Is My Heel Pain Plantar Fasciitis or Arthritis?
Most heel pain is a local, mechanical problem that improves with simple measures. Sometimes, though, heel pain is the first visible sign of an inflammatory arthritis that also affects the spine or other joints.
The heel takes the full weight of your body with every step. Pain here is very common, especially in people who stand for long hours, walk on hard floors or wear thin-soled footwear.
Where exactly does your heel hurt?
- Under the heel, worst with the first steps in the morning or after sitting: typical of plantar fasciitis, irritation of the thick band of tissue that runs under the foot. It usually affects one foot.
- At the back of the heel, where the Achilles tendon attaches: can be Achilles tendon strain from overuse, or inflammation where the tendon joins the bone (called enthesitis).
- Both heels, without an obvious reason: more likely to have an inflammatory cause, such as spondyloarthritis.
Enthesitis means inflammation at the spot where a tendon or ligament attaches to bone. It is a key feature of ankylosing spondylitis, psoriatic arthritis and reactive arthritis. If your heel pain comes with back pain that is worse at rest, psoriasis, a painful red eye or bowel symptoms, mention this to your doctor.
Mechanical or inflammatory?
Here is how common mechanical heel pain usually differs from inflammatory heel pain.
| Feature | Mechanical (plantar fasciitis, tendon strain) | Inflammatory (spondyloarthritis) |
|---|---|---|
| Where | Usually under the heel; one foot | Under or behind the heel; often both feet |
| Linked to | Long standing, weight gain, hard floors, new activity, worn footwear | Back stiffness, other swollen joints, psoriasis, red eye, bowel symptoms |
| Morning pattern | Sharp pain with first steps, eases after a few minutes of walking | Morning stiffness elsewhere too, often lasting over 30 minutes |
| Swelling | Usually none | Sometimes visible swelling at the back of the heel |
| Response to rest and stretching | Usually improves over weeks to months | Often persists or returns despite simple measures |
| Age | Often 40–60 | Often starts before 45 |
Common causes of heel pain
- Plantar fasciitis: the most common cause. Stretching, supportive footwear, weight management and reducing long periods of standing usually help.
- Achilles tendon problems: pain and thickening at the back of the heel, often after a sudden increase in walking or sport.
- Ankylosing spondylitis / axial spondyloarthritis: heel enthesitis with back pain.
- Psoriatic arthritis: heel pain with skin or nail psoriasis, or sausage-shaped toes.
- Reactive arthritis: heel and joint pain a few weeks after a bowel or urinary infection.
- Gout: more often affects the big toe, ankle or midfoot, but can cause sudden pain in the foot.
- Stress fracture: pain that steadily worsens with walking, especially after a sudden increase in activity.
A heel spur seen on X-ray is common and often not the cause of pain on its own.
When is it urgent?
Get same-day medical help if: you felt a sudden snap or kick at the back of the heel and cannot push off or stand on tiptoe (possible Achilles tendon rupture); the heel or foot is hot, red and swollen with fever; or you have diabetes and notice a wound, redness or swelling on the foot. Call +91 93386 53086 during clinic hours (Mon–Sat, 9 AM–2 PM & 4:30–9 PM). Outside clinic hours, or if symptoms are severe, go to the nearest emergency department straight away.
Which doctor should you see?
- Pain in both heels, heel pain with back pain, psoriasis or eye inflammation, or pain lasting over six weeks: see a rheumatologist. At OARC, Dr. Jyoti Ranjan Parida (Saheed Nagar) or Dr. Debashis Maikap (Sailashree Vihar).
- Pain under one heel with first morning steps, otherwise well: often plantar fasciitis. Start with stretching and footwear advice; physiotherapy can help.
- Heel pain after an injury, or a suspected tendon rupture or fracture: an orthopaedic surgeon or emergency department. OARC does not offer orthopaedic surgery.
When to book an appointment
Book a rheumatology appointment if your heel pain has lasted more than six weeks despite stretching and good footwear, if both heels hurt, or if you also have back pain, swollen joints, psoriasis or eye inflammation.
Heel pain that won’t settle may be part of a bigger picture. A rheumatologist can check for spondyloarthritis.
Heel pain: common questions
See a rheumatologist in Bhubaneswar
OARC has two centres in Bhubaneswar, with an in-house lab, Immunix Labs (working with NABL-accredited partner labs), pharmacy, imaging and physiotherapy. Bring any previous reports, X-rays or scans and a list of your current medicines.
Saheed Nagar (Main Centre)
Dr. Jyoti Ranjan Parida consults here
A/90 Saheed Nagar, opp. Ayakar Bhavan, Bhubaneswar 751007
Mon–Sat 9 AM–2 PM & 4:30–9 PM · Sunday closed
Sailashree Vihar, Chandrasekharpur
Dr. Debashis Maikap consults here
P-13/14 Sailashree Vihar, Chandrasekharpur, Bhubaneswar 751021
Mon–Sat 8–9 AM & 5–6 PM · Sunday closed
References
- NHS. Heel pain. NHS website. www.nhs.uk/symptoms/foot-pain/heel-pain/
- NHS. Ankylosing spondylitis. NHS website. www.nhs.uk/conditions/ankylosing-spondylitis/
- NICE. Spondyloarthritis in over 16s: diagnosis and management (NG65), 2017. www.nice.org.uk/guidance/ng65
- NHS. Psoriatic arthritis. NHS website. www.nhs.uk/conditions/psoriatic-arthritis/
This page gives general information and is not a diagnosis. Please see a doctor about your own symptoms. Read our editorial policy to learn how we write and review medical content.