Heel pain is one of the most common foot complaints, and in the vast majority of cases it comes from one of a handful of treatable conditions. The most likely culprit is plantar fasciitis, which accounts for roughly 80% of heel pain cases. But the exact cause depends on where the pain is, when it strikes, and how it started. Understanding those details can help you narrow down what’s going on and what to do about it.
Pain Under the Heel: Plantar Fasciitis
The plantar fascia is a thick band of tissue that runs along the bottom of your foot, connecting your heel bone to your toes. When that band gets repeatedly strained, it becomes inflamed and painful, especially where it attaches to the heel. This is plantar fasciitis, and its signature symptom is a stabbing pain on the bottom of the foot near the heel with your first few steps in the morning or after sitting for a long time. The pain typically fades after a few minutes of walking as the tissue loosens up.
Another hallmark: pain after exercise, not during it. You might feel fine on a run or a long walk, then notice the ache setting in once you stop. If you press along the bottom of your foot, the fascia often feels like a tight band when stretched. Risk factors include spending long hours on your feet, carrying extra weight, tight calf muscles, high arches or flat feet, and a sudden increase in activity.
One common point of confusion is heel spurs. These bony growths at the bottom of the heel bone show up on X-rays and were once blamed for the pain. But most people with heel spurs have no pain at all. Heel spurs are a result of long-term tension on the plantar fascia, not the cause of the discomfort. Plantar fasciitis pain can be treated successfully without ever removing a spur.
Pain Behind the Heel: Achilles Tendinitis
If your pain is at the back of the heel or just above it rather than underneath, the problem is more likely your Achilles tendon. This tendon connects your calf muscles to your heel bone and takes a beating during walking, running, jumping, and climbing stairs. Achilles tendinitis usually starts as a mild ache after activity, then progresses to more noticeable burning or soreness with stair climbing, sprinting, or longer runs.
The tendon weakens with age, which is why this condition is especially common among weekend athletes and people who ramp up their training too quickly. Running in worn-out shoes, running in cold weather, and hill running all increase the risk. The pain can occur in the middle of the tendon or right where it inserts into the heel bone. Insertional Achilles tendinitis, the type closest to the heel, is sometimes linked to inflammatory conditions like ankylosing spondylitis or psoriatic arthritis, particularly if there’s no obvious overuse trigger.
Deep Center-of-Heel Pain: Fat Pad Syndrome
Your heel has a built-in cushion: a pad of fat that absorbs shock every time your foot hits the ground. Over time, or after repeated impact, that pad can thin out or lose its elasticity. The result is a deep, bruise-like pain right in the center of the heel when you walk, stand, or run. It feels different from plantar fasciitis, which tends to concentrate closer to the front edge of the heel.
A normal heel pad is about 1 to 2 centimeters thick. When it thins significantly or becomes stiff and hard, it no longer cushions effectively. This is more common in older adults and people with a history of high-impact activity. Walking barefoot on hard surfaces often makes it worse. If pressing directly into the center of your heel reproduces that deep aching sensation, fat pad atrophy is a strong possibility.
Burning, Tingling, or Numbness
Heel pain that comes with burning, tingling, or a pins-and-needles sensation points toward nerve involvement. The most common nerve-related cause is tarsal tunnel syndrome, where the tibial nerve gets compressed as it passes through a narrow channel on the inside of your ankle. The pain and tingling typically radiate to the bottom of the foot and toes, and symptoms often worsen with prolonged standing or walking.
Tarsal tunnel syndrome is sometimes mistaken for plantar fasciitis because both cause pain on the bottom of the foot. The key difference is the quality of the pain: plantar fasciitis produces a sharp or aching mechanical pain, while nerve compression produces electrical sensations like burning and numbness. If your heel pain has that nerve-like quality, it’s worth bringing up specifically, since the treatments are different.
Stress Fractures in the Heel Bone
A calcaneal stress fracture is a small crack in the heel bone that develops gradually from repetitive impact. It’s most common in runners and people who play sports with a lot of direction changes, like basketball, soccer, and tennis. Unlike a traumatic fracture from a fall or car accident (which causes sudden severe pain and visible swelling), a stress fracture starts as a mild twinge that slowly becomes more noticeable over days or weeks.
