Heel pain is most often caused by plantar fasciitis, a condition where the thick band of tissue running along the bottom of your foot becomes irritated and inflamed. But the location of your pain, when it strikes, and what it feels like can point to several different causes, some minor and some worth getting checked out. Here’s how to figure out what’s going on.
Pain on the Bottom of Your Heel
If you feel a stabbing pain on the underside of your heel, especially with your first steps in the morning, plantar fasciitis is the most likely culprit. The plantar fascia is a tough band of tissue connecting your heel bone to your toes. Repeated stress causes tiny tears in this tissue, leading to irritation and pain. The morning pain happens because the fascia tightens while you sleep, and those first steps stretch it before it’s had a chance to warm up.
The pattern is distinctive: pain that’s worst when you get out of bed, improves after a few minutes of walking, then flares again after long periods of standing or sitting. The tender spot is usually on the inner side of the heel, right where the fascia attaches to the bone. This condition is especially common in runners, people who are on their feet all day, and those carrying extra weight.
A related but different problem is heel pad syndrome, which produces a deep, bruise-like ache right in the center of the heel rather than along the inner edge. Your heel has a built-in cushion of fat that absorbs impact when you walk. This fat pad naturally thins with age (peaking in thickness around your 30s and gradually declining after that), and women tend to have thinner heel pads than men at every age. Walking barefoot on hard surfaces or spending long hours on your feet makes this pain worse. Body weight is the single biggest factor in heel pad thickness, which is one reason heavier individuals are more prone to this type of pain.
Pain at the Back of Your Heel
If the pain is behind your heel rather than underneath it, the problem is likely your Achilles tendon. Achilles tendinopathy causes an achy, sometimes sharp pain along the tendon that runs from your calf muscle down to the back of your heel bone. The pain gets worse with activity and with pressure on the area. You might notice the tendon feels thicker than usual or that pointing your toes upward toward your shin increases the discomfort.
This tends to develop gradually after an increase in activity, like ramping up running mileage or starting a new sport. It’s an overuse injury, not something that happens overnight, and it responds well to a gradual return to activity paired with calf strengthening and stretching.
Heel Pain That Burns or Tingles
Burning, tingling, or numbness along with heel pain points toward a nerve issue. Branches of the nerves running behind and beneath your ankle bone can become compressed or irritated, producing symptoms that feel very different from the dull ache of plantar fasciitis. This type of pain is almost always on one side only. If your heel pain comes with any electrical or burning sensations, that’s a strong clue that a nerve is involved rather than a tendon or bone problem.
Could It Be a Stress Fracture?
A calcaneal stress fracture is a tiny crack in the heel bone itself. It typically shows up after a sudden increase in weight-bearing activity (training for a marathon, starting a new high-impact sport) or after switching to a harder walking or running surface. The pain starts during activity and is relieved by rest, but over time it can begin hurting even when you’re off your feet. Swelling and bruising around the heel are common. One quick test: if squeezing both sides of your heel bone together reproduces your pain, a stress fracture is a real possibility. Runners, basketball players, and dancers are at higher risk.
Heel Pain in Children
If your child is complaining about heel pain, the most common cause is Sever’s disease, which is not really a disease at all. It’s inflammation of the growth plate at the back of the heel bone, and it’s extremely common between ages 8 and 14, when growth spurts happen. Children’s bones are softer at the growth plates, and the new bone forming there is made of cartilage that’s more vulnerable to stress. Active kids who play running and jumping sports are especially prone. Sever’s disease resolves on its own once the growth plate finishes hardening, though rest and supportive footwear can help manage pain in the meantime.
What About Heel Spurs?
If you’ve been told you have a heel spur on an X-ray, it may not actually be the source of your pain. Heel spurs are bony growths that form on the underside of the heel bone, and they’re surprisingly common in people with zero foot pain. Less than 5% of people with heel spurs actually experience pain from them. The spur itself is usually a byproduct of long-term tension on the plantar fascia, not the direct cause of your discomfort. Treating the underlying fascia problem typically resolves the pain regardless of whether the spur remains.
When Heel Pain Signals Something Systemic
Occasionally, heel pain isn’t a local injury at all. Rheumatoid arthritis can affect the hindfoot (the heel region), and a key distinguishing feature is that it usually occurs in both feet, in the same joints on each side. Early signs include difficulty walking on uneven ground, grass, or gravel. Over time, the bones in the foot can shift out of alignment, leading to arch collapse and tendon pain. Gout can also strike the heel, producing sudden, intense pain with redness and swelling. If your heel pain affects both feet symmetrically, comes and goes in dramatic flares, or is accompanied by joint problems elsewhere in your body, a systemic condition is worth considering.
What Actually Helps
For plantar fasciitis, which accounts for the majority of heel pain, the most effective first-line treatments are stretching and hands-on therapy. The 2023 clinical practice guidelines from the Academy of Orthopaedic Physical Therapy give their highest recommendation (Grade A) to two specific approaches: stretching the plantar fascia directly and stretching the calf muscles. Plantar fascia stretches appear to be more effective than Achilles tendon stretches alone, so focus on pulling your toes back toward your shin to feel a stretch along the arch of your foot. Do this several times a day, especially before your first steps in the morning.
Night splints, which hold your foot in a gently flexed position while you sleep, also receive a top recommendation. A one to three month program is suggested for anyone who consistently has pain with those first morning steps. The splint keeps the fascia from tightening overnight, which directly addresses the worst part of most people’s symptoms.
Taping the foot with rigid or elastic tape can provide short-term relief when combined with stretching and physical therapy. Foot orthotics (arch support inserts) can help as part of a broader treatment plan, but they aren’t very effective on their own. And here’s a useful finding for your wallet: a review of about 1,800 people across 20 studies found no difference in pain relief between custom-made orthotics and store-bought versions. Researchers at Harvard noted that orthotics weren’t better at relieving pain or improving function than stretching, heel braces, or night splints. So a $30 pair of insoles from the drugstore is a perfectly reasonable starting point.
Ice, rest from aggravating activities, and supportive shoes with cushioned soles all help reduce symptoms while the tissue heals. Avoid walking barefoot on hard floors, especially first thing in the morning. Most people with plantar fasciitis improve significantly within several months of consistent stretching, though some stubborn cases take longer.