Right heel pain during walking is most commonly caused by plantar fasciitis, a condition where the thick band of tissue running along the bottom of your foot becomes irritated and inflamed. But the specific location of your pain matters: pain on the bottom of the heel points to different causes than pain at the back of the heel. Most heel pain resolves within a year with simple home measures, and the majority of people never need surgery.
Where Exactly Does It Hurt?
The two most common zones for heel pain are underneath the heel and at the back of it. Pain underneath, especially near the inner edge of the heel bone, typically involves the plantar fascia or the heel’s fat pad. Pain at the back of the heel, where the Achilles tendon meets the bone, usually involves tendon inflammation or bursitis. Pinpointing your pain location is the single most useful step in narrowing down the cause.
Plantar Fasciitis: The Most Likely Culprit
The plantar fascia is a tough band of tissue connecting your heel bone to the base of your toes. It acts like a bowstring supporting the arch. When this tissue is overloaded repeatedly, small tears develop at its attachment point on the heel, producing a sharp or stabbing pain on the bottom of the foot near the heel.
The hallmark of plantar fasciitis is pain with your first steps in the morning or after sitting for a long time. Walking loosens the tissue and pain often decreases after a few minutes, only to return after extended time on your feet. During walking, the push-off phase stretches the fascia as your toes bend upward, which is why each step can re-aggravate the problem.
You’re more likely to develop it if you have flat feet, high arches, tight calf muscles, or if you’ve recently increased your activity level. Excess body weight also increases load on the fascia with every step.
Heel Spurs Are Usually Not the Problem
Many people worry that a bone spur is stabbing them from inside. Heel spurs do show up on X-rays in people with long-standing plantar fasciitis, but they develop as a response to chronic tension on the fascia, not as a separate problem. Most people who have bone spurs on their heels have no pain at all. According to the American Academy of Orthopaedic Surgeons, heel spurs do not cause plantar fasciitis pain, and the condition can be treated without removing the spur.
Fat Pad Syndrome
Your heel has a built-in shock absorber: a thick pad of fat tissue beneath the heel bone. Over time, this pad can thin out or shift, especially with aging, prolonged standing, or high-impact activities. The resulting pain feels like a deep bruise right in the center of the heel, distinct from the inner-edge pain of plantar fasciitis.
Fat pad pain tends to worsen when walking barefoot on hard surfaces like tile or concrete, during high-impact activities, and after long periods of standing. Pressing firmly into the center of the heel with your thumb reproduces the sensation. Mild cases may only bother you occasionally, while more advanced thinning can make every step on a hard floor uncomfortable.
Achilles Tendonitis and Back-of-Heel Pain
If your pain is at the back of the heel rather than the bottom, the Achilles tendon is the most likely source. This tendon connects your calf muscles to your heel bone and absorbs significant force during walking, especially when climbing stairs or going uphill.
Achilles tendonitis produces stiffness and tenderness at the back of the heel that’s often worst in the morning and improves as you move around. You may also notice swelling along the tendon, weakness in the leg, and increased discomfort the day after exercise. Tight or weak calf muscles, flat arches, and overpronation (ankles rolling inward when you walk) all increase your risk. Bursitis, where fluid-filled cushioning sacs near the tendon become inflamed, can produce a similar tender, bruise-like feeling at the back of the heel.
Stretches That Help
For bottom-of-heel pain, three stretches have solid evidence behind them. Do two sets of each per day.
- Seated toe pull with massage: Sit in a chair and cross your painful foot over the opposite thigh. Pull your toes toward your shin until you feel a stretch along the sole. Hold 10 seconds while massaging the bottom of your foot with slight pressure using your other hand. Repeat 10 times per set.
- Wall toe stretch: Stand facing a wall and press the toes of your painful foot against it with your heel on the floor, keeping heel and toes in a straight line. Lean slightly toward the wall to deepen the stretch. Hold 10 seconds, repeat 10 times per set.
- Kneeling toe stretch: Get on all fours with toes bent back against the floor. Slide your hips backward toward your heels until you feel a stretch. Hold for about one minute, repeat three times per set. To intensify it, sit fully upright on your heels.
Research on night splints, which hold your foot in a stretched position while you sleep, shows that 88% of patients improved in pain levels, with over a third becoming completely pain-free. These splints are available over the counter and can be especially helpful if morning pain is your biggest issue.
Shoes That Reduce Heel Pain
The right footwear can make a significant difference. A good supportive shoe distributes pressure more evenly across the foot, stabilizes the heel, and cushions impact. There’s a quick test you can do in the store: try to bend the shoe in half. If it folds easily like a taco, it lacks the rigidity your foot needs. Then press on the heel counter, the firm cup at the back of the shoe. It should resist collapsing inward, which helps control side-to-side heel motion. Finally, grip the front and back of the shoe and twist in opposite directions. If the middle stays rigid, it has adequate arch support.
Look for shoes with built-in arch support, shock-absorbing midsoles, a deep and wide toe box, and removable insoles so you can swap in custom inserts if needed. Adjustable closures like laces or straps help accommodate swelling that naturally occurs throughout the day. In one study, a prefabricated silicone heel insert combined with stretching produced improvement in over 95% of participants.
How Long Recovery Takes
Plantar fasciitis generally resolves within a year, and most cases respond well to conservative measures without any medical procedures. Combining stretching with supportive inserts is more effective than either approach alone. One study found that patients using night splints were cured at an average of 12.5 weeks, compared to about a third of a control group who improved in a similar timeframe. Consistency matters more than intensity: daily stretching and wearing supportive shoes at all times, including around the house, accelerates recovery.
Signs That Need Medical Attention
Heel pain that persists for more than a few weeks despite rest, ice, and stretching is worth getting evaluated. Pain that occurs even when you’re not standing or walking can indicate something beyond typical overuse. Seek prompt attention if you experience 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, numbness, or tingling.