The most common reason your heels hurt is plantar fasciitis, a condition where the thick band of tissue running along the bottom of your foot becomes irritated where it connects to your heel bone. It causes a stabbing pain near the heel that’s typically worst with your first few steps in the morning. But plantar fasciitis isn’t the only possibility. Several other conditions target the heel, and figuring out which one you’re dealing with starts with paying attention to exactly where the pain is and when it shows up.
Plantar Fasciitis: The Most Likely Culprit
Plantar fasciitis accounts for the majority of heel pain complaints. The plantar fascia is a tough, fibrous band that supports the arch of your foot, and it takes a beating every time you walk, run, or stand. When it’s overloaded, tiny tears develop near its attachment point at the heel, triggering inflammation and pain.
The hallmark symptom is that sharp, stabbing pain on the bottom of your foot near the heel, especially during your first steps after sleeping. While you sleep, the fascia tightens up in a shortened position. When you stand on it, those first few steps forcibly stretch it again, which is why mornings feel the worst. The same thing happens after sitting for a long time. Pain also tends to flare up after prolonged standing, though it often fades somewhat once you’ve been moving for a while.
Risk factors include spending long hours on your feet, carrying extra body weight, having very flat or very high arches, and suddenly increasing your activity level. Runners are particularly prone to it, but it’s just as common in people who work on hard floors all day.
Achilles Tendon Problems
If your pain is at the back of your heel rather than the bottom, the Achilles tendon is a more likely source. This is the large tendon connecting your calf muscles to your heel bone, and it can become inflamed (tendinitis) from overuse, tight calves, or a sudden jump in physical activity.
Tendinitis is the acute, inflammatory phase. You’ll notice pain, stiffness, and sometimes mild swelling at the back of your heel or just above it. Left untreated, tendinitis can progress to tendinosis, a chronic condition where the tendon’s cells begin to degenerate rather than simply stay inflamed. This distinction matters because tendinosis responds to different treatments and, if ignored long enough, raises the risk of a partial or complete tendon tear.
Heel Fat Pad Syndrome
Beneath your heel bone sits a specialized cushion of fat that absorbs shock with every step. Over time, or after repeated impact, this fat pad can thin out or lose its elasticity. The result is a deep, bruise-like pain in the center of your heel when you walk, stand, or run.
This condition is frequently misdiagnosed as plantar fasciitis because the pain is in a similar area. The key difference is location: plantar fasciitis pain concentrates where the fascia attaches to the front-underside of the heel bone, while fat pad pain sits right in the middle of the heel. A normal heel pad measures 1 to 2 centimeters thick. When it thins or stiffens, you lose that natural shock absorption, and hard surfaces like concrete or hardwood floors become especially painful. Walking barefoot tends to make it noticeably worse.
Fat pad syndrome is more common in older adults, people who spend years running or jumping on hard surfaces, and those who are overweight.
Haglund’s Deformity (Pump Bump)
Haglund’s deformity is a bony growth on the back of your heel bone, right where the Achilles tendon attaches. You can often see and feel the bump through your skin. It earned the nickname “pump bump” because rigid-backed shoes like pumps and high heels press directly against the growth, making it especially painful.
Symptoms include heel pain, visible swelling, and sometimes skin discoloration around the bump. Over time, the constant pressure and friction from the bony growth can irritate nearby structures, leading to Achilles tendinitis or bursitis (inflammation of the small fluid-filled sac between the tendon and bone). If you notice a hard bump on the back of your heel that gets worse in certain shoes, this is worth investigating.
Heel Pain in Kids and Teens
If your child complains of heel pain, the most common cause is Sever’s disease, which is not actually a disease but an inflammation of the growth plate in the heel bone. It’s extremely common between ages 8 and 14, when growth spurts put extra stress on the heel’s growth plate before it fully hardens into solid bone.
Symptoms include pain in one or both heels (most kids report both), pain that worsens with squeezing the heel or putting weight on it, stiffness after sleeping, and sometimes limping or toe-walking after running. Active children involved in sports that require a lot of running or jumping are most affected. The condition resolves on its own once the growth plate closes, but rest and activity modification help manage the pain in the meantime.
When Both Heels Hurt at Once
Pain in a single heel usually points to a mechanical or overuse issue. When both heels hurt simultaneously, particularly if the pain came on without a clear change in activity, it’s worth considering systemic causes. Conditions like gout, rheumatoid arthritis, and a group of inflammatory conditions called spondyloarthropathies can all produce bilateral heel pain. These conditions involve the immune system attacking joint and tendon tissue throughout the body, and the heel is a common target.
If your heel pain is accompanied by joint pain or swelling elsewhere in your body, morning stiffness lasting more than 30 minutes, or if it doesn’t improve with typical rest and stretching strategies, a blood test or imaging may help identify an underlying inflammatory condition.
What Actually Helps
For the most common causes of heel pain, a few evidence-based strategies make a real difference.
Stretching: For plantar fasciitis specifically, targeted stretching of the plantar fascia itself is one of the most effective first-line treatments. The technique is straightforward: sit down, cross the affected foot over your opposite knee, and pull your toes back toward your shin until you feel a stretch along the bottom of your foot. Hold for 20 seconds, repeat 10 times, and do this twice a day. A second variation involves standing with your toes on a wall and your heel on the floor, then pressing forward to stretch the fascia. Consistent stretching over several weeks often produces significant improvement.
Orthotics and inserts: Heel cups, arch supports, and cushioned insoles can help by redistributing pressure away from the painful area. If you’ve been considering expensive custom orthotics, it’s worth knowing that a large analysis of about 1,800 patients across 20 studies found no difference in short-term pain relief between custom-made orthotics and store-bought versions. The researchers also found that orthotics weren’t more effective than stretching, night splints, or heel braces. So a $20 pair of gel inserts from the pharmacy is a perfectly reasonable starting point.
Footwear changes: Supportive shoes with cushioned soles make a big difference, especially if you’ve been wearing flat shoes, worn-out sneakers, or going barefoot on hard floors. For Haglund’s deformity, switching to shoes with soft or open backs can relieve pressure on the bump.
Rest and activity modification: Reducing high-impact activities temporarily while the tissue heals prevents the cycle of re-injury that keeps heel pain going. Swimming or cycling can maintain fitness without pounding the heel.
Signs That Need Prompt Attention
Most heel pain improves gradually with stretching, better footwear, and reduced impact. But certain symptoms warrant immediate medical evaluation: severe heel pain right after an injury, significant swelling near the heel, inability to bend your foot downward or rise onto your toes, inability to walk normally, or heel pain accompanied by fever or numbness and tingling. These can signal a fracture, tendon rupture, or nerve involvement that requires more urgent care.