Heel pain

Heel pain is very common and usually comes from a local, mechanical cause. The most frequent is plantar fasciitis: inflammation and irritation of the thick band of tissue along the sole, causing sharp pain under the heel that is classically worst with the first steps in the morning or after rest, and often linked to a lot of standing, new activity, unsupportive footwear or increased weight. Pain at the back of the heel usually involves the Achilles tendon (tendinopathy or, less often, a partial tear or bursitis). A bruised heel, a stress fracture from repetitive impact, or a pinched nerve can also cause it. Most heel pain is self-limiting and mechanical. But there is a distinctive and important pattern to recognise: inflammation at the point where a tendon or ligament attaches to bone, called enthesitis. Enthesitis of the heel (at the Achilles insertion or the plantar fascia) is a characteristic feature of the spondyloarthritis family — ankylosing spondylitis, psoriatic arthritis and related conditions — so heel pain that comes with inflammatory back stiffness, swollen fingers or toes, psoriasis, or a painful red eye deserves a rheumatology perspective. Less commonly, gout can cause a hot, acutely painful heel. So while most heel pain is a simple mechanical problem, its context sometimes points to a wider inflammatory disease.

• Plantar fasciitis — the commonest cause; sharp under-heel pain, worst with the first steps in the morning.
• Achilles tendon problems — pain at the back of the heel, often with activity.
• Stress fracture or heel bruise — from repetitive impact or a knock.
• Enthesitis (spondyloarthritis) — inflammation at the tendon insertion; a clue to ankylosing or psoriatic arthritis, especially with other inflammatory features.
• Gout — a hot, acutely painful heel, uncommonly.
• Pinched nerve — burning or tingling heel pain.

Most heel pain is mechanical and needs no blood tests — it is diagnosed clinically and managed with rest, footwear, stretching and physiotherapy. Testing is reserved for when heel pain fits a wider inflammatory pattern: with inflammatory back stiffness, swollen digits, psoriasis or eye inflammation, when inflammatory markers ESR and CRP help support a spondyloarthritis, alongside imaging and specialist assessment. If a hot, acutely painful heel suggests gout, uric acid is relevant (though it can be normal during an attack). Mediora.AI surfaces raised inflammatory markers or uric acid from your results when the picture suggests an inflammatory or gouty cause rather than a purely mechanical one; the interpretation belongs with your doctor.