suggests a heel fracture. Diagnosis involves a physical examination and X-rays to determine the fracture’s severity and guide treatment.
Stress Fracture of the Heel
Stress fractures, on the other hand, are small hairline cracks that develop gradually in the bone, often due to repetitive stress. The onset of pain is typically gradual.
Symptoms of a stress fracture vary depending on the fracture’s location and severity. Heel pain that is present during walking, but may or may not subside with rest, is a common sign. The pain might be less intense in the morning and worsen as the day progresses, especially with activity.
If you suspect a stress fracture, it’s crucial to immediately cease weight-bearing activity and limit pressure on the heel. Consulting a podiatrist is essential for proper diagnosis and treatment. Untreated stress fractures can worsen, potentially leading to a complete fracture.
Plantar Bone Spurs: An Uncommon Cause of Heel Pain
While often associated with heel pain, plantar bone spurs are surprisingly an uncommon direct cause. Plantar bone spurs are bony growths that develop on the heel bone due to long-term strain on the ligaments connecting the heel and toes. They are essentially the body’s attempt to heal itself under chronic stress.
[alt]: A side view X-ray of a foot showing a plantar bone spur, a bony projection extending forward from the heel bone towards the toes, illustrating its location and shape.
Plantar bone spurs are relatively common, affecting approximately 1 in 10 people. However, only about 5% of individuals with bone spurs experience foot pain directly attributable to them. In most cases of heel pain, other conditions like plantar fasciitis are more likely culprits. In fact, many individuals with plantar fasciitis also have plantar bone spurs, but the spur itself is not usually the primary pain generator.
Taking the Right Step Towards Heel Pain Relief
If you’re experiencing heel pain, it’s important to listen to your body. While many cases of heel pain can be effectively managed at home with rest, ice or heat therapy, exercises and stretches, and supportive footwear, persistent or worsening pain warrants professional attention.
[alt]: A friendly podiatrist examining a patient’s foot in a clinic setting, demonstrating a consultation for heel pain, highlighting the expert care available for foot conditions.
Make an appointment with a podiatrist or visit one of our TRIA orthopedic urgent care locations for expert evaluation and treatment. Podiatrists specialize in all aspects of foot and ankle care. They can diagnose the underlying cause of your heel pain, provide in-office treatments, and recommend personalized strategies, including medications and therapies, to alleviate pain and facilitate healing. Many podiatrists are also skilled foot and ankle surgeons, offering advanced care when necessary. Don’t let heel pain hold you back – seeking help is a step in the right direction towards pain-free movement.
