The most common reason your heels hurt is plantar fasciitis, a condition where the thick band of tissue running along the bottom of your foot breaks down from repetitive stress. It accounts for the majority of heel pain cases. But “heel pain” isn’t one condition. Where exactly you feel it, when it’s worst, and how it started all point to different causes, some minor and some worth getting checked.
Plantar Fasciitis: The Most Likely Cause
The plantar fascia is a tough strip of connective tissue that spans from your heel bone to your toes, supporting your arch with every step. When you repeatedly stress this tissue, tiny tears develop where it attaches to the heel bone. Over time, the body struggles to repair itself because blood flow to the damaged area becomes compromised. The tissue degenerates rather than heals, which is why the problem tends to linger.
The hallmark symptom is sharp pain on the underside of your heel, especially with your first steps in the morning. After sitting for a while, those initial steps hurt again. The pain often eases once you’ve walked around for a few minutes, because movement increases blood flow and loosens the tissue. But it can flare up after long periods of standing or after exercise, not usually during it.
Several factors raise your risk. Carrying extra weight places significantly more strain on the fascia, and even gaining a few pounds can shift your balance enough to create new stress patterns in your feet. Poor foot mechanics, flat feet or very high arches, inadequate footwear, and jobs that keep you on your feet all contribute. Runners and people who suddenly increase their activity level are especially prone.
The good news: roughly 80 to 90 percent of people with plantar fasciitis see complete resolution within 6 to 18 months, with or without treatment. Active management speeds that timeline considerably.
Other Causes of Bottom-of-Heel Pain
Not all pain under the heel is plantar fasciitis. Heel pad syndrome produces a deep, bruise-like ache in the center of the heel rather than the inner edge. The fat pad that cushions your heel bone thins out with age or repeated impact, leaving the bone less protected. This pain tends to worsen with barefoot walking on hard surfaces.
Nerve entrapment is another possibility. Branches of the nerves running through your ankle can get compressed, producing burning, tingling, or shooting pain in the heel that sometimes radiates into the toes. This type of pain doesn’t follow the classic “worst in the morning” pattern of plantar fasciitis and often feels more electric than aching.
Calcaneal stress fractures deserve attention, particularly if you recently ramped up running, walking, or a sport involving repetitive impact like basketball or tennis. The pain gets worse the longer you stand or bear weight, and it eases when you rest. Your heel may feel tender or warm to the touch, and you might notice bruising or stiffness. Unlike plantar fasciitis, this pain doesn’t loosen up after a few minutes of walking. It just keeps building.
When the Pain Is at the Back of Your Heel
Pain at the back of the heel points to a different set of problems, all involving the Achilles tendon or the structures around it. Achilles tendonitis causes stiffness and soreness either where the tendon inserts into the heel bone or a couple of inches higher in the body of the tendon itself. It’s common in runners and weekend athletes.
Retrocalcaneal bursitis involves a small fluid-filled sac between the Achilles tendon and the heel bone becoming inflamed. You’ll notice pain, redness, and swelling right at the back of the heel. A Haglund deformity, sometimes called a “pump bump,” is a bony enlargement on the back of the heel that can irritate both the bursa and the tendon, especially in rigid or tight-backed shoes.
In adolescents (typically ages 8 to 14), heel pain at the back is often Sever disease, where the growth plate in the heel bone becomes irritated during periods of rapid growth. It’s not dangerous but can sideline active kids for weeks if not managed with rest and proper footwear.
What Heel Spurs Actually Mean
If you’ve been told you have a heel spur, it probably isn’t the source of your pain. Heel spurs are bony growths that form on the underside of the heel bone, and they show up on X-rays frequently. About 15 percent of people with no heel pain at all have visible spurs on imaging. Less than 5 percent of people with spurs experience any pain from them. The spur is typically a byproduct of long-term tension on the plantar fascia, not the cause of the problem. Treatment targets the fascia, not the spur.
Stretches and Home Treatment That Work
Consistent stretching is the single most effective thing you can do at home. Aim for at least 10 minutes a day, and focus on the calf, Achilles tendon, and the plantar fascia itself.
- Seated toe stretch: Cross one foot over your opposite knee, pull your toes back toward your shin until you feel a stretch along the arch. Hold for three to five slow breaths. Repeat two to three times per foot.
- Calf and Achilles stretch: Stand facing a wall with one foot behind you, heel flat on the ground, and lean forward until you feel the stretch in your calf. Hold for three to five breaths, then switch sides.
- Stair stretch: Stand on a step with your heels hanging off the edge. Let your heels drop below the step until you feel a pull through your calves. Hold for three to five breaths.
- Massage roll: Roll a frozen water bottle or tennis ball under your foot for two to three minutes. You can do this several times a day, and the cold helps reduce discomfort.
These stretches work best first thing in the morning, before you take those painful first steps, and again after long periods of sitting. Ice for 15 to 20 minutes after activity helps manage pain. Over-the-counter anti-inflammatory medication can take the edge off during flare-ups.
Choosing the Right Footwear and Insoles
What you put on your feet matters more than most people realize. If your daily shoes are flat, floppy, or worn out, they’re making the problem worse. Look for shoes with structured arch support and a slight heel elevation, which reduces tension on the plantar fascia.
If you’re shopping for insoles, firmness matters more than softness. A common mistake is choosing insoles that feel plush and cushiony. While soft inserts feel great initially, they don’t provide the structural support needed to control how your foot moves. Over the course of a day, firmer insoles with a deep heel cup deliver more meaningful, lasting relief. The heel cup holds your heel in place and controls rear-foot motion, while firm arch support prevents the fascia from overstretching with each step. Some cushioning in the heel and ball of the foot helps absorb impact, but the foundation should be supportive, not squishy.
When Basic Treatment Isn’t Enough
Most heel pain responds well to stretching, better footwear, and time. But if you’ve been consistent for two to three months and your pain hasn’t improved, or if it’s getting worse, there are next-level options.
Shockwave therapy uses pressure waves directed at the damaged tissue to stimulate healing. Clinical studies confirm it reduces both pain and disability in plantar fasciitis patients, typically delivered in weekly sessions over three weeks. The radial form of this therapy tends to be better tolerated than the focused version, with similar results. Corticosteroid injections can provide shorter-term relief, though the effects tend to fade after a few months.
Physical therapy offers targeted strengthening and gait correction that addresses the root cause, not just the symptoms. Night splints hold your foot in a stretched position while you sleep, reducing that characteristic morning pain. Custom orthotics, molded to your specific foot shape, may help when off-the-shelf insoles fall short.
For stress fractures, the approach is different: you’ll need to significantly reduce weight-bearing activity, sometimes using a walking boot, to give the bone time to heal. Continuing to push through stress fracture pain risks a complete break.