The most likely reason your heels hurt is plantar fasciitis, a condition that affects about 10% of people at some point in their lives. It happens when the thick band of tissue running along the bottom of your foot becomes irritated from repeated stress. But several other conditions can cause heel pain too, and where exactly you feel the pain, when it strikes, and what makes it worse all point toward different causes.
Plantar Fasciitis: The Most Common Cause
The plantar fascia is a tough band of tissue connecting your heel bone to the base of your toes. It supports your arch and absorbs shock every time your foot hits the ground. When that tissue gets overloaded, small tears develop, leading to irritation and pain at or near the heel.
The hallmark symptom is a stabbing pain in the bottom of your foot, right near the heel, that’s worst with your first steps in the morning. After you’ve been off your feet for a while (sleeping, sitting at your desk), the fascia tightens up. When you stand and put weight on it, those first few steps stretch the tightened tissue and cause a sharp jolt of pain. The discomfort usually fades after a few minutes of walking, then creeps back if you’re on your feet for a long time.
If you press firmly into the inside edge of your heel, right where the arch begins, and feel a sharp, stabbing tenderness, that’s a strong indicator. Pulling your toes back toward your shin will often reproduce the pain too, because it stretches the fascia along the bottom of the foot.
Pain at the Back of the Heel
If your pain is behind the heel rather than underneath it, the Achilles tendon is the more likely culprit. Achilles tendinopathy causes an achy, sometimes sharp pain that worsens with activity and with pressure on the area. You may notice the tendon itself feels thick or swollen compared to the other side. Bending your foot upward stretches the tendon and typically makes the pain worse.
Retrocalcaneal bursitis is another possibility for posterior heel pain. A small fluid-filled sac sits between the Achilles tendon and the heel bone, and it can become inflamed from repetitive friction or pressure from tight, rigid shoes. The area behind and slightly above the heel becomes red, swollen, and tender to the touch. Some people develop this alongside a bony bump at the back of the heel (sometimes called a “pump bump”), which makes the irritation worse.
The Truth About Heel Spurs
If you’ve had an X-ray that showed a heel spur, it’s natural to assume that’s the source of your pain. But heel spurs are present in roughly 11% to 16% of people who have zero symptoms. Less than 5% of people with spurs actually experience pain from them. About three-quarters of people with heel pain do have spurs visible on X-ray, but the spur itself is rarely the problem. It’s the soft tissue irritation around it, usually plantar fasciitis, that hurts. Removing or treating the spur alone doesn’t typically resolve the pain.
Fat Pad Thinning
Your heel has a built-in cushion: a pad of fatty tissue that absorbs impact with every step. Over time, or with enough wear, that pad can thin out and lose its elasticity. When it does, you feel a deep, bruise-like pain in the center of the heel, especially on hard surfaces or when walking barefoot. Pressing your fingers firmly into the middle of the heel reproduces that deep ache.
This is different from plantar fasciitis in both location and behavior. Fat pad pain sits squarely in the middle of the heel (not the inner edge), and it tends to get worse the longer you’re on your feet rather than being worst with those first morning steps. Several factors speed up fat pad breakdown: aging, higher body weight, repetitive high-impact activities like running or basketball, walking barefoot on hard floors, and wearing shoes with little cushioning. Some people also have a genetic predisposition to it.
Nerve-Related Heel Pain
When heel pain comes with burning, tingling, numbness, or a “pins and needles” sensation, a nerve issue may be involved. Tarsal tunnel syndrome occurs when the nerve running through a narrow passage on the inside of the ankle gets compressed. It causes pain along the inner ankle and the bottom of the foot, and symptoms typically worsen during or after physical activity. In more severe or long-standing cases, the burning and tingling can become constant, and you may notice weakness in the small muscles of the foot.
Nerve-related heel pain feels distinctly different from the mechanical ache of plantar fasciitis or fat pad problems. If your heel pain has an electrical, burning quality, or if it comes with numbness in parts of your foot, that’s worth bringing up with a healthcare provider specifically.
Heel Pain in Kids and Teens
If your child is complaining about heel pain, the most common cause is Sever’s disease, which isn’t really a disease at all. It’s an irritation of the growth plate at the back of the heel where the Achilles tendon attaches. During growth spurts, bones grow faster than the muscles and tendons can keep up with, creating extra tension at that attachment point. Repetitive running and jumping sports pile additional stress on top of that tension.
Kids with Sever’s disease feel pain when you squeeze the heel from both sides, and the discomfort gets worse with running, jumping, or walking on their heels. It’s most common between ages 8 and 14, and it resolves on its own once the growth plate matures and closes. Less active kids can develop it too, especially if they wear very flat shoes with no arch support. Rest, ice, cushioned heel inserts, and temporarily dialing back high-impact activity are usually enough to manage it.
Stretches and Exercises That Help
For plantar fasciitis, a consistent stretching routine can produce noticeable improvement within four to six weeks. Physical therapists recommend doing these moves three times each morning:
- Towel curls: Sit with your feet flat on the floor, place a small towel in front of you, and use your toes to scrunch it toward you. This strengthens the small muscles that support your arch.
- Arch doming: With your feet flat on the floor, lift your inner arch to form a dome shape while keeping your toes flat (not curled). You’ll feel your toes slide slightly on the ground as the arch rises.
- Hamstring and calf stretch: Stand and extend one leg in front of you with the heel on the ground and toes pointing up. Bend your back knee and hinge forward at the waist. The more you pull your toes up, the deeper the calf stretch. Hold for 30 seconds on each side.
- Calf raises: Stand on both feet, rise onto your toes, hold for two seconds, then lower. Repeat 10 to 20 times. This builds strength in the muscles that support the Achilles tendon and plantar fascia.
Consistency matters more than intensity. A few minutes daily will do more than an aggressive session once a week.
Orthotics and Footwear Choices
Arch supports and cushioned insoles can reduce the strain on the plantar fascia and heel pad. If you’re considering custom orthotics, here’s something worth knowing: clinical trials have found that prefabricated (off-the-shelf) insoles are just as effective as custom-made ones at both three months and twelve months. Custom orthotics cost significantly more, so starting with a good-quality prefabricated insert is a reasonable first step.
Shoes themselves matter just as much as inserts. Footwear with a slightly raised heel, firm arch support, and good shock absorption reduces the load on both the plantar fascia and the heel fat pad. Avoid going barefoot on hard surfaces like tile or concrete, particularly if your pain is worse in the morning. Keeping a supportive pair of shoes or sandals next to your bed so you can put them on before those first steps can make a real difference.
When Heel Pain Doesn’t Improve
Most heel pain from plantar fasciitis improves with stretching, supportive footwear, and activity modification. But if several weeks of consistent home treatment haven’t helped, additional options exist. Shockwave therapy, which uses focused pressure waves to stimulate healing in the tissue, has a 75% to 80% success rate for persistent heel pain. Treatment typically involves three sessions spaced one to two weeks apart.
Certain symptoms signal that something more serious may be going on. Severe heel pain immediately following an injury, significant swelling near the heel, inability to bend your foot downward or walk normally, and heel pain accompanied by fever or numbness all warrant prompt medical evaluation. These patterns can indicate a fracture, a ruptured tendon, or an infection rather than a soft tissue overuse problem.