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Question : For the past few days I have woken up with a dull aching pain in my heel. The majority of the pain is on the bottom of the heel. I have not done anything out of the ordinary, and can think of no reason for this. What could be causing this pain?
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The Trusted Source
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Howard LeWine, M.D.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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January 17, 2013
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A:

You can get pain in the bottom of your heel for a number of reasons. Many of them are not associated with any change in activity or specific trigger.

Here are some of the most common causes:

  • Plantar fasciitis. This is an inflammation of the tough band of tissue called fascia that supports the arch and attaches on the bottom of the heel. This common condition tends to affect runners and tennis players. It also affects people who have flat feet, are overweight or wear shoes with poor arch support. People with diabetes are also more likely to get this condition. Pain is usually worse first thing in the morning, for the first few steps.
  • Bursitis. This is inflammation of the bursa (a sac that lines many joints). It’s more common in people with flat feet, who have an abnormal gait, or those who wear shoes that don’t properly cushion the heel. It tends to be worse in people who stand for a long period of time. "Pump bumps" are one type of bursitis in the heel common in young women wearing pump shoes. But in this condition, pain is in the back of the heel.
  • A "stone bruise" or other trauma. Even minor trauma may explain heel pain. For example, when people walking barefoot step on a stone or other sharp object. People with weak bones (as with osteoporosis) or who have landed hard on the heels can fracture the heel bone (called the calcaneus).
  • Nerve irritation or compression. This can happen after a sprain or other trauma. It causes numbness, tingling or pain in the heel.
  • Tendonitis, such as inflammation of the Achilles tendon. This is quite common, especially among people engaged in sports that require jumping. But it tends to cause pain behind the heel, not on the bottom.

The good news is that most heel pain improves within a short period. It may take only a few days for minor injuries to improve. Or up to six to eight weeks for plantar fasciitis to go away.

Treatment depends on the cause. But if often includes:

  • Rest
  • Stretching
  • Ice massage
  • A change in footwear
  • Orthotics (inserts in the shoe to cushion the foot or change foot position during walking)
  • Taping of the foot to provide support
  • Medicine for pain (such as acetaminophen) or inflammation (such as ibuprofen or naproxen).

Occasionally, severe or long-lasting heel pain may require:

  • A splint or cast to provide more complete rest
  • One or more cortisone shots
  • Surgery

See your doctor if your heel pain is significant or persistent. He or she will review your symptoms and past medical history and examine you to determine the cause and best course of treatment. He or she may also recommend that you see a foot specialist, such as a podiatrist or an orthopedist.

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