Does your heel feel tender or swollen, appear red, or feel like a lump has developed? 

Heel pain is not a medical term or diagnosis but commonly describes discomfort in the bottom of the foot. This can occur in people with almost any foot type. Interestingly, 15-20% of adult foot complaints are due to heel pain.

The pain usually occurs in two areas, beneath the heel and on the back side of the heel by the Achilles. Two important structures are related to the heel- the fat pad and plantar fascia. The fat pad is a specialized piece of fat that absorbs shock, maintains its shape on weight bearing, and cushions/protects vital tendons, nerves, and other structures during the walking pattern.

The plantar fascia is a thick, strong band of tissue that originates from the inner heel, extending through the arch to the base of all toes. The fascia helps support and stabilize the longitudinal arch and aids in elevating the arch in walking. It naturally tightens as a person rises on their tiptoes.

It can be difficult to determine if the heel pain is due to bursitis or caused by the plantar fascia or the Achilles tendon without an examination by one of our professionals. Heel bursitis is tiny sacs of fluid at the back of or one under the heel, which can become inflamed, causing pain. Two such sacs are located on the back of your heel, and on either side of the Achilles tendon, between the skin and the Achilles tendon, and the skin and the bone. The sacs as pillows between the tendon and the bone. 

If either or both of these bursae become inflamed, pain and tenderness result. The shoes you usually wear can be difficult to put on. You might also notice symptoms such as redness, swelling, or a “lump” along the back of your heel. Bony heel pain, often referred to as a “pump bump,” is also caused by inflamed bursae.

 Ignoring symptoms can make heel bursitis worse, leading to more serious conditions such as a ruptured Achilles tendon. Overuse is one of the main reasons for inflammation of the bursae and why this condition is often seen in runners and athletes. Other contributing factors to bursae inflammation include gout, rheumatoid arthritis, Haglund’s deformity, and ill-fitting shoes. 

Treatment of Inflamed Bursae

Anti-inflammatory medications are a common treatment, along with rest and ice. These medications reduce inflammation and are not used to "kill the pain." Limiting weight-bearing activities may also help avoid excessive walking, running, or training. Mixing your shoes and not going barefoot is important in treating bursitis. You do not want your shoes to rub or hit the same spot, causing more problems.

Surgical shoes, immobilization, orthotics or night splints, and physical therapy may all be part of the treatment.

Surgery should be reserved for chronic, unrelenting cases; only a small percentage (2-5%) go on to surgery. Surgery may involve exploration of the nerve, plantar fascia, and heel spur.


Healthmark physicians need to examine and determine the true diagnosis of heel problems. Heel pain can easily be mistaken for plantar fasciitis. If you are experiencing heel pain, schedule an appointment today.

Are You Looking for a Bursitis Specialist in Philadelphia?

If you are looking for heel pain care in Philadelphia, PA? Contact Healthmark Foot and Ankle Associates today.