Heel Pain: Causes, Treatment & When to See a Doctor

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.

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, after standing

→ Could be inferior calcaneal bursitis or heel pad atrophy

• Deep ache rather than sharp
• Worse with prolonged standing on hard surfaces
• Less morning-specific than plantar fasciitis

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

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 — running, prolonged standing
• Stretch your calves and the plantar fascia several times daily
• Ice the heel for 15–20 minutes after activity
• Supportive shoes with good arch support and cushioned heels
• Heel cups or arch supports (over-the-counter)
• Avoid going barefoot on hard floors
• NSAIDs short-term for pain

If not improving after 2 weeks

• Custom orthotics
• Night splints for plantar fasciitis
• Physical therapy for tailored programs
• Walking boot for severe acute flares

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

• Pain doesn’t improve after 2 weeks of conservative care
• Severe pain, can’t bear weight
• Pain at night or at rest (worth investigating beyond mechanical causes)
• Numbness, tingling, or burning rather than mechanical pain
• Swelling, redness, or warmth (could indicate infection or inflammatory arthritis)
• Recent significant injury
• Heel pain in a child outside the typical Sever’s age range
• Weight loss, fever, or systemic symptoms with the pain

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