The most common reason your heel hurts is plantar fasciitis, an inflammation of the thick band of tissue that runs along the bottom of your foot from the heel bone to the toes. It accounts for the majority of heel pain cases in adults. But several other conditions can cause heel pain too, and where exactly you feel it, when it gets worse, and what the pain feels like all point toward different causes.
Plantar Fasciitis: The Most Likely Cause
Plantar fasciitis produces a sharp or stabbing pain on the bottom of the heel, right where the tissue band attaches to the bone. The hallmark symptom is pain with your first steps in the morning. While you sleep, your foot naturally points downward for hours, letting the inflamed tissue tighten and shorten. When you stand up and flatten your foot, those first steps stretch the tissue suddenly, and the pain can be intense. It typically eases after a few minutes of walking, then may flare again after long periods of standing or when you stand up after sitting.
The underlying problem is excessive tension on the tissue. Anything that increases strain on the bottom of your foot raises your risk: a sudden jump in activity, spending long hours on your feet, tight calf muscles, high arches, flat feet, or carrying extra body weight. It’s not a one-time injury but a gradual overload that builds over weeks.
Heel Spurs Are Rarely the Problem
If you’ve heard that a bony spur on the heel causes pain, the reality is more nuanced. About 15% of the general population has heel spurs visible on X-rays with no pain at all, and less than 5% of people with spurs ever experience symptoms. Spurs form in response to chronic pulling on the heel bone, often from the same tension that causes plantar fasciitis. They’re a sign of long-term stress, not usually the source of pain itself. Treating the underlying tissue inflammation is what brings relief.
Pain in the Back of the Heel
If your pain is behind the heel rather than underneath it, Achilles tendonitis is the more likely culprit. The Achilles tendon connects your calf muscles to your heel bone, and overuse from running, jumping, or a sudden increase in activity can inflame it. You’ll typically feel a stiff, aching pain along the back of the heel or just above it, especially after exercise or first thing in the morning. The tendon area may feel tender to the touch or slightly swollen.
This is a useful distinction to make early. Plantar fasciitis hurts on the bottom of the heel. Achilles tendonitis hurts at the back. The two conditions have different stretching and treatment approaches, so identifying the right location matters.
Deep, Aching Pain That Worsens With Activity
A calcaneal stress fracture (a small crack in the heel bone) produces a deep, aching pain that feels different from the sharp stab of plantar fasciitis. The key difference is how the pain behaves: stress fracture pain gets worse the more active you are and doesn’t improve with walking like plantar fasciitis often does. The pain is localized directly over the heel bone, and you may notice swelling around the heel. Squeezing the heel from both sides often reproduces the pain.
Stress fractures develop from repetitive impact, particularly in runners, military recruits, or anyone who rapidly increases high-impact activity. They’re often missed on initial X-rays and may require imaging weeks later to confirm. If your heel pain keeps getting worse with activity rather than loosening up, this is worth considering.
Tingling, Burning, or Numbness
When heel pain comes with tingling, burning, or numbness on the bottom of the foot, a nerve issue called tarsal tunnel syndrome may be involved. A nerve that runs through a narrow passage on the inner side of the ankle gets compressed, producing symptoms that feel electrical or buzzy rather than purely mechanical. You might notice weakness in your toes or abnormal sensations that spread from the ankle into the sole. In severe cases, the small muscles of the foot can weaken noticeably. This condition is less common than plantar fasciitis but important to recognize because the treatment is different.
Fat Pad Thinning in Older Adults
Your heel has a built-in cushion: a pad of fatty tissue that absorbs shock with every step. As you age, this pad loses thickness and elasticity. The result is a bruise-like pain in the center of the heel that gets worse when you walk on hard surfaces, go barefoot, or stand for long periods. It’s the second most common cause of heel pain after plantar fasciitis, and it’s frequently misdiagnosed as plantar fasciitis because the pain location overlaps.
The difference is subtle but worth noting. Plantar fasciitis pain tends to concentrate where the tissue attaches at the front edge of the heel, and it’s worst with those first morning steps. Fat pad pain sits more centrally under the heel and worsens progressively the longer you’re on your feet, especially on hard floors. Pressing your fingers into the middle of the heel will reproduce it. Cushioned shoes and gel heel inserts help more than stretching for this condition.
Heel Pain in Children and Teens
If your child complains of heel pain, the most likely cause is Sever’s disease, an irritation of the growth plate at the back of the heel. It affects girls typically between ages 8 and 10, and boys between 10 and 12. Running and jumping sports like soccer and gymnastics are common triggers. The growth plate is softer than the surrounding bone and vulnerable to repetitive stress from the Achilles tendon pulling on it. Once the heel bone finishes growing, usually by age 15, the condition resolves and doesn’t return.
Simple Stretches That Help
For plantar fasciitis and Achilles-related heel pain, consistent stretching is one of the most effective home treatments. The Mayo Clinic recommends three stretches done two to three times a day, holding each for at least 30 seconds without bouncing:
- Calf stretch: Stand facing a wall with your back leg straight and heel flat on the floor. Push your hips forward until you feel a stretch in the calf.
- Arch stretch: While sitting, grab your toes and gently pull them toward you until you feel a stretch along the bottom of your foot.
- Towel curls: Place a towel on the floor and scrunch it toward you using only your toes. This strengthens the small muscles that support the arch.
Ice after activity, supportive shoes, and reducing high-impact exercise also help in the short term. Most cases of plantar fasciitis improve within several months with these measures alone.
Signs That Need Prompt Attention
Most heel pain is manageable at home, but certain symptoms warrant faster action. Seek care promptly if you have severe heel pain immediately after an injury, significant swelling near the heel, inability to bend your foot downward or rise on your toes, or heel pain accompanied by fever and numbness or tingling. Pain that persists at rest (not just when standing or walking), or heel pain that lingers beyond a few weeks despite rest, ice, and stretching, is also worth getting evaluated.