The most common reason your heel hurts is plantar fasciitis, a condition where the thick band of tissue connecting your heel bone to the ball of your foot becomes inflamed or develops small tears. About 1% of U.S. adults are diagnosed with it in any given year. But several other conditions can cause heel pain too, and where exactly you feel the pain, what it feels like, and when it shows up all point toward different causes.
Plantar Fasciitis: The Most Likely Culprit
The plantar fascia is a strong, stretchy band of tissue that runs along the bottom of your foot, connecting your heel bone to your toes and forming the arch. Think of it like a thick rubber band. When that band gets overused or overstretched, it swells and becomes painful, especially right where it attaches to the heel bone.
The hallmark symptom is a sharp, stabbing pain in the bottom of your heel with your first steps in the morning. After you’ve been off your feet for a while, the tissue tightens up. When you suddenly put weight on it, those first few steps re-aggravate the inflammation. The pain usually eases once you’ve walked around for a few minutes, but it can return later in the day after long periods of standing or when you stand up after sitting. Plantar fasciitis does not cause tingling, numbness, or burning. If you’re feeling those sensations, something else is going on.
Several things raise your risk. Carrying extra weight puts more load on the fascia with every step. Jobs that keep you on your feet for hours are a well-documented risk factor. Having very flat feet or very high arches changes how force distributes across the bottom of your foot, and limited ankle flexibility makes the problem worse. For runners and other athletes, training more than six days a week or logging more than about 60 kilometers (37 miles) per week increases the chances of developing it. Interestingly, people who don’t exercise regularly also have higher rates of plantar fasciitis, likely because their foot and calf muscles are weaker and less flexible.
Pain in the Back of Your Heel
If the pain is behind your heel rather than under it, the Achilles tendon is the more likely source. Achilles tendinitis comes in two forms. The insertional type affects the spot where the tendon attaches to the heel bone and can happen to anyone, even people who aren’t particularly active. The non-insertional type involves the middle portion of the tendon, higher up from the heel, and tends to affect more active people. Both types cause pain, swelling, and stiffness at the back of the heel.
Bursitis is another possibility. Bursae are small fluid-filled sacs that cushion joints, and the one near your heel can become inflamed from prolonged time on your feet. It produces a deep, tender, bruise-like feeling at the back of the heel. Haglund’s deformity is a related condition where chronic irritation leads to a visible, bony bump forming on the back of the heel. It’s sometimes called a “pump bump” because rigid-backed shoes can contribute to it.
Heel Spurs Are Rarely the Problem
Many people worry that a heel spur is causing their pain, but the American Academy of Orthopaedic Surgeons is clear on this point: most people with heel spurs on X-rays have no heel pain at all. Heel spurs are bony growths that develop over time from tension on the plantar fascia, but they are a consequence of the underlying problem, not the cause of your pain. Plantar fasciitis pain can be treated successfully without ever removing a spur, and surgery to address the spur itself is rarely necessary.
Nerve Pain Feels Different
Tarsal tunnel syndrome is sometimes mistaken for plantar fasciitis because both cause pain in the foot. But the sensations are distinct. Nerve-related heel and foot pain feels sharp or electric, often with burning, tingling, or a pins-and-needles quality. You might notice numbness along the inside of your ankle or the bottom of your foot, and the pain can radiate into your toes. Some people notice symptoms even while resting, particularly in the evening. Plantar fasciitis, by contrast, produces a localized ache or stab at the heel without any tingling or numbness. If your pain has that electric, burning character, it’s worth mentioning to your doctor because the treatment approach is different.
Bone Injuries and Bruising
A bone bruise on the heel can happen after landing hard on a rock or stepping off a curb awkwardly. You might not see any discoloration on the skin, but the heel feels tender when you walk and sometimes even at rest. Stress fractures are a more serious possibility, particularly for runners or anyone who has recently ramped up their activity level. A stress fracture can cause pain along the bottom, side, and back of the heel, and the pain tends to worsen steadily rather than improving with movement the way plantar fasciitis often does.
Heel Pain in Children
If your child is complaining about heel pain, Sever’s disease is the most likely explanation. It’s not actually a disease. It’s inflammation of the growth plate in the heel bone, and it’s very common in active kids between the ages of 8 and 14, when growth spurts happen. During these periods, bones grow faster than muscles and tendons can keep up. The Achilles tendon gets tight and pulls on the heel bone during running and jumping, irritating the growth plate. Doctors diagnose it with a physical exam, pressing gently on the heel to locate the pain, and sometimes asking the child to walk, run, or jump. Imaging is usually only needed to rule out other conditions. The good news is that it resolves on its own once the growth plate closes, and in the meantime, rest and reducing high-impact activity help manage the pain.
What Helps Heel Pain at Home
About 90% of plantar fasciitis cases respond well to conservative treatment without any procedures. The single most effective thing you can do is a specific stretch: sit down, cross your affected foot over your opposite knee, grab your toes, and gently pull them back toward your shin. Hold for 10 seconds, repeat 10 times, and do this at least three times a day for a minimum of eight weeks. The most critical time to do it is before your first steps in the morning and before standing after you’ve been sitting for a while. An Achilles tendon stretch can provide additional benefit but should be done after the plantar fascia stretch, not before.
Beyond stretching, reducing the load on your feet matters. Supportive shoes with cushioned heels make a difference, and going barefoot on hard floors tends to aggravate the problem. Ice applied to the heel for 15 to 20 minutes after activity helps control inflammation. If you’ve recently increased your exercise volume, backing off temporarily gives the tissue time to heal.
When Imaging Comes Into Play
Most heel pain doesn’t need an X-ray or scan to diagnose. Doctors typically rely on your description of the pain, its timing, and a physical exam. Imaging enters the picture in two situations: when heel pain hasn’t improved after weeks of conservative treatment, or when your symptoms suggest something other than plantar fasciitis. An X-ray is useful for spotting stress fractures, bone spurs, arthritis, or alignment issues. Ultrasound can reveal soft tissue problems like a thickened plantar fascia (anything over 4 mm is considered abnormal), tendon damage, or nerve compression. MRI provides the most detailed view and can identify tears or ruptures in the plantar fascia, tendon injuries, cysts, and Haglund’s deformity. If your heel pain came on very suddenly, is getting worse despite rest and stretching, or is accompanied by tingling and numbness, those are all reasons your doctor may want a closer look.