Recognizing Achilles Tendonitis, Haglund’s Deformity & Other Heel Pain Causes
Heel pain and plantar fasciitis are often treated as synonymous, and for good reason. Plantar fasciitis is one of the most common causes of pain on the bottom of the heel, with an estimated two million patients treated for the condition each year.
Research published by the American Academy of Family Physicians also suggests that up to one in ten people will experience plantar fasciitis at some point in their lifetime.
But plantar fasciitis is far from the only cause of heel pain.
“Heel pain is one of the most common and persistent foot problems affecting men and women of all ages,” notes the American College of Food and Ankle Surgeons. “Not all heel pain, however, is caused by plantar fasciitis. It also can occur from inflammation of the Achilles tendon, bursitis, arthritis, gout, stress fractures, bone or soft tissue tumors, or irritation of one or more of the nerves in the region.”
Understanding when heel pain is more than plantar fasciitis is important, as an incorrect assumption can delay proper diagnosis and treatment. In some cases, heel pain may point to Achilles tendinitis, Haglund’s deformity, nerve compression, or even a stress fracture.
The location of your pain, when it appears, and how it changes throughout the day can provide important clues about what is really happening in your foot. Below, we break down common and lesser known causes of heel pain and explain when it is time to see a foot and ankle specialist.
Plantar Fasciitis
Plantar fasciitis occurs when the plantar fascia, a thick band of tissue running from the heel bone to the toes, becomes irritated and inflamed. This tissue supports the arch of the foot and helps absorb shock with every step.
Common symptoms include sharp or aching pain at the bottom of the heel, pain with the first steps in the morning, and discomfort after sitting or resting that often eases as you move around.
Risk factors for plantar fasciitis include:
- Flat feet or very high arches.
- Tight calf muscles or limited ankle flexibility.
- Sudden increases in walking, running, or standing time.
- Repetitive high-impact activities on hard surfaces.
- Excess body weight or recent weight-gain.
Heel spurs are frequently seen on imaging in people with plantar fasciitis, but they are not usually the source of the pain and rarely need to be treated directly.
Achilles Tendinitis
Achilles tendinitis involves irritation and inflammation of the tendon that connects the calf muscles to the heel bone. Pain is typically felt at the back of the heel or just above it and often worsens with activity.
People with Achilles tendinitis may notice morning stiffness, tenderness along the tendon, swelling, or discomfort when wearing shoes that rub against the back of the heel. Insertional Achilles tendinitis affects the point where the tendon attaches to the heel bone and may cause a noticeable bump in this area.
Insertional Achilles tendinitis is often associated with inflammation of a nearby bursa, the small fluid-filled sac that cushions the tendon against the heel bone. When this bursa becomes inflamed, pain and swelling at the back of the heel can become even more pronounced.
Haglund’s Deformity
Haglund’s deformity is a bony enlargement on the back of the heel bone that can irritate the surrounding soft tissues. It is often aggravated by rigid or poorly fitting shoes that rub against the back of the heel.
Common symptoms include:
- A visible bump at the back of the heel.
- Redness or irritation where the shoe contacts the heel.
- Swelling around the back of the heel.
- Pain that worsens with shoe wear or pressure on the area.
Haglund’s deformity often occurs alongside bursitis and insertional Achilles irritation, because the bony prominence increases friction and pressure at the back of the heel.
Other Causes of Heel Pain You Should Not Ignore
Not all heel pain is caused by plantar fasciitis or tendon inflammation. Several other conditions can produce similar symptoms and require different treatment approaches.
Peripheral Neuropathy
Peripheral neuropathy involves damage or irritation to the nerves and often causes burning, tingling, numbness, stabbing sensations, or electric-like pain. While it often begins in the toes, it can progress to involve the heel, and may be related to diabetes, vitamin deficiencies, autoimmune disorders, nerve injuries, or certain medications.
Fat Pad Atrophy
The natural fat pad beneath the heel cushions impact with each step. Over time, this padding can thin, leading to deep, bruise-like pain directly under the heel, especially in older adults and people with connective tissue disorders.
Stress Fractures
Stress fractures of the heel bone develop from repetitive stress or overuse rather than a single injury. Pain usually increases with activity, may become constant if not treated, and is often accompanied by swelling and tenderness; imaging is typically needed to confirm the diagnosis.
Inflammatory and Systemic Conditions
In some cases, heel pain is linked to underlying inflammatory or systemic conditions rather than a localized foot problem. Forms of arthritis such as rheumatoid arthritis and psoriatic arthritis can cause inflammation where tendons and ligaments attach to the heel bone, leading to ongoing pain and stiffness.
Gout is another less common but important cause of heel pain. It occurs when uric acid crystals accumulate in joints and surrounding tissues, triggering sudden episodes of intense pain, swelling, redness, and warmth that most often affect the big toe but can also involve the heel and ankle.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome occurs when the posterior tibial nerve is compressed near the inside of the ankle. Symptoms may include pain, burning, tingling, or numbness that that radiates into the heel, arch, toes, or calf, and risk factors include flat feet, prior injuries, space-occupying masses such as cysts, and certain systemic conditions.
Rare Causes, Including Bone or Soft Tissue Tumors
Although uncommon, benign bone or soft tissue tumors can develop in the heel and cause persistent pain. Imaging studies, such as X‑rays or advanced scans, are often used to rule out these conditions during an evaluation.
Unicameral bone cysts are among the most common benign bone tumors in children and are often asymptomatic unless a fracture occurs. Osteoid osteomas, more frequently seen in adolescents and young adults, tend to cause pain that worsens at night and improves with anti-inflammatory medication.
Because these conditions are rare and can mimic more common sources of heel pain, persistent or unexplained symptoms should always be assessed by a foot and ankle specialist.
Signs Your Heel Pain May Be More Than Plantar Fasciitis
Certain symptoms suggest that heel pain may not be caused by plantar fasciitis alone. You should seek evaluation if:
- Your pain is severe, getting worse, or lasting more than a few weeks.
- Pain does not improve as you move around during the day.
- You notice swelling, redness, or warmth around the heel.
- Pain is located more at the back of the heel than on the bottom.
- You feel numbness, tingling, burning, or “electric” sensations.
- You have trouble putting weight on the foot or walking normally.
These signs do not always point to a serious problem, but they do mean it is time for a foot and ankle specialist to take a closer look.
Get Expert Help for Heel Pain
Heel pain can stem from many different causes, and the right treatment starts with a precise diagnosis. What works for plantar fasciitis may not be effective for Achilles tendinitis, nerve pain, or stress fractures.
At Sweeney Foot & Ankle Specialists, we take the time to identify the exact source of your discomfort and design a treatment plan tailored to your needs. Our goal is to relieve pain, restore mobility, and help you get back to the activities you enjoy.
Contact Sweeney Foot & Ankle Specialists today to schedule an evaluation and take the first step toward lasting heel pain relief.
