The most likely reason your heels hurt is plantar fasciitis, an irritation of the thick band of tissue that runs along the bottom of your foot and connects to your heel bone. It’s the single most common cause of heel pain in adults. But several other conditions can produce intense heel pain too, and where exactly you feel the pain, when it’s worst, and what it feels like all point toward different causes.
Pain on the Bottom of Your Heel
Plantar fasciitis causes a stabbing pain right at the base of your heel, and it’s usually worst with your first steps in the morning or after sitting for a long time. The tissue along the bottom of your foot becomes inflamed from repeated stress, and overnight it tightens up. That’s why standing up after rest produces that sharp jolt of pain that can gradually ease as you move around, only to return after long periods on your feet.
Many people with plantar fasciitis are told they have a heel spur, a small bony growth on the underside of the heel bone. But heel spurs are surprisingly common in people with zero pain. Studies have found calcaneal spurs in 10% to 63% of people who have no heel symptoms at all. The spur itself usually isn’t the problem. The inflammation in the surrounding tissue is.
Another bottom-of-heel cause is fat pad atrophy. Your heel has a built-in shock absorber made of fatty tissue and thick elastic fibers. Over time, that pad thins out. Age is a major factor, but excess body weight, walking barefoot on hard surfaces like concrete or tile, and wearing shoes without adequate cushioning all accelerate the breakdown. The pain from fat pad thinning tends to feel like a deep bruise and gets worse with prolonged standing or walking on hard floors, rather than showing the classic first-step-in-the-morning pattern of plantar fasciitis.
Pain at the Back of Your Heel
If the pain is at the back of your heel rather than the bottom, the Achilles tendon is the most likely culprit. Achilles tendinitis develops when the tendon connecting your calf muscles to your heel bone becomes irritated from overuse. Runners, weekend athletes, and people who suddenly increase their activity level are especially prone. The pain typically starts as a mild ache above the heel after exercise and worsens over time.
A related condition called retrocalcaneal bursitis involves inflammation of a small fluid-filled sac that sits between the Achilles tendon and the heel bone. It can feel similar to Achilles tendinitis but produces more swelling and tenderness right where the tendon meets the bone. Haglund’s deformity, a bony bump at the back of the heel, can contribute to this irritation, especially when stiff-backed shoes press against it repeatedly.
Burning, Tingling, or Numbness
Heel pain that comes with burning, tingling, pins-and-needles sensations, or numbness points toward a nerve issue rather than a structural one. Tarsal tunnel syndrome is the most common nerve-related cause. A nerve that runs along the inside of your ankle gets compressed as it passes through a narrow space, producing pain in the inner ankle or the bottom of the foot. You might also notice weakness in your foot muscles. The sensation is distinctly different from the sharp, localized ache of plantar fasciitis. It often radiates and can feel electric or buzzing.
Peripheral neuropathy, where nerves in the feet are damaged (often from diabetes or other systemic conditions), can also produce burning heel pain, typically in both feet.
Heel Pain in Kids and Teens
If your child is complaining about heel pain, especially between ages 8 and 14, the most common cause is Sever’s disease. Despite the name, it’s not really a disease. It’s inflammation of the growth plate in the heel bone caused by repetitive stress during activity. Growth spurts make it more likely because bones grow faster than tendons, creating extra tension at the heel. It’s very common in young athletes and resolves on its own once the growth plate closes, though rest and proper footwear can help manage pain in the meantime.
Shoes That Make Heel Pain Worse
Footwear is one of the biggest controllable factors in heel pain. Several types of shoes are particularly problematic:
- Flat shoes with no support. Ballet flats, flip-flops, and flat sandals let the plantar fascia stretch excessively with every step, concentrating strain at the heel.
- High heels. They shift your weight forward and shorten the Achilles tendon over time. The result is that when you switch back to flat shoes, the shortened tendon pulls harder on the heel, triggering pain.
- Worn-out shoes. Shoes lose their structure gradually. The cushioning thins, the heel counter weakens, and the midsole stops absorbing impact effectively. If you’re logging serious mileage in the same pair, they may look fine but offer almost no protection.
What helps is a shoe with proper arch support to distribute pressure across the foot, a cushioned heel (EVA foam or gel) to absorb impact, a firm heel counter to stabilize the back of the foot, and a slight heel elevation. Even an inch of lift reduces tension on both the Achilles tendon and the plantar fascia without compromising stability. Completely flat soles are harder on your heels than most people realize.
What You Can Do at Home
For plantar fasciitis specifically, a targeted stretch is one of the most effective first-line treatments. Sit down, cross the affected leg over your other knee, grab your toes, and pull them back toward your shin. Hold for 10 seconds, and you should feel a stretch along the arch of your foot. Do 10 repetitions, at least three times a day, for a minimum of 8 weeks. The single most important time to do this stretch is before your first step out of bed in the morning, or before standing up after sitting for a long period. That pre-loads the tissue before it takes the shock of your body weight.
Ice can help too. Rolling your foot over a frozen water bottle for 10 to 15 minutes applies cold therapy and gentle massage at the same time. Reducing activity that aggravates the pain, switching to supportive footwear, and maintaining a healthy body weight all take pressure off the heel. Recovery from plantar fasciitis with these conservative measures takes anywhere from a few weeks to a few months, so consistency matters more than intensity.
For fat pad atrophy, cushioned insoles and heel cups can compensate for the lost natural padding. Avoiding barefoot walking on hard surfaces is especially important.
Signs That Need Medical Attention
Most heel pain responds to home treatment, but certain symptoms signal something more serious. Seek medical attention right away if you have severe heel pain immediately after an injury, significant swelling near the heel, inability to bend your foot downward or rise onto your toes, or heel pain accompanied by fever and numbness or tingling. These can indicate a fracture, a ruptured tendon, or an infection, all of which require professional evaluation rather than watchful waiting.