The telltale signs include pain that gets worse when you stretch your foot or stand for a long time, a heel that feels tender or warm to the touch, and sometimes bruising or stiffness. Stress fractures don’t always show up on initial X-rays, so imaging with an MRI or bone scan is sometimes needed. If your heel pain came on gradually during a period of increased training and doesn’t improve with typical plantar fasciitis treatments, a stress fracture is worth investigating.
Heel Pain in Children and Teens
If your child complains of heel pain, the most likely cause is Sever’s disease (calcaneal apophysitis). This isn’t actually a disease but an inflammation of the growth plate in the heel bone. It happens during growth spurts when the bones grow faster than the muscles and tendons can keep up. Girls are most at risk around ages 8 to 10, and boys between ages 10 and 12.
Active kids who play running and jumping sports are especially prone. A health history and physical exam are usually all that’s needed to diagnose it, and it resolves on its own once the growth plate matures. Rest from aggravating activities, cushioned heel inserts, and calf stretches can help manage the pain in the meantime.
When Heel Pain Signals Something Bigger
Most heel pain is mechanical, meaning it comes from strain or overuse of a specific structure. But occasionally, heel pain is a sign of a systemic condition. Pain with warmth, redness, and swelling in the foot or ankle can indicate gout (a crystal deposit in the joint), an infection, or inflammatory arthritis. Posterior heel pain without a clear injury history, especially with morning stiffness lasting more than 30 minutes, can be associated with conditions like psoriatic arthritis or ankylosing spondylitis. If your heel pain is accompanied by fever, came on suddenly with intense redness and swelling, or doesn’t respond at all to rest and basic care over several weeks, these are signs worth getting evaluated promptly.
Stretches and Exercises That Help
For plantar fasciitis and general heel pain from soft tissue strain, a consistent stretching routine is one of the most effective treatments. The American Physical Therapy Association recommends several exercises that target the fascia and calf muscles directly.
- Plantar fascia massage: Roll a frozen water bottle or tennis ball slowly back and forth under your foot, 10 times per foot, two sets, once daily. The cold from a frozen bottle also helps reduce inflammation.
- Seated plantar fascia stretch: Cross one foot over your opposite knee, pull your toes back gently toward your shin until you feel a stretch along the bottom of your foot. Hold 20 seconds, repeat three times per foot, once daily.
- Wall-facing calf stretch: Stand facing a wall with one foot forward and one back, keeping the back knee straight and heel on the floor. Lean into the wall until you feel a stretch in your back calf. Hold 20 seconds, repeat three times per leg, once daily.
- Towel scrunches: Place a towel flat on the floor and use your toes to scrunch it toward you. Do 10 to 15 scrunches, two sets per foot, one to three times daily. This strengthens the small muscles in your foot.
- Heel raises: Rise up on your toes slowly, then lower back down. Ten repetitions, two sets, once daily.
Consistency matters more than intensity. Most people start noticing improvement within a few weeks of daily stretching, though full resolution can take several months.
Other Treatment Options
Beyond stretching, supportive footwear with good arch support and cushioned heels makes a meaningful difference. Avoid walking barefoot on hard floors, especially first thing in the morning. Over-the-counter arch supports or custom orthotics can redistribute pressure away from the painful area. Icing the heel for 15 to 20 minutes after activity helps control inflammation.
If conservative measures aren’t enough after several months, steroid injections are sometimes used for plantar fasciitis. They can provide short-term relief, but they carry real risks: about 2.4% of patients experience a rupture of the plantar fascia after an average of 2.7 injections, and pain at the injection site is the most commonly reported side effect. Repeated injections can also thin the heel’s fat pad, potentially trading one problem for another. For this reason, injections are generally reserved for cases that haven’t responded to physical therapy and supportive care.
Other options for persistent cases include night splints (which keep the foot stretched while you sleep), extracorporeal shockwave therapy, and in rare cases, surgery. Most people with plantar fasciitis recover fully with conservative treatment alone, though it can take 6 to 12 months.