Yes, you can get arthritis in your heel. The heel bone (calcaneus) connects to other bones through joints that are vulnerable to the same cartilage breakdown, inflammation, and damage that affect knees, hips, and hands. The most commonly affected joint in this area is the subtalar joint, where the heel bone meets the bone above it (the talus), but several types of arthritis can cause heel pain in different ways.
Which Joint Is Involved
The subtalar joint sits where the heel bone meets the talus, and it’s the primary spot where heel arthritis develops. This joint is responsible for letting your foot tilt side to side, which is how you stay balanced on uneven ground. When the cartilage in this joint wears down, that sideways motion becomes painful and stiff.
Pain from subtalar arthritis typically shows up just below the ankle bones on either side of the foot. Another common tender spot is a small hollow just in front of the outer ankle bone called the sinus tarsi. The pain gets worse with standing and walking, especially on uneven surfaces like gravel, grass, or hiking trails. This is a useful clue: if flat, smooth surfaces feel tolerable but uneven ground makes your heel area hurt significantly more, the subtalar joint is a likely source.
Nearby, the talonavicular joint (where the talus meets a bone further forward in the foot) can also develop osteoarthritis. A large population study of adults over 50 found that about 5.8% had symptomatic, X-ray-confirmed osteoarthritis at this joint, making it one of the more commonly affected joints in the foot.
Types of Arthritis That Affect the Heel
Post-Traumatic Arthritis
This is the most common cause of subtalar arthritis. If you’ve ever fractured your heel bone or badly sprained your ankle, the initial damage to the cartilage surface sets the stage for arthritis years later. The severity of cartilage damage during the original injury is the strongest predictor of whether arthritis develops. For joints in the lower leg and hindfoot, severe osteoarthritis can appear 5 to 12 years after the fracture, though the timeline varies.
Rheumatoid Arthritis
Rheumatoid arthritis, an autoimmune condition, frequently involves the subtalar and midtarsal joints of the foot. It can also cause inflammation of the bursa near the Achilles tendon (the fluid-filled sac that cushions the back of the heel), which is more common in women. Over time, rheumatoid involvement in these joints can cause the heel to drift outward and the arch to flatten, changing the shape of the foot.
Gout
Gout, caused by uric acid crystal buildup, can affect the heel area indirectly. It promotes the formation of bony spurs at two key attachment points on the heel bone: where the Achilles tendon connects at the back and where the plantar fascia connects on the bottom. Gout patients with metabolic conditions like diabetes or high blood pressure are at higher risk for these spurs, likely because of poor blood flow that leads to calcification where tendons and ligaments anchor to bone. Gout can also cause cartilage loss, erosions with distinctive “punched-out” holes visible on X-rays, and new bone formation around the heel.
Ankylosing Spondylitis
This inflammatory condition primarily affects the spine but frequently shows up as heel pain through a process called enthesitis, which is inflammation where tendons and ligaments attach to bone. The heel is one of the most common sites for this. Many people with unexplained heel pain and normal lab results are eventually found to have a form of spondyloarthropathy once their back, other joints, and enthesitis sites are carefully examined. Patients often don’t mention their back stiffness or pain elsewhere because they assume it’s unrelated.
How Heel Arthritis Feels Different From Plantar Fasciitis
Plantar fasciitis is far more common, so many people assume their heel pain must be that. But the two conditions feel different in important ways. Plantar fasciitis causes a stabbing pain on the bottom of the foot near the heel, and it’s characteristically worst with your first steps in the morning or after sitting for a while. Once you get moving, it often eases up.
Subtalar arthritis pain, by contrast, is located around the sides of the heel below the ankle bones, not on the bottom of the foot. It gets progressively worse the longer you’re on your feet and is especially aggravated by walking on uneven terrain. You may also notice stiffness or a grinding sensation when you try to tilt your foot inward or outward. If your pain fits this pattern, particularly if you have a history of a heel or ankle fracture, arthritis is worth investigating with imaging. A CT scan or MRI can reveal the extent of joint damage and rule out other conditions like tendon problems.
How Heel Arthritis Is Managed
Treatment typically starts conservatively. Stiff-soled shoes or rocker-bottom shoes reduce how much the subtalar joint has to move with each step, which can significantly cut down on pain. Studies in patients with rheumatoid foot arthritis found that high-top rocker shoes with a wide toe box improved pain, disability, and daily activity levels. Custom orthotics that limit side-to-side heel motion can also help. Anti-inflammatory medications, steroid injections into the subtalar joint, and activity modification (avoiding uneven ground, reducing time on your feet) are other common first steps.
If conservative measures stop working, the main surgical option is subtalar fusion, which permanently joins the heel bone to the talus. This eliminates the painful joint motion but also eliminates the foot’s ability to tilt side to side, which means walking on uneven surfaces will always feel a bit awkward. In one long-term study following patients for a median of nearly five years, all 28 fusions successfully healed, with bone union taking about 13 weeks on average. Most patients were satisfied with the outcome: 19 of 26 were satisfied without reservations, and all had a stable hindfoot after surgery.
Recovery from fusion involves about six weeks in a non-weight-bearing cast, followed by another six weeks in a walking cast with partial weight bearing. Full weight bearing and rehabilitation begin around the three-month mark once X-rays confirm the bones have fused. The functional results are generally good, though some patients notice stiffness or mild limitations afterward, and adjacent joints can take on extra stress over time.
Who Is Most at Risk
Your risk of developing heel arthritis is highest if you’ve fractured your heel bone or talus, even if that injury happened a decade ago. Misalignment of the heel bone, whether from an old injury, a structural abnormality, or progressive flatfoot, also puts abnormal stress on the subtalar joint and accelerates cartilage loss. People with rheumatoid arthritis, gout, or ankylosing spondylitis carry additional risk because of the systemic inflammation or crystal deposits these conditions produce. Osteoarthritis of the foot in general becomes more common after age 50, with nearly 17% of older adults showing symptomatic, X-ray-confirmed arthritis in at least one foot joint.