Heel Pain: Causes by Location, Treatment & Red Flags

Quick answer

“My heel hurts” can mean a lot of different things. The location and timing of the pain are your best clues. Most heel pain comes from a few common conditions, all treatable with conservative care. If the pain isn’t in your heel, start from the wider map instead: foot pain by location.

Where exactly does it hurt? Use this guide

Bottom of the heel: first steps in the morning

→ Most likely plantar fasciitis (the most common cause of heel pain)

• Sharp, stabbing pain at the inside of the heel
• Worst with first steps in the morning or after sitting
• Eases after walking, returns with prolonged standing

Bottom of the heel: deep, central, bruise-like

→ Likely heel fat pad syndrome (see the section below) or inferior calcaneal bursitis

• Deep, central ache rather than a sharp stab, often described as walking on a stone or a permanent bruise
• Worst barefoot on hard floors, and worse the longer you stand
• Lacks the classic first-steps-of-the-morning spike that defines plantar fasciitis
• More common with age, years on hard surfaces, or after repeated cortisone injections

Back of the heel: pain with shoe contact

→ Likely insertional Achilles tendinitis or Haglund’s deformity (“pump bump”)

• Tender right at the back where the Achilles attaches
• Worse with stiff-backed shoes
• Sometimes a visible bump

Back of the heel: swelling and pain that worsens with activity

→ Achilles tendinopathy (mid-portion, slightly above the heel)

• Pain 2–6 cm above the heel attachment
• Stiffness in the morning
• Painful tendon is often visibly swollen

Side or center of the heel: pain that built up gradually with running

→ Calcaneal stress fracture

• Pain with weight-bearing
• Tender on squeezing the sides of the heel
• History of running, military training, or repetitive impact

Heel pain in a child aged 8–14

→ Almost certainly Sever’s disease (calcaneal apophysitis)

• Pain after sports, both sides often
• Tender on squeezing the sides of the heel
• Self-limiting; resolves with growth

Heel pain with numbness or tingling into the foot

→ Tarsal tunnel syndrome (nerve entrapment at the inside of the ankle)

• Burning or tingling rather than mechanical pain
• May be worse at night
• Can radiate into the arch or toes

→ Baxter’s neuritis (nerve entrapment deep in the heel)

• Burning pain similar to plantar fasciitis but slightly different location
• Worse with activity, doesn’t have the classic morning-pain-that-warms-up pattern
• A common reason “plantar fasciitis” doesn’t respond to standard treatment

Heel pain at rest, at night, with fever or weight loss

→ Concerning: needs evaluation

• Could be inflammatory arthritis (ankylosing spondylitis, reactive arthritis)
• Or rarely, infection or malignancy
• Mechanical heel pain typically eases with rest

Heel fat pad syndrome: the one that gets missed

Your heel sits on a purpose-built shock absorber: a thick pad of fat divided into chambers by fibrous walls, engineered to spread the impact of every step. A healthy pad measures roughly 12 to 28 mm thick. When it thins or the chambers break down, the heel bone starts taking that impact more directly, and the result is a deep, central, bruise-like ache.

It matters because it is the second most common cause of bottom-of-heel pain after plantar fasciitis, and because it is treated almost oppositely. Fasciitis responds to stretching and support; a worn-out fat pad needs cushioning, and stretching does nothing for it.

How it differs from plantar fasciitis:

Who gets it: older adults (the pad thins with age), people who spend years standing on concrete, runners with high mileage, and people who have had repeated cortisone injections into the heel. That last one is worth stating plainly, because it’s iatrogenic: repeated steroid injections for plantar fasciitis can thin the fat pad and, less commonly, contribute to plantar fascia rupture. It’s one of the main reasons injections into the heel are used sparingly rather than repeatedly. See cortisone injections for foot pain for how that trade-off is weighed.

What helps: silicone or gel heel cups, well-cushioned shoes, and a firm rule against barefoot walking on tile or hardwood. Weight management reduces the load the pad has to absorb. There is no way to regrow the pad, so the goal is to replace its function externally and stop making it worse.

What to do for most heel pain

If your pain pattern fits plantar fasciitis or general heel discomfort and you don’t have any red flags, start here:

First 1–2 weeks

• Reduce aggravating activity, don’t eliminate it: shorten walks, swap running for cycling or pool work. Complete rest tends to stiffen things further.
• Stretch your calves and the plantar fascia several times daily. The most evidence-supported one is the plantar fascia-specific stretch: sit, cross the sore foot over the opposite knee, pull the toes back toward the shin, hold 10 seconds, 10 times, three times a day.
• Ice the heel for 15–20 minutes after activity
• Supportive shoes with a firm midsole and a cushioned heel, worn indoors too. This is the step people skip and the one that matters most.
• Heel cups or arch supports (over-the-counter). Cushioning helps fat pad pain; arch support helps fasciitis.
• Avoid going barefoot on hard floors
• Topical anti-inflammatories or short-term NSAIDs for pain

If not improving after 2 weeks

• Custom orthotics
• Night splints for plantar fasciitis: they hold the fascia at length overnight so the first steps hurt less
• Physical therapy for a tailored loading program
• Walking boot for severe acute flares

If it’s still there after months

At this point the most useful thing is usually not another treatment but a second look at the diagnosis. A meaningful share of “plantar fasciitis that won’t respond” turns out to be Baxter’s neuritis, a calcaneal stress fracture, fat pad syndrome, or inflammatory arthritis. Imaging (X-ray, ultrasound, or MRI) sorts most of these out. Escalating treatment for the wrong diagnosis is how heel pain turns into a multi-year story.

Refer to specific condition pages

• Plantar Fasciitis, for bottom-of-heel morning pain
• Achilles Tendinitis, for back-of-heel pain
• Heel Spurs, often coexists with plantar fasciitis
• Sever’s Disease, for kids aged 8–14
• Stress Fractures, for activity-related pain that builds
• Tarsal Tunnel Syndrome, for nerve-type pain at the inner ankle
• Baxter’s Neuritis, for nerve-type pain deep in the heel, often misdiagnosed as plantar fasciitis

When to see a clinician

Same-day

• Any heel pain in someone with diabetes or neuropathy: a heel that can’t feel pressure can be forming an ulcer under the skin
• Fever, redness, or warmth at the heel, or feeling unwell
• Can’t bear weight after an injury
• A sudden pop at the back of the heel with weak push-off (possible Achilles rupture)

Standard appointment

• Pain that hasn’t improved after 2 weeks of conservative care
• Pain at night or at rest: mechanical heel pain typically eases when you’re off it, so pain that doesn’t deserves a look beyond the fascia
• Numbness, tingling, or burning rather than mechanical pain
• Both heels hurting in a younger adult, especially with morning stiffness over an hour or back pain (raises inflammatory arthritis)
• Unexplained weight loss or systemic symptoms with the pain
• Heel pain in a child outside the 8–14 Sever’s window, or a child’s heel pain that doesn’t settle with rest

Prevention

Most heel pain comes from mechanical overload. The same prevention applies to most causes:

• Stretch calves daily: tight calves drive a lot of heel pain
• Replace shoes every 300–500 miles of running, or once a year for daily wear
• Build training gradually: sudden mileage increases trigger most overuse heel issues
• Maintain a healthy weight
• Avoid prolonged barefoot on hard floors at home
• Address mechanics early: flat feet or high arches with mild discomfort are easier to manage than after they’ve caused a chronic problem

Bottom line

“My heel hurts” is a location, not a diagnosis, and the location plus the timing usually names the problem before any imaging. Sharp pain at the inside-front of the heel with the first steps of the morning is plantar fasciitis, the most common cause by a wide margin. A deep, central, bruise-like ache that’s worst barefoot on hard floors is the fat pad, and it needs cushioning rather than stretching. Pain at the back belongs to the Achilles and its bursae. Pain that worsens the longer you stand, rather than warming up, raises a stress fracture. And burning or tingling points at a nerve, not the fascia.

Most heel pain resolves with unglamorous consistency: supportive shoes worn indoors too, daily calf and fascia stretching, and backing off the load without stopping entirely. The cases that turn chronic are usually the ones treated for months as the wrong diagnosis. If a real effort hasn’t moved it in a few months, the next step is a better diagnosis, not a stronger treatment.