The most common reason your heel hurts is plantar fasciitis, a condition where the thick band of tissue running along the bottom of your foot becomes irritated or inflamed. It accounts for the majority of heel pain cases, affecting roughly 2 to 4 out of every 1,000 adults per year. But several other conditions can cause heel pain too, and where exactly it hurts, when it hurts, and what it feels like are the best clues to figuring out what’s going on.
Plantar Fasciitis: Pain on the Bottom of Your Heel
The plantar fascia is a band of tissue that connects your heel bone to the base of your toes. It supports your arch and absorbs shock every time you take a step. When that tissue is repeatedly stretched and stressed, small tears develop, leading to irritation and pain. The hallmark symptom is a stabbing pain on the bottom of the foot, right near the heel.
What makes plantar fasciitis distinctive is its timing. The pain is usually worst with your first few steps in the morning. While you sleep, the fascia tightens in a shortened position. When you stand and put weight on it, those first steps forcefully stretch the tissue again, producing that sharp jolt. The same thing happens after you’ve been sitting for a while. Pain typically eases as you move around, but it can flare again after long periods of standing or at the end of a physically active day.
Flat feet are one of the strongest risk factors. If your arches are low, the plantar fascia stretches more with every step, and shoes without arch support make it worse. Ballet flats, worn-out sneakers, and loafers are frequent culprits. People who spend long hours on their feet, runners who ramp up mileage too quickly, and those carrying extra body weight are all more prone to developing it.
Achilles Tendinitis: 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 more likely source. This tendon connects your calf muscles to your heel bone, and it comes under enormous stress during walking, running, and jumping. There are two types, and they feel different.
Insertional Achilles tendinitis affects the lowest part of the tendon, right where it attaches to the heel bone. You’ll feel pain and possibly a hard bump at the back of the heel, which can be a bone spur forming at the attachment point. Tight calf muscles are a frequent cause, because they increase the pulling force on that insertion point. This type can happen at any activity level, not just in athletes.
Non-insertional Achilles tendinitis affects the middle portion of the tendon, a couple of inches above the heel. It’s more common in younger, active people, especially runners. You might notice thickening or swelling in the tendon itself. The distinction matters because the exercises that help each type are different. Heel drop exercises, for example, are effective for non-insertional tendinitis but can actually worsen the insertional type.
Heel Spurs: Not Always the Problem
If you’ve had an X-ray and were told you have a heel spur, that finding alone doesn’t explain your pain. Heel spurs are bony growths on the underside of the heel bone, and they show up on X-rays of 10% to 63% of people who have zero heel pain. The spur itself is usually a byproduct of long-term tension on the plantar fascia or Achilles tendon, not the direct cause of pain. Treatment focuses on the soft tissue problem, not the spur.
Nerve Pain: Burning and Tingling
Heel pain that comes with burning, tingling, numbness, or a “pins and needles” sensation points toward a nerve issue rather than a tendon or fascia problem. Tarsal tunnel syndrome is the most common nerve-related cause. It happens when the tibial nerve, which runs along the inside of your ankle, gets compressed as it passes through a narrow space near the ankle bone.
The pain from tarsal tunnel syndrome tends to show up on the inside of the ankle or the bottom of the foot. It often gets worse during or after physical activity, and in more severe cases, symptoms can become constant. You might also notice weakness in your foot muscles. The key distinguishing feature is the nerve-type quality of the pain. Plantar fasciitis feels like a stab or deep ache; nerve compression feels like electricity, heat, or numbness.
Stress Fractures: A Subtle but Serious Cause
A stress fracture of the heel bone is less common but worth considering if your pain came on gradually during a period of increased activity, particularly running or other high-impact sports. These fractures are small cracks in the bone caused by repetitive force, and they can be tricky to identify because the symptoms overlap with plantar fasciitis and Achilles tendinitis. The pain tends to worsen with any weight-bearing activity and doesn’t follow the classic morning-pain pattern of plantar fasciitis. Squeezing the sides of the heel sometimes reproduces the pain, though this test isn’t always reliable. Stress fractures often don’t show up on initial X-rays and may need an MRI for confirmation.
Heel Pain in Kids and Teens
If your child is between 8 and 14 and complaining of heel pain, the most likely cause is Sever’s disease (calcaneal apophysitis). It’s not actually a disease. It’s inflammation of the growth plate in the heel bone, and it’s extremely common during growth spurts. The heel bone grows faster than the surrounding muscles and tendons, and a tight Achilles tendon pulls on the heel during activity, creating pain.
High-impact sports on hard surfaces make it worse, but sometimes normal walking is enough to trigger symptoms. Sever’s disease resolves on its own once the growth plate closes, typically by the mid-teens. In the meantime, reducing activity, stretching the calves, and using cushioned heel inserts help manage the pain.
What You Can Do at Home
For the most common causes of heel pain, a few daily habits can make a real difference. These are particularly effective for plantar fasciitis but also help with general heel tightness and Achilles-related pain.
- Toe and arch stretch: Sit down and cross the affected foot over your other leg. Pull your toes back toward your shin to stretch the arch, and use your other hand to massage along the bottom of your foot. Hold for 10 seconds, repeat 10 times, once or twice a day.
- Frozen bottle roll: Place a frozen water bottle or a tennis ball under your foot and roll it back and forth for 3 to 5 minutes, twice a day. This combines a gentle stretch with icing.
- Standing calf stretch: Stand facing a wall with your affected foot behind you, knee straight, and your front knee bent. Lean forward until you feel a stretch in the back calf, keeping your rear heel on the ground. Hold for 45 seconds, repeat 2 to 3 times, and do this 4 to 6 times throughout the day.
Consistency matters more than intensity. Most people with plantar fasciitis see meaningful improvement within several weeks of daily stretching, supportive footwear, and avoiding prolonged barefoot walking on hard surfaces. Shoes with good arch support and a slightly raised heel reduce strain on both the plantar fascia and the Achilles tendon.
Signs That Need Prompt Attention
Most heel pain improves with the steps above, but certain symptoms suggest something more serious. Severe pain and swelling near the heel immediately after an injury could indicate a rupture or fracture. If you can’t bend your foot downward, can’t rise onto your toes, or can’t walk normally, that warrants urgent evaluation. Heel pain accompanied by fever, or numbness and tingling in the heel, also needs prompt medical attention rather than a wait-and-see approach.