The most likely reason your heel hurts is plantar fasciitis, a condition where the thick band of tissue running along the bottom of your foot becomes irritated and develops small tears from repeated stress. It accounts for the vast majority of heel pain cases, but it’s not the only possibility. Where exactly the pain hits, when it’s worst, and how it started can point to different causes, each with its own path to relief.
Pain on the Bottom of Your Heel
Plantar fasciitis causes an aching pain in the heel or along the bottom of the foot. The hallmark symptom is intense pain with your first few steps after waking up. That morning stab happens because the fascia tightens overnight while your foot is at rest, and those initial steps stretch the already damaged tissue before it has a chance to warm up. The pain typically fades after a few minutes of walking, then returns if you’ve been sitting or standing for a long stretch.
Repeated tension and stress on the fascia cause small tears that accumulate over time. You’re more likely to develop it if you spend long hours on your feet, have gained weight recently, wear flat or unsupportive shoes, or have ramped up a running or walking routine too quickly. High arches and flat feet both increase your risk because they change how force distributes across the sole.
Heel spurs, small bony growths that poke out from the bottom of the heel bone where it connects to the plantar fascia, often show up on X-rays of people with plantar fasciitis. But many people with heel spurs have zero pain, and many people with severe heel pain have no spur at all. The spur itself is rarely the problem.
Pain at the Back of Your Heel
If the pain is behind your heel rather than underneath it, Achilles tendonitis is the more likely culprit. This condition affects the tendon connecting your calf muscles to the heel bone, and it can occur either in the middle of the tendon or right where it attaches to the bone. The pain usually starts as a mild ache after running or other activity and can progress to burning or aching pain after longer efforts, stair climbing, or sprinting. Over time, it can hurt even at rest.
Like plantar fasciitis, Achilles tendonitis tends to feel stiff in the morning and loosens up with mild activity. But the location is distinctly different: the back of the ankle and heel, not the sole. The Achilles tendon weakens naturally with age, making this increasingly common in your 40s and beyond. It’s especially prevalent in “weekend warriors” who play sports like tennis or basketball only occasionally, and in runners who suddenly increase their distance or intensity.
Flat arches and high arches both increase strain on the Achilles tendon, just as they do on the plantar fascia. If you have both conditions simultaneously (which isn’t rare), shoe choice becomes particularly important.
Less Common Causes Worth Knowing
A calcaneal stress fracture produces generalized heel pain that develops slowly over days to weeks, usually after a period of increased activity. Unlike plantar fasciitis, which has that sharp first-step pattern, a stress fracture tends to hurt more consistently and worsens with any weight-bearing. One telling sign: if squeezing your heel from both sides reproduces the pain, a stress fracture is more likely. This needs imaging to confirm and rest to heal.
Gout can also strike the heel, though it behaves very differently from overuse injuries. A gout flare comes on suddenly, often late at night or early in the morning, with intense pain, swelling, skin discoloration, and a burning sensation. Flares last days to weeks and tend to affect one joint at a time. Risk factors include kidney problems, high blood pressure, diabetes, obesity, and a diet high in purines (red meat, organ meats, certain seafood, alcohol). If your heel pain arrived out of nowhere with visible swelling and heat, gout belongs on the list.
What Actually Helps
Nearly 90% of people with plantar fasciitis improve with non-surgical treatment. The catch is that recovery takes patience. You may need weeks to months before reaching full relief, so consistency matters more than intensity.
Stretching is the foundation. A standing calf stretch held for 45 seconds, repeated two to three times per session and done four to six times throughout the day, reduces tension on the fascia. A towel stretch (looping a towel around the ball of your foot and pulling gently) follows the same timing. For the fascia itself, a toe extension stretch held for 10 seconds and repeated over two to three minutes, done two to four times daily, targets the tissue directly. These stretches are most effective first thing in the morning, before those painful first steps.
Rolling a frozen water bottle under your foot for 10 to 15 minutes combines stretching with icing and can provide immediate, if temporary, relief.
Shoes and Inserts That Make a Difference
Footwear matters more than most people realize. For plantar fasciitis, shoes with moderate to maximum cushioning and an 8 to 10 millimeter heel-to-toe drop help reduce strain on the fascia, especially during those first steps. That heel drop means the heel sits 8 to 10 millimeters higher than the toe, which slightly shortens the fascia and takes tension off it. Avoid minimalist or ultra-flat shoes (0 to 4 millimeter drop) during the early phase of recovery, even if you normally prefer them.
If you’ve been considering custom orthotics, here’s something worth knowing: research comparing custom-made orthotics to prefabricated over-the-counter inserts found no difference in effectiveness at either two to three months or 12 months. Prefabricated inserts with good arch support work just as well for most people and cost a fraction of the price. Save the custom route for cases where standard inserts haven’t helped after several months.
When Heel Pain Signals Something Bigger
Most heel pain is mechanical: too much stress on tissue that wasn’t ready for it. But certain patterns suggest something beyond a simple overuse injury. Sudden onset with swelling, redness, and heat points toward gout or infection. Pain that worsens steadily despite rest and doesn’t follow the classic morning-stiffness pattern could indicate a stress fracture. Heel pain in both feet alongside joint stiffness elsewhere in the body raises the possibility of an inflammatory condition like rheumatoid arthritis.
Heel pain that hasn’t improved after six to eight weeks of consistent stretching, icing, and supportive footwear deserves professional evaluation. The vast majority of cases resolve without anything invasive, but getting the right diagnosis ensures you’re not spending months treating plantar fasciitis when the problem is actually your Achilles tendon, a stress fracture, or something systemic.