A sore heel is most often caused by plantar fasciitis, a condition where the thick band of tissue running along the bottom of your foot becomes irritated and inflamed. It affects roughly 1 in 120 adults and is the single most common reason people seek help for heel pain. But where exactly your heel hurts, and when it hurts most, points to different causes that call for different responses.
Pain Location Narrows the Cause
Heel soreness isn’t one condition. The heel is a surprisingly complex structure where bones, tendons, and connective tissue all converge, and pain at different spots signals different problems. Pain on the bottom of the heel, especially near the front edge of the heel pad, almost always involves the plantar fascia. Pain at the back of the heel, where your shoe presses against the bone, typically involves the Achilles tendon or the small fluid-filled sac (bursa) that sits between the tendon and the bone. Pain that wraps around the sides of the heel can point to a stress fracture, nerve irritation, or in children, a growth plate issue.
Paying attention to exactly where the soreness is and what triggers it gives you a much clearer picture of what’s going on.
Plantar Fasciitis: The Most Likely Culprit
If your heel is worst first thing in the morning, plantar fasciitis is the most probable explanation. The plantar fascia is a long, thin ligament that runs directly under the skin on the bottom of your foot, connecting your heel bone to the base of your toes. When this tissue is repeatedly stretched and stressed, small tears develop. Over time, this causes inflammation and a stabbing pain near the heel.
The hallmark symptom is intense pain with your first few steps after sleeping. While you’re off your feet, the fascia tightens and contracts. When you stand on it again, those micro-tears get pulled apart. The same pattern happens after sitting for a long time. Many people notice the pain eases once they’ve walked around for a few minutes, only for it to return after extended standing or at the end of the day.
You’re at higher risk if you spend long hours on your feet, have recently increased your activity level, carry extra weight, or have flat feet or very high arches. Worn-out shoes with little arch support are a common contributor.
The good news: most people recover within several months using conservative measures like stretching, icing, and avoiding the activities that aggravate it. Surgery is rarely needed.
Achilles Tendon Problems
If the soreness 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 takes a beating during running, jumping, or even prolonged walking. Achilles tendonitis is an overuse injury. It develops gradually as repeated stress outpaces the tendon’s ability to repair itself.
The pain tends to be a dull ache along the back of the leg just above the heel, or right where the tendon attaches to the bone. It’s often stiff in the morning but worsens with activity rather than improving as you walk. Sometimes a bony bump develops at the attachment point, a condition called Haglund’s deformity, which can also irritate the nearby bursa and create additional swelling.
One important distinction: if you felt a sudden “pop” in the back of your ankle during physical activity followed by sharp pain, that may be a partial or complete Achilles tendon rupture, which needs prompt medical attention.
Heel Spurs Are Rarely the Problem
Many people worry that a bone spur is causing their heel pain, but this is one of the most misunderstood aspects of foot health. Heel spurs are bony growths that form on the underside of the heel bone, and they show up clearly on X-rays. However, most people who have heel spurs on X-ray have no pain at all.
According to the American Academy of Orthopaedic Surgeons, heel spurs do not cause plantar fasciitis pain. A spur can develop as a result of long-standing tension where the plantar fascia attaches to the bone, so it’s a byproduct of the problem, not the source. Plantar fasciitis is successfully treated without removing the spur in the vast majority of cases.
Heel Pain in Children and Teens
If your child is complaining about heel soreness, the cause is often different from what adults experience. Sever’s disease (calcaneal apophysitis) is one of the most common causes of heel pain in growing children and adolescents. It involves irritation of the growth plate in the heel bone, which hasn’t yet fully hardened.
The pain typically shows up during or after sports and physical activity. A key sign is tenderness when you squeeze both sides of the heel, not just the bottom. Doctors diagnose it mainly through a physical exam, since X-rays of Sever’s disease look similar to a normal, pain-free foot. X-rays are sometimes ordered to rule out a fracture, not to confirm the diagnosis. The condition resolves on its own once the growth plate fully closes, though rest and activity modification help manage pain in the meantime.
Stretches That Actually Help
Stretching is one of the most effective things you can do at home for heel pain, particularly for plantar fasciitis. A study published in the Journal of Orthopaedic & Sports Physical Therapy tested two specific approaches in 60 patients with heel pain and found that calf and foot stretches reduced pain, with even greater improvement when stretches were combined with hands-on physical therapy during the first month of treatment.
Three stretches stood out:
- Straight-leg calf stretch: Stand facing a wall with one foot behind you, toes pointing forward. Lean forward with your back leg straight and your heel pressed into the floor until you feel a pull in your calf.
- Bent-knee calf stretch: Same position, but slightly bend your back knee. This targets the deeper calf muscle closer to the Achilles tendon.
- Seated foot stretch: While sitting, grab the base of your toes and pull them gently toward your shin. You should feel a stretch along the bottom of your foot.
The protocol that worked: hold each stretch for 20 seconds, rest for 20 seconds, repeat three times per stretch, and do the whole routine twice a day. Consistency matters more than intensity here.
Footwear and Orthotics
What you put on your feet has a direct effect on heel pain. Shoes with minimal arch support or thin, flat soles force the plantar fascia and Achilles tendon to absorb more stress with every step. Switching to supportive shoes with a cushioned heel and firm arch support is often one of the first and most effective changes people make.
Orthotics, whether over-the-counter insoles or custom-made devices, work by improving foot alignment, redistributing pressure more evenly across the foot, and absorbing shock. For people with flat feet or overpronation (where the foot rolls inward too much), functional orthotics can correct the mechanical imbalance that puts extra strain on the heel. For people who primarily need cushioning, accommodative orthotics focus on padding and pressure relief. If you’re active in sports, sport-specific orthotics are designed to handle higher-impact forces.
Custom orthotics are more expensive but are molded to your specific foot shape. Many people get meaningful relief from quality over-the-counter insoles as a starting point.
Signs That Need Immediate Attention
Most heel soreness is a nuisance, not an emergency. But certain symptoms point to something more serious, like a fracture, rupture, or infection. 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 or numbness and tingling. These patterns suggest damage that won’t resolve with rest and stretching alone.