The Complete Guide to Heel Pain
Updated: Aug 17
Heel pain is one of the most common reasons people visit a podiatrist. Whether it's a sharp pain when you take your first steps in the morning, an aching heel after a long day at work, or discomfort that stops you enjoying exercise, heel pain can have a significant impact on everyday life.
The good news is that most cases of heel pain can be successfully treated once the underlying cause has been identified. The key is understanding what is causing your pain rather than simply trying to mask the symptoms.
This guide explains the most common causes of heel pain, how to recognise them, what treatments are available, and when it's time to seek professional advice.
What is heel pain?
Heel pain describes pain felt anywhere around the heel bone. It may develop suddenly after an injury or gradually over weeks or months.
The pain may occur:
Under the heel
At the back of the heel
Around the