Bottom Of Heel Pain

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Patient receiving treatment for bottom of heel pain

Many active individuals experience pain at the bottom of the heel at some point in their lives. In most cases, this pain is caused by plantar fasciitis due to micro tearing of the plantar fascia. The latter is a thick band of fibrous tissue covering the bottom of the foot.

This micro tearing is the result of stress on the plantar fascia over an extended period. The resulting injury is therefore an overuse one.

In this article, we will first briefly discuss the causes of plantar fasciitis. We will  then move on to describe the nature of its pain in greater detail. We will then describe the typical manner in which the cause of the pain is diagnosed. Finally, the main methods of treating and preventing this pain will be described.

What Is Plantar Fasciitis Pain Like?

Plantar fasciitis, as we have already mentioned, results in pain at the bottom of the heel. In this section, we will describe the general characteristics of this pain. This information will help its victims to suspect when plantar fasciitis may be present.

People with plantar fasciitis describe the pain as either dull and continuous or, alternatively, as a “stabbing” type of pain. It also usually is particularly severe just after awakening in the morning and when taking the first steps of the day.

The pain may also tend to flare up after an exercise session, although not usually during the session. You may also experience “flare ups” when recommencing activity after taking a daytime rest that involves sitting or lying down.

Although the pain of plantar fasciitis usually starts at the bottom of the heel, it can spread after a while to other areas. For example, if you have had the condition for a while, you may also start to feel back pain. The reasons for this are not clear. However, it may be a result of changes to your gait in a subconscious effort to minimize the bottom of heel pain.

Long term plantar fasciitis sufferers may also start to feel ankle pain. If this happens, it may be due to the irritation of nerves in the foot as a result of the injury to the plantar fascia.

Other Symptoms

In addition to pain at the bottom of your heel and other areas, you may experience:

  • Swelling of the heel;
  • A feeling of “tightness” in the Achilles tendon. This tendon connects your calf muscles to your heel bone.
  • The formation of a hard ridge along the bottom of your heel. In some cases, tears in the plantar fascia may cause calcium deposits to form to “fill in” the tear. These deposits may eventually form bone-like structures called heel spurs.

Other Potential Causes Of Pain At The Bottom Of The Heel

Although much less common, the following are also potential causes for bottom of heel pain:

  • Fractures of the metatarsal bone just behind the toes of the foot. These injuries appear simultaneously with a blow to the bottom of the foot or a  fall. With this injury, you will experience intense pain more or less continually. By contrast, as mentioned above, plantar fasciitis pain will tend to be intermittent;
  • Foot arthritis is another potential cause of heel pain. However, this pain will be accompanied by ankle stiffness, warmth and redness. Your ankle will also exhibit occasional swelling.
  • Pain at the bottom of the heel may also be a result of a trapped nerve. This will tend to cause numbness or other unusual sensations in addition to (or instead of) the pain. The pain will also tend to be unrelated to your activity level (unlike plantar fasciitis pain).
  • A cyst at the bottom of your heel may also cause pain there. However, if this is the cause, you will tend to experience continual pain which may be greater when walking or running. You will also likely notice a bump or swelling along the bottom of your foot.


If you suspect, based on the information above, that you are a victim of plantar fasciitis, we suggest seeking medical advice. This should include a proper diagnosis as well as treatment recommendations.

Your doctor will likely diagnose the cause of your bottom of heel pain by reviewing your medical history and then examining your foot. She may press on the plantar fascia along the bottom of your foot and also ask you to try standing on the balls of your feet.

Some doctors may also ask about the times at which the pain is worst and when it eases.

To eliminate the possibility that your foot pain may be due to the other causes listed above, your doctor may request an imaging scan. X-rays, Bone scans and MRI or ultrasound procedures can all help to eliminate or identify other potential causes of heel pain.

Treating Pain At the Bottom Of The Heel

If your pain is due to plantar fasciitis, there are 3 broad classes of treatment that your doctor may recommend. These are home based treatments (which tend to be the least invasive), outpatient treatments and surgery.

Home Based Treatments

These will include:

  • Abstaining from physical exercise for a period to allow the plantar fascia injuries to heal naturally;
  • Wearing a night splint while sleeping in order to keep the plantar fascia stretched and reduce morning pain;
  • Applying ice packs or cold compresses to the bottom of the heel to reduce pain and inflammation;
  • If the pain is still intense, consider taking an over the counter pain medication like Advil or Tylenol;
  • Performing regular stretching exercises for the calf muscles or the plantar fascia. Some of these exercises are described here. These can be part of a physical therapy program intended to loosen your calf muscles;
  • If your plantar fasciitis is due to flat feet, a podiatrist can recommend a pair of shoe inserts. These will do a better job of supporting the arches and reducing stress on the plantar fascia. A podiatrist can also help to reduce pain due to high arches.

Outpatient Treatments

These may be the next choice if home based treatments do not work. Some examples are:

  • Injecting cortisone into the plantar fascia to directly fight inflammation;
  • Shockwave therapy, which is a new technique that claims to promote natural healing.

Surgical Approaches

These may include:

  • Operating to lengthen the calf muscles and reduce long term stress on the plantar fascia (a procedure known as gastrocnemius recession);
  • Making a partial incision in the plantar fascia to reduce stress on it die to stretching (known as a “release” procedure).


Some of the suggestions we can make to avoid bottom of heel pain are:

  • Warm up properly before attempting exercise. Pay particular attention to ensuring your calf muscles are loose and supple;
  • Avoid using old or worn out shoes for exercise that may not properly support the arch of the foot. Instead, try to wear shoes with adequate cushioning and arch support;
  • Reduce your amount of high impact exercise by mixing in activities like swimming or cycling;
  • Avoid wearing high heels shoes for long periods in order to reduce stress on your calf muscles.

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