The sensation of a burning heel, often described as tingling, prickling, or hot discomfort, is a form of neuropathic pain or paresthesia. This symptom signals irritation or damage to the sensory nerves that transmit signals from the foot to the brain. Unlike mechanical pain, which usually feels sharp or dull, burning pain indicates a problem with the nervous system itself. Understanding the underlying cause is important because the conditions range from localized physical compression to body-wide medical disorders.
Local Nerve Compression and Entrapment
A common cause of localized burning pain is the physical compression of a nerve as it passes through a narrow anatomical space in the ankle or foot, known as nerve entrapment. The most recognized example is Tarsal Tunnel Syndrome, which affects the posterior tibial nerve on the inner side of the ankle.
This nerve compression occurs within the tarsal tunnel, a tight passageway bounded by bone and the flexor retinaculum ligament. Trauma, swelling from a sprain, a ganglion cyst, or excessive foot pronation can narrow this space, placing pressure on the nerve. Symptoms typically include a burning or shooting sensation that radiates along the sole of the foot toward the heel.
Another specific form of local nerve irritation is Baxter’s neuropathy, involving the entrapment of the inferior calcaneal nerve. This nerve runs beneath the arch of the foot near the heel bone. Because its pathway is close to the plantar fascia, chronic inflammation or the presence of a bone spur can compress it. This entrapment often results in chronic burning pain sometimes misdiagnosed as purely mechanical heel pain.
Systemic Conditions Causing Neuropathy
When burning in the heel is symmetrical and affects both feet, it is often a sign of peripheral neuropathy, a generalized condition involving damage to the peripheral nerves throughout the body. This damage typically impacts the longest nerves first, creating a characteristic “stocking-glove” pattern of symptoms.
Diabetes Mellitus is the most frequent metabolic cause. High blood glucose levels damage the small blood vessels that supply oxygen and nutrients to the nerves. This process, known as diabetic polyneuropathy, can affect up to half of all people with diabetes. The resulting nerve malfunction leads to burning, tingling, and numbness that may worsen at night.
Deficiencies in certain nutrients, particularly Vitamin B12, can also impair nerve function and result in neuropathic pain. Vitamin B12 is necessary for maintaining the health of the myelin sheath, the protective covering around nerves. Similarly, chronic alcohol use can lead to toxic-metabolic damage, preventing the body from properly absorbing necessary vitamins and directly injuring nerve fibers.
Other systemic health issues, such as hypothyroidism or chronic kidney and liver disorders, can cause toxins to accumulate in the bloodstream, affecting peripheral nerve health. When the body’s immune system mistakenly attacks its own nerve tissues, as occurs in some autoimmune diseases, this inflammation can also cause generalized neuropathy. The presence of burning heel pain warrants a thorough evaluation for these underlying body-wide conditions.
Inflammation and Musculoskeletal Stress
While the primary source of burning pain is nerve-related, certain structural foot issues can create an inflammatory environment that secondarily irritates nearby nerves. Plantar Fasciitis, the inflammation of the thick band of tissue spanning the bottom of the foot, typically causes a sharp, stabbing pain. However, in severe or chronic cases, the intense swelling and tissue thickening can encroach upon surrounding nerves, leading to a burning component of the pain.
Similar inflammatory conditions, like Achilles Tendinitis, which causes irritation where the tendon meets the back of the heel bone, can also cause secondary nerve symptoms. The significant inflammation in the area may irritate the small nerves that supply the skin and surrounding structures. Additionally, small cracks in the heel bone, known as calcaneal stress fractures, cause localized swelling and pressure.
These mechanical injuries and overuse syndromes are usually characterized by pain that is worse with activity or when standing. Foot structure abnormalities, such as flat feet or high arches, can alter biomechanics, leading to repetitive strain that triggers both tissue inflammation and nerve compression over time.
Immediate Care and When to Consult a Doctor
For mild, recent onset heel pain, initial self-care can help manage symptoms and prevent further irritation. Implementing the RICE protocol—Rest, Ice, Compression, and Elevation—can reduce localized inflammation and swelling. Applying an ice pack to the heel for 15 to 20 minutes several times a day helps calm irritated tissues and nerves.
Changing to supportive footwear with a low heel and soft sole, or using over-the-counter arch supports, helps to minimize strain on the heel structures and nerves. Non-prescription anti-inflammatory medications may also provide temporary relief from pain and inflammation. Avoiding activities that aggravate the burning sensation is necessary for recovery.
It is important to seek professional medical evaluation if the burning heel pain persists for more than a few weeks despite home care. Immediate medical attention is necessary if the pain is severe, occurred suddenly after an injury, or is accompanied by signs of infection like warmth, spreading redness, or fever. You should also consult a doctor if you experience numbness, loss of feeling, or if the burning sensation begins to spread upward into your legs. These symptoms may point to a progressive neuropathy or a systemic health condition that requires specific diagnosis and treatment.