Heel pain accompanied by a burning sensation suggests involvement of the nervous system or severe irritation of surrounding soft tissues, differentiating it from simple mechanical discomfort. The addition of a burning feeling often points toward a neuropathy or an inflammatory process causing secondary nerve impingement. Determining the source of this neurogenic or inflammatory pain is necessary for effective management. A thorough evaluation by a healthcare provider is required to accurately determine the specific cause.
Nerve Compression Syndromes That Cause Burning
A burning sensation is the nervous system’s characteristic signal of irritation or compression, making nerve entrapment syndromes a common cause. Tarsal Tunnel Syndrome (TTS) involves the posterior tibial nerve, which travels through a narrow fibrous canal on the inside of the ankle. Compression of this nerve can be caused by factors like swelling, trauma, flat feet, or bony growths. This pressure results in sharp, shooting pain, tingling, numbness, and a burning feeling that radiates into the sole and heel.
Baxter’s nerve entrapment is a highly localized form of nerve compression affecting the first branch of the lateral plantar nerve (inferior calcaneal nerve). This small nerve runs along the inside of the heel, and compression often occurs between the abductor hallucis and quadratus plantae muscles. Symptoms typically present as chronic, burning pain on the inner aspect of the heel, often worsening with activity. Baxter’s neuropathy is estimated to be the source of pain in up to 20% of chronic heel pain cases often mistakenly diagnosed as Plantar Fasciitis.
The location of the burning sensation helps differentiate these nerve issues. TTS pain often extends broadly across the bottom of the foot and arch, sometimes radiating up the calf. Baxter’s nerve entrapment is more focused on the heel’s medial-plantar aspect. Nerve root compression higher up in the spine (sciatica) can also refer pain down the leg, causing a burning sensation in the heel due to pressure on the L5-S1 nerve roots.
Severe Inflammation of Connective Tissue
Plantar Fasciitis, the most common cause of mechanical heel pain, involves inflammation and micro-tears in the tissue along the bottom of the foot. While the hallmark symptom is sharp, stabbing pain with the first steps in the morning, a burning sensation can occur in cases of severe or prolonged irritation. This burning may result from the inflammatory process irritating small nerve branches near the damaged plantar fascia.
Repetitive strain and excessive tension can lead to this inflammatory response, especially in individuals with poor foot mechanics or those who spend extended periods on their feet. Similarly, Achilles Tendinitis, which affects the large tendon connecting the calf muscle to the heel bone, can cause discomfort described as a tightening or burning sensation. The inflammation and irritation at the tendon’s insertion point on the back of the heel can produce localized heat and pain.
The distinction between inflammatory burning and nerve compression burning often lies in the associated symptoms. Inflammatory pain, such as from Plantar Fasciitis, is typically most intense after periods of rest, like first thing in the morning, and may temporarily improve with movement. Conversely, nerve-related burning, such as in Tarsal Tunnel Syndrome, frequently includes tingling or numbness and may worsen after prolonged activity or at night.
Systemic Conditions and Structural Breakdown
A persistent burning sensation in the heel can manifest from systemic conditions. Peripheral neuropathy, which involves damage to peripheral nerves, is a frequent cause of burning pain in the feet and lower extremities. The most common cause is diabetes, where prolonged high blood glucose levels damage nerve fibers, leading to symptoms like numbness, tingling, and a bilateral burning or “hot” feeling.
Structural degradation in the heel can also contribute to this type of discomfort. The heel fat pad is a specialized layer of connective tissue that acts as the foot’s primary shock absorber. When this pad thins out (fat pad atrophy), the calcaneus bone loses its natural cushioning. The resulting lack of protection subjects the heel bone and surrounding tissues to increased impact forces, which can generate pain described as deep aching or burning, particularly when bearing weight.
Although less common, bone stress injuries can present with a deep, localized burning sensation. A calcaneal stress fracture, a small crack in the heel bone often caused by repetitive high-impact activity, can cause deep-seated pain sometimes accompanied by localized warmth or heat. Differentiation is based on the history of sudden training increase or trauma, and the pain often intensifies with weight-bearing activities.
Immediate Steps and Professional Consultation
Initial self-management of burning heel pain should focus on reducing inflammation and pressure. Resting the foot and avoiding aggravating activities limits further irritation to tissues or nerves. Applying cold therapy (an ice pack wrapped in a cloth) for 15 to 20 minutes several times a day helps soothe localized inflammation. Wearing supportive footwear with adequate arch support and cushioning, or using over-the-counter orthotics, helps manage biomechanical stresses.
While conservative steps provide relief, professional diagnosis is required to determine the exact cause, whether it is nerve entrapment, inflammation, or a systemic issue. Seek prompt medical attention if you experience warning signs, including sudden severe pain, inability to bear weight, or signs of infection like fever, chills, or spreading redness. Persistent pain that does not improve after a few weeks of home care also warrants an office visit.