A sensation of warmth or burning in the heel can range from mild to persistent discomfort. This feeling may or may not be accompanied by actual physical heat. While a hot heel is a specific symptom, its underlying reasons are varied, stemming from different biological processes. Understanding how the body registers temperature can shed light on why such a sensation might occur.
How the Body Senses Heat
The body uses specialized sensory receptors called thermoreceptors to detect temperature changes. Warmth receptors, a type of thermoreceptor, are free nerve endings located just beneath the skin’s surface. When stimulated by temperatures above 30°C (86°F), they convert thermal information into electrical signals. These signals travel along nerve pathways to the brain, where they are interpreted as warmth. However, these receptors can also be activated by chemical mediators released during inflammation or by direct irritation or damage to nerves, leading to a perceived sensation of heat even without an external heat source.
Common Causes of a Hot Heel
Many conditions can lead to a hot heel sensation, often due to inflammation or nerve irritation. Inflammation commonly involves increased blood flow and the release of specific chemicals that activate warmth receptors. Nerve-related issues can cause phantom sensations of heat or burning as a result of nerve damage or compression.
Inflammation
Plantar fasciitis, an inflammation of the thick band of tissue running along the bottom of the foot, can cause a burning sensation, especially if swelling is present. Achilles tendinitis, inflammation of the Achilles tendon connecting the calf muscles to the heel bone, often presents with pain, warmth, redness, and a burning feeling. This condition commonly arises from overuse or sudden increases in physical activity. Bursitis, where small fluid-filled sacs (bursae) cushioning joints become irritated, can cause pain, swelling, redness, and warmth around the heel.
Arthritis
Arthritis, an inflammation of the joints, can affect the foot and ankle, leading to joint pain, stiffness, swelling, and a feeling of heat. Gout, a type of arthritis caused by uric acid buildup, and psoriatic arthritis, an inflammatory condition associated with psoriasis, can both manifest with warm, swollen, and painful joints in the foot.
Nerve-Related Issues
Nerve-related issues represent another significant category for a hot heel. Neuropathy, which refers to nerve damage, often causes burning sensations in the feet. Diabetic neuropathy, a common complication of diabetes due to high blood sugar damaging nerves, frequently results in burning, tingling, or numbness. Alcoholic neuropathy, caused by excessive alcohol use, also leads to nerve damage and a hot burning feeling.
Sciatica, where the sciatic nerve in the lower back is compressed, can cause pain, numbness, or tingling that radiates down the leg and into the foot, sometimes perceived as heat. Tarsal tunnel syndrome involves compression of the posterior tibial nerve as it passes through a narrow space on the inside of the ankle, leading to burning, tingling, or shooting pain in the heel, arch, or toes.
Infections
Infections are a less common but serious cause of a hot heel. Cellulitis, a bacterial skin infection, typically presents with visible redness, swelling, and actual warmth to the touch, often spreading rapidly. Localized abscesses, collections of pus, would also cause significant heat, redness, and swelling. These conditions involve the body’s immune response, which includes increased blood flow to fight the infection.
Injury or Trauma
Injury or trauma can also result in a hot heel sensation as part of the healing process. Stress fractures, tiny cracks in the heel bone (calcaneus) from repetitive activity, can cause pain and the skin to feel warm to the touch. Sprains, which involve stretched or torn ligaments, initially cause inflammation, leading to swelling and a feeling of warmth as the body attempts to heal the injury.
Vascular Issues
Vascular issues, although less commonly presenting primarily as a hot sensation, can contribute to nerve problems or skin changes that may indirectly cause a feeling of warmth. Conditions affecting blood flow, such as peripheral artery disease, can impact nerve health and sensation.
Associated Symptoms and When to Seek Medical Care
A hot heel sensation is often accompanied by other symptoms that can help pinpoint the underlying cause. Common co-occurring symptoms include pain, which can be sharp, dull, or aching, and may worsen with activity or at night. Swelling and redness are frequently observed, particularly with inflammatory conditions or infections.
Other associated symptoms include:
Numbness, tingling, or a “pins and needles” sensation may indicate nerve involvement.
Weakness or difficulty bearing weight on the affected foot can also occur.
Changes in skin appearance, such as rashes or sores.
A fever and chills, suggesting a possible infection.
It is prudent to seek medical attention if:
Severe pain, especially after an injury, or if the pain is sudden and intense.
Worsening symptoms, inability to walk or bear weight, or visible signs of infection such as spreading redness or pus.
A hot heel sensation combined with a fever, or if you have underlying conditions like diabetes.
The sensation persists for more than a few days despite rest and self-care.
Understanding Diagnosis and General Management
When seeking medical care for a hot heel, a healthcare provider will typically begin with a thorough medical history review. This involves discussing when the symptoms started, what makes them better or worse, and any other associated symptoms you are experiencing. A physical examination will follow, where the doctor will check for tenderness, swelling, range of motion in the foot and ankle, and neurological function.
To further investigate the cause, several diagnostic tests may be utilized:
X-rays can help identify bone fractures or signs of arthritis.
Blood tests may be performed to check for markers of inflammation or systemic conditions like gout or diabetes.
In cases of suspected nerve involvement, nerve conduction studies may be conducted.
For soft tissue issues like tendon or ligament damage, or more detailed bone assessment, an MRI might be ordered.
General management principles for a hot heel depend entirely on the specific underlying cause. Initial approaches often include:
Rest to prevent further irritation and ice application to reduce inflammation and numb the area.
Over-the-counter anti-inflammatory medications can help manage pain and swelling.
Physical therapy may be recommended to improve flexibility, strength, and biomechanics.
Custom orthotics or supportive footwear can also help alleviate pressure and improve foot alignment.
For nerve pain, specific medications may be prescribed.
If an infection is diagnosed, antibiotics are typically necessary.
Addressing any underlying systemic conditions, such as managing blood sugar levels for diabetes, is also a crucial part of treatment.