No matter where heel pain strikes (front, middle, back, or everywhere!), the biggest question on your mind is likely, “How can I make it stop?” However, the location of your heel pain reveals important clues about its underlying cause!
Inner heel pain can present as achy, bruise-like, or sharp and intense. By understanding your unique symptoms and honing in on the why your inner heel hurts, you can take more effective steps toward treatment. Let’s get to the bottom of your inner heel pain:
Why Does My Inner Heel Hurt?
The most common causes of heel pain deep within the heel are trapped nerves, plantar fasciitis, fat pad syndrome, and stress fractures.
Trapped Nerves in the Heel
Sometimes, nerves in the heel can become “entrapped,” or squeezed/constricted because of injury to the foot, trauma, or simply overuse. There are several key nerves that run along the inside of the heel and connect to the posterior tibial nerve. These nerves include the medial plantar nerve medial calcaneal nerve, the lateral plantar nerve, and the nerve to the abductor digiti minimi.
- Pain may feel tingling, numb, or burning
- You may notice tenderness to the touch along the inner heel. The exact location of the pain will depend on which nerve is entrapped.
- Symptoms may flare up when you walk or participate in physical activities, and improve somewhat with rest
- Pain from an entrapped nerve is usually felt in just one foot
If your inner heel pain is caused by an entrapped nerve, your doctor will likely recommend rest from activities that aggravate pain, icing, stretching, and anti-inflammatory medication as needed. If these more conservative treatment methods do not work, your doctor may recommend surgery to decompress the entrapped nerve.
Heel Pad Syndrome
A thin, atrophied heel pad can result in a painful condition known as Heel Pad Syndrome. This condition can be caused by aging, weight gain, repetitive impact on hard surfaces, or unsupportive, uncushioned footwear.
- Bruise-like pain deep in the heel as the fat pad is no longer able to cushion the heel effectively
- Pain that can be recreated by firm pressure on the bottom of the heel
- Pain that gets worse when you walk on hard surfaces
- Heel Pad Syndrome is often closely linked with plantar fasciitis
Treatments for Heel Pad Syndrome involve lots of rest and better support and cushioning for the heel. Your doctor will likely recommend icing, anti-inflammatory medicines as needed, taping, and orthotic inserts that cushion the heel, support the foot, and reduce pain while walking.
Stress Fractures on the Heel
A stress fracture on the heel is a very thin crack in the heel bone that can be caused by repetitive stress or impact to the heel, or a sudden blow to the heel. The risk for stress fractures is elevated in high impact sports, for people with osteoporosis or with low vitamin D levels, or for individuals who increase the intensity of their workouts significantly without warming up.
- Pain may come on gradually or onset suddenly and is typically sharp and intense
- Pain that gets worse the longer you stay on your feet and gets worse if you stretch
- Pain that is located in one very specific spot on the heel
- Swelling, redness, and tenderness to the touch
It’s important to see a doctor and treat suspected stress fractures right away, to avoid further damage or a complete break in the bone. Your doctor may recommend an Ace Bandage or KT tape to help stabilize the foot, and may also recommend crutches, a cast, and complete rest from the foot while you heal. Icing and anti-inflammatories can help with pain while you heal.
Plantar fasciitis is caused by damage to the plantar fascia ligament, which runs from the heel to the ball of the foot. This damage, combined with inflammation in the heel can lead to intense pain in the heel. Risk factors for plantar fasciitis include weight gain, wearing unsupportive shoes, intense exercise without proper warmup, and jobs that require a lot of standing and walking.
- Pain that is worst in the morning, with the first few steps out of bed
- Pain that gets slightly better with movement and improves with stretching
- Stiff, aching heels
- Swelling, pain, and inflammation in the heels
- Pain may be dull, or sharp and needling
Thankfully, most cases of plantar fasciitis can be treated at home with rest, stretches to improve flexibility, and orthotic inserts that realign the plantar fascia and cushion the heel. Icing, anti-inflammatory medication, and dietary changes to lose weight when possible can also help speed up healing.
What to Do if You Have Inner Heel Pain
If you have inner heel pain, the most important thing you can do is hone in on your unique symptoms and educate yourself — while you rest from any activities that seem to be exacerbating the pain!
This information will help you communicate effectively with your doctor, determine the source of your inner heel pain, and form an effective and actionable plan for treatment.
In general, most cases of inner heel pain can be resolved with conservative treatment rather than invasive medical procedures like surgery. Unless your heel pain is very severe, or you suspect a fracture, try conservative treatment methods first! In most cases, you’ll be back on your feet in a relatively short amount of time.