Heel pain is most often caused by plantar fasciitis, a condition affecting the thick band of tissue that runs along the bottom of your foot. It accounts for the majority of heel pain cases, and roughly 1 in 120 adults in the U.S. have dealt with it in any given month. But several other conditions can also make your heels hurt, and figuring out which one you’re dealing with starts with paying attention to exactly where and when the pain shows up.
Plantar Fasciitis: The Most Common Cause
Plantar fasciitis causes a stabbing pain on the underside of your heel, and its signature feature is timing. The pain is worst with your first steps in the morning or after you’ve been sitting for a while. Once you move around, it tends to ease up, only to return after long stretches of standing or walking. This happens because the tissue along the bottom of your foot tightens while you rest, then gets suddenly stretched when you put weight on it again.
The exact cause isn’t fully understood, but the pattern is consistent: repetitive stress on the plantar fascia creates micro-damage faster than the tissue can repair itself. Carrying extra weight, spending long hours on your feet, having very flat or very high arches, and suddenly ramping up physical activity all increase the load on this tissue. Most people feel the pain right at the front edge of the heel bone, where the fascia attaches.
Pain at the Back of the Heel
If your pain is at the back of your heel rather than underneath it, the Achilles tendon is the more likely source. Achilles tendinitis comes in two forms. Insertional tendinitis affects the lowest part of the tendon, right where it connects to the heel bone. It can happen to anyone, even people who aren’t particularly active, though long-distance runners get it most often. Non-insertional tendinitis hits the middle portion of the tendon, where the fibers start to break down and thicken, and it’s more common in active people.
The distinction matters because insertional tendinitis can also involve a bony bump forming at the back of the heel, and it tends to be aggravated by shoes that press against that area. Both types cause stiffness and tenderness that worsen with activity, but neither typically produces the sharp “first step” pain that plantar fasciitis does.
When the Pain Burns or Tingles
Not all heel pain is mechanical. Tarsal tunnel syndrome is a nerve condition that causes burning, numbness, tingling, or a “pins and needles” feeling on the inside of your ankle or the bottom of your foot. It happens when the nerve that runs through a narrow passage on the inner side of the ankle gets compressed or irritated.
The key difference is the quality of the pain. Plantar fasciitis and tendon problems produce aching or stabbing sensations that relate clearly to movement and pressure. Nerve pain tends to feel electric, burning, or buzzy, and it can come with weakness in the foot muscles. If your heel pain includes any of these sensations, you’re likely dealing with something different from the usual suspects.
Heel Pain in Both Feet
When heel pain shows up in both feet at the same time, it raises the possibility of a systemic condition rather than a local injury. Inflammatory types of arthritis, including rheumatoid arthritis and a group of conditions called spondyloarthropathies (which also affect the spine and other joints), can target the heel. Gout and fibromyalgia are also on the list. The general rule clinicians follow is that nerve-related heel pain is usually one-sided, so bilateral pain should prompt a look at broader inflammatory or metabolic causes.
Heel Pain in Kids
Children between ages 8 and 14 who complain of heel pain are often dealing with Sever’s disease, which is inflammation of the growth plate in the heel bone. It’s extremely common during growth spurts, when bones grow faster than the surrounding tendons can keep up with, putting extra pull on the heel. High-impact sports on hard surfaces are a frequent trigger, though sometimes normal walking is enough. It’s not a permanent condition and resolves once the growth plate closes, but it can sideline an active kid for weeks if not managed with rest and proper footwear.
How Your Shoes Affect Your Heels
The “heel drop” of a shoe, meaning the height difference between the heel and the toe, plays a direct role in how force is distributed through your foot. A higher drop elevates the heel and reduces strain on the Achilles tendon and calf, which can help with posterior heel pain. But that same elevated heel shifts more load to the hips and knees. A lower drop shoe does the opposite: it puts more stress on the foot, ankle, and lower leg.
If you’re dealing with plantar heel pain, shoes with good arch support and a moderate heel drop reduce the stretch on the plantar fascia. If your pain is at the back of the heel, a slightly higher heel can take tension off the Achilles tendon. Flat shoes with no support, worn-out sneakers, and going barefoot on hard floors are common aggravators for both conditions.
Stretching That Actually Helps
For plantar fasciitis specifically, stretching the plantar fascia directly is more effective than stretching the calf alone, and the benefit has been shown to persist for up to two years. The most studied technique involves crossing one foot over the opposite knee, grabbing the toes, and gently pulling them back toward your shin until you feel a stretch along the arch. Holding this for 10 seconds and repeating it 10 times, especially before your first steps in the morning, targets the tissue that’s causing the pain.
Calf stretches still have value, particularly for Achilles-related heel pain, but if you only have time for one exercise and your pain is on the bottom of your heel, the plantar fascia stretch is the better choice.
What Happens if It Doesn’t Improve
Most heel pain resolves within several months with consistent stretching, supportive footwear, and activity modification. When it doesn’t, shockwave therapy is one of the more effective next steps for chronic cases. This involves directing focused pressure waves at the affected area over three sessions spaced one to two weeks apart, with success rates around 75 to 80 percent for persistent heel pain. It’s noninvasive, doesn’t require anesthesia, and each session takes only a few minutes.
Signs That Need Prompt Attention
Most heel pain is a nuisance, not an emergency. But certain patterns warrant faster evaluation. Severe pain and swelling that come on suddenly after an injury could indicate a fracture. Heel pain accompanied by fever, or numbness and tingling in the heel, suggests something beyond a simple overuse problem. If you can’t bend your foot downward, can’t rise onto your toes, or can’t walk normally, those are signs of a more significant structural issue. Heel pain that persists at rest, especially pain that wakes you at night and doesn’t respond to a few weeks of ice, rest, and stretching, also deserves a closer look.