Pain in the ball of your heel, the weight-bearing bottom portion of the heel bone, most commonly comes from plantar fasciitis or a thinning of the natural fat pad that cushions the bone. These two conditions account for the vast majority of cases, though nerve compression, stress fractures, and inflammatory conditions can also be responsible. The specific location of the pain, when it shows up during the day, and what makes it worse can help you narrow down the cause.
Plantar Fasciitis: The Most Common Cause
Plantar fasciitis is inflammation or degeneration of the thick band of tissue that runs along the bottom of your foot, connecting the heel bone to the toes. When this tissue is strained repeatedly, it develops small tears near where it attaches to the heel, producing pain on the inside or bottom part of the heel closer to the arch.
The hallmark pattern is unmistakable: sharp pain with your very first steps out of bed in the morning. That pain typically eases within about ten minutes as the tissue loosens up, then returns toward the end of the day after prolonged standing or walking. You’ll also notice it flaring after sitting for a while and then standing, a pattern sometimes called “post-static” pain. Exercise itself may not hurt much, but the pain comes back afterward.
You can test for it at home with a simple check. While sitting, have someone push your big toe upward toward your shin (or do it yourself). If this reproduces the pain in your heel, the plantar fascia is likely the source. The same test works standing: place the ball of your foot on the edge of a step and let someone extend your big toe upward. Pain at the end of that motion points strongly to plantar fasciitis.
Heel Fat Pad Syndrome
Underneath your heel bone sits a specialized fat pad roughly 9 to 10 millimeters thick. This pad acts as a shock absorber every time your foot strikes the ground. When it thins or loses its structure, the heel bone sits closer to the surface and takes more direct impact with each step. Research published in Pain Physician found that heel pain becomes significantly more likely when that fat pad drops below about 9.2 mm in men or 8.15 mm in women.
Fat pad pain feels different from plantar fasciitis in important ways. The pain tends to center directly under the heel bone rather than toward the arch, and it’s a deep, bruise-like ache rather than a sharp, stabbing sensation. Unlike plantar fasciitis, it doesn’t follow that classic “worst in the morning, better after walking” pattern. Instead, it gets progressively worse the longer you’re on your feet and on hard surfaces. Walking barefoot on tile or concrete is particularly painful.
Age is the biggest risk factor. The fat pad naturally thins as you get older, and years of high-impact activity accelerate the process. Obesity increases the load on whatever cushion remains. Unfortunately, there are no randomized controlled trials proving any specific treatment restores the fat pad itself, so management focuses on replacing that lost cushion externally with viscoelastic heel cups, supportive footwear, and reducing time on hard surfaces.
Nerve Compression in the Heel
A small nerve runs along the inside of the heel and can become pinched between muscle and bone, a condition called Baxter’s nerve entrapment. This produces a sharp, radiating pain along the inner side of the heel that tends to get worse at night and after physical activity. You may also feel tingling, burning, or numbness spreading outward across the bottom of the foot.
What sets nerve-related heel pain apart is that quality of radiating discomfort. It doesn’t stay in one spot. Pressing firmly on the inner heel, just above where the arch muscles begin, can trigger pain that shoots outward. People with flat feet or overpronation (feet that roll inward) are more susceptible because the foot mechanics place extra pressure on the nerve’s path. Over time, untreated nerve compression can weaken the small muscles on the outer edge of the foot.
Stress Fractures of the Heel Bone
A calcaneal stress fracture is a tiny crack in the heel bone itself, usually from repetitive overload rather than a single injury. Runners, military recruits, and anyone who suddenly ramps up their activity level are at highest risk. Women with low bone density are also more vulnerable.
The pain from a stress fracture is diffuse, meaning it doesn’t pinpoint to one exact spot. It hurts with any weight-bearing activity and doesn’t have the morning-then-better-then-worse pattern of plantar fasciitis. A useful clue: if you squeeze the sides of your heel bone (pressing inward from both sides at once) and it hurts, that suggests the bone itself is the problem rather than soft tissue. This squeeze test is highly specific, meaning a positive result is a reliable indicator, though it doesn’t catch every fracture. Imaging is usually needed to confirm the diagnosis.
When Heel Pain Signals Something Systemic
In a small percentage of cases, persistent heel pain is an early sign of an inflammatory condition affecting the whole body. Conditions like ankylosing spondylitis and other forms of inflammatory arthritis target the places where tendons and ligaments attach to bone, and the heel is one of the most commonly affected sites. If your heel pain came on without any change in activity, doesn’t respond to typical treatments, and is accompanied by morning stiffness lasting more than 30 minutes (especially in your lower back), or if you’re under 40 with alternating buttock pain or stiffness, an inflammatory condition is worth investigating.
How to Tell These Conditions Apart
- Worst with first morning steps, improves, then returns later: plantar fasciitis
- Deep bruise that worsens steadily throughout the day, especially on hard floors: fat pad thinning
- Sharp or burning pain that radiates outward, worse at night: nerve entrapment
- Diffuse pain with any weight-bearing, painful when squeezing the sides of the heel: stress fracture
- Persistent pain plus prolonged morning stiffness in the back or joints: inflammatory condition
Treatment That Works for Most Heel Pain
The 2025 clinical practice guidelines from the Journal of Orthopaedic & Sports Physical Therapy give the highest recommendation (Grade A) to four approaches for plantar fasciitis, which also benefit most other causes of heel pain.
Stretching is one of the most effective things you can do at home. Plantar fascia-specific stretching (pulling your toes back toward your shin while seated) and calf stretches both reduce pain in the short and long term. Do them before your first steps in the morning and after any period of sitting. Night splints, which hold your foot in a flexed position while you sleep, are specifically recommended for people whose worst symptom is that first-step morning pain. A one to three month program typically shows results.
Foot taping with either rigid athletic tape or elastic kinesiology tape provides short-term relief, especially when combined with other treatments. Strengthening exercises for the foot and ankle muscles carry a strong recommendation as well. Simple exercises like towel curls with your toes, single-leg calf raises, and resistance band work for the ankle build the support structures around the heel.
For fat pad-related pain specifically, conservative management centers on rest, activity modification, icing, and viscoelastic heel cups that replace some of the lost cushioning. While no controlled trials have proven these heel cups restore the fat pad, they do reduce direct impact on the heel bone during walking.
What to Expect for Recovery
Most heel pain resolves with consistent conservative treatment, but the timeline is longer than many people expect. Weeks to months of daily stretching, strengthening, and footwear changes are typical before you feel significant improvement. Patience matters here. Many people abandon their routine after two or three weeks because the pain hasn’t vanished, but the tissue changes underlying most heel pain simply take longer to heal than a typical muscle strain.
If several months of conservative care haven’t helped, shockwave therapy has shown effectiveness for medium and long-term pain reduction. Corticosteroid injections can help in the short term, but studies show they don’t outperform shockwave therapy over longer periods. The evidence on combining injections with exercise and shockwave therapy is mixed, with results varying widely across studies.
One practical change that helps across nearly all causes: stop going barefoot on hard surfaces. Even around the house, a supportive sandal or shoe with a cushioned heel protects the area while it heals and prevents the repeated micro-trauma that keeps the cycle going.