The appearance of a red heel, medically known as erythema, is a common physical complaint. Redness indicates an increase in blood flow to a specific area as part of the body’s vascular response to injury, irritation, or an underlying infection. Understanding the source of this inflammation is the first step toward finding relief, as the cause can range from simple shoe friction to a more serious medical condition.
Redness Caused by Mechanical Stress
The most frequent cause of heel redness comes from direct physical contact and friction, often involving footwear. When a shoe does not fit correctly, especially if the heel counter is rigid or too loose, the repetitive rubbing irritates the skin’s outermost layer. This mechanical trauma causes blood vessels near the surface to dilate, resulting in the visible red patch.
A common result of this friction is a blister, a pocket of fluid that develops between irritated skin layers to protect the underlying tissue. If friction continues over a long period, the skin may thicken its surface, producing a callus as a protective measure against chronic pressure. These friction-induced issues are generally acute, appearing quickly and resolving once the source of mechanical irritation is removed.
Redness can also result from a single, minor impact, such as stepping on a hard object, causing a small bruise. In athletes or those who recently increased activity, redness might signal localized inflammation due to overuse or excessive pressure on the heel fat pad during activities like running or jumping.
Inflammatory and Dermatological Conditions
Redness without an obvious mechanical cause often points toward a dermatological or inflammatory issue. One common infectious cause is Tinea pedis, or Athlete’s foot, a fungal infection presenting as red, scaly, and intensely itchy patches on the heel or sole. This infection thrives in warm, moist environments and may also cause peeling or flaking of the skin.
Another possibility is contact dermatitis, an inflammatory reaction occurring when the skin encounters an irritant or allergen. This could be from a new laundry detergent, chemicals in shoe materials, or ingredients in a foot cream. Contact dermatitis typically causes a red rash that may include small, itchy bumps or blisters, differing from the smooth redness caused by friction.
Chronic inflammatory disorders like eczema or psoriasis can also manifest on the heel. Psoriasis causes raised, well-defined patches of red skin covered with silvery scales due to the rapid buildup of skin cells. Less commonly, a systemic inflammatory condition like a gout flare, caused by uric acid crystals, can cause sudden, intense pain, swelling, and redness in the joints of the foot, sometimes including the heel area.
Deep Tissue and Pressure Injuries
Some causes of heel redness involve deeper structures or ongoing tissue damage that requires prompt medical attention. A deep skin infection like cellulitis is a bacterial infection of the dermis and subcutaneous tissues that causes the heel to become markedly red, swollen, and warm to the touch. The redness from cellulitis often spreads rapidly and may be accompanied by systemic symptoms such as fever and chills.
Bursitis is the inflammation of a bursa, a small fluid-filled sac that cushions structures like the Achilles tendon where it meets the heel bone. Retrocalcaneal bursitis causes localized swelling, pain, and redness just above the back of the heel, often triggered by repetitive motion or constant pressure from rigid footwear. If the bursa becomes infected (septic bursitis), the pain and warmth become severe.
A Stage 1 pressure injury, often called a bedsore or pressure ulcer, is a critical cause, particularly in individuals with limited mobility or nerve damage. This injury is defined by intact skin with a localized area of persistent, non-blanchable redness, usually over the bony prominence of the heel. Non-blanching indicates underlying tissue damage from restricted blood flow because the area does not turn white when pressed. In people with darker skin tones, this may appear as a persistent purple, blue, or maroon discoloration, and the area may feel firmer or softer than the surrounding tissue.
When to Consult a Healthcare Provider
While many cases of heel redness resolve with simple home care, certain symptoms require professional medical evaluation. Seek immediate care if the redness is spreading quickly, is accompanied by a fever, chills, or a general feeling of illness, or if there is any pus or foul-smelling drainage. These signs may point to a serious infection like cellulitis or septic bursitis.
A healthcare provider should also examine the heel if you experience intense, sudden pain, numbness, or tingling, which could indicate nerve involvement or a deep tissue issue. Similarly, any redness that does not begin to improve within a week of removing the pressure source needs professional evaluation.