Heel Pain Explained: Causes, Symptoms, Diagnosis & Treatment (Complete Guide)

Heel pain is a common foot problem that can affect people of all ages. While plantar fasciitis is the most frequent cause, several other conditions can also lead to discomfort in the heel. Understanding each cause helps you choose the right treatment and avoid long-term issues.

What Causes Heel Pain?

Heel pain can result from multiple issues involving muscles, bones, ligaments, nerves, or excessive stress on the heel.

Common causes of heel pain include:

  • Tight calf muscles
  • Long hours standing or walking on hard floors
  • Wearing hard-soled or unsupportive footwear
  • Thinning or weakening of heel fat pads
  • Injury to the heel bone or surrounding tissues
  • Arthritis in the ankle or subtalar joint
  • Nerve irritation on either side of the heel
  • Stress fractures of the heel bone (calcaneum)

Although many conditions can cause discomfort, plantar fasciitis remains the leading reason for heel pain.

Understanding Plantar Fasciitis

The heel plays a vital role in absorbing shock as your foot hits the ground. Beneath the heel bone lies a cushion made of fat-filled pockets that soften each step. Strong ligaments connect the heel to the front of the foot—among them, the plantar fascia, which supports the arch and helps propel you forward.

Why the plantar fascia becomes painful

Plantar fasciitis develops when the plantar fascia becomes irritated or inflamed, usually at its attachment on the heel bone. The inflammation may also occur in the mid-foot.

Common triggers for plantar fasciitis:

  • Tight calf muscles (gastrocnemius) causing constant pulling on the heel
  • Flat feet or high-arched feet, which reduce shock absorption
  • Overuse and long periods on your feet
  • Being overweight
  • Direct injury to the heel
  • Inflammatory diseases such as rheumatoid arthritis or ankylosing spondylitis
  • Lack of stretching or rehabilitation after injury

Plantar fasciitis often improves on its own but may take months—sometimes years—and can recur.

Are Heel Spurs the Cause of Pain?

Many people with heel pain are told they have a heel spur, but this is usually not the true source of discomfort.

Heel spurs commonly form when the body deposits excess calcium to repair tissue damaged by plantar fasciitis.
While heel spurs often appear alongside plantar fasciitis, the spur itself does not cause the pain.

Self-Care: What Can You Do for Heel Pain?

Most heel pain improves with simple lifestyle changes. You can help relieve symptoms by reducing stress on your heel.

Helpful home strategies:

  • Stretch your calf muscles daily
  • Avoid weight gain or consider weight reduction if appropriate
  • Minimize walking on hard surfaces when possible
  • Use cushioned, supportive footwear with shock-absorbing heels
  • Consider custom or pre-made moulded insoles for flat or high-arched feet
  • After any ankle or foot injury, perform rehabilitation exercises to regain mobility
  • Begin gentle plantar fascia stretching and strengthening exercises

These steps often allow natural healing to begin, improving symptoms significantly.

When Should You See a Specialist?

If heel pain continues to interfere with daily activities despite rest and home treatment, it is time to consult a Foot and Ankle Orthopaedic surgeon.

Possible diagnostic tests may include:

  • Blood tests to check for arthritis
  • X-ray to look for fractures, cysts, or arthritis
  • Ultrasound to assess plantar fascia thickness
  • MRI if a stress fracture or deep tissue problem is suspected

An X-ray may show a spur, but remember—the spur is not the source of the pain.

Treatment Options for Persistent Heel Pain

Since heel pain is usually caused by stress on tissues, treatment focuses on reducing that stress.

Common conservative treatments:

  • Stretching the Achilles tendon and plantar fascia
  • Wearing proper footwear with appropriate padding
  • Using soft heel cups or pads for shock absorption
  • Correcting flat or high arches with supportive insoles
  • Pain relief with paracetamol or doctor-approved anti-inflammatory medications
  • Night splints to prevent calf tightening during sleep—especially helpful for morning heel pain
  • Targeted steroid injections to reduce inflammation (avoiding repeated blind injections)

If pain still persists, further evaluation is needed before exploring surgical options.

Do You Need Surgery for Heel Pain?

Surgery is rarely required and is reserved for people who:

  • Have tried all conservative treatments
  • Are of healthy weight
  • Cannot improve stress on the heel through activity modification or footwear changes

What surgery involves:

The goal is to release part of the plantar fascia to reduce tension.
This is usually done through keyhole surgery, using small incisions of about 1 cm on each side of the heel.

Recovery can take months, and some people may experience temporary tingling or numbness afterward.

Should the Heel Spur Be Removed?

No. Removing a heel spur does not solve the underlying problem.
Since heel pain is caused by plantar fascia inflammation—not the spur—taking the spur out alone has been ineffective for decades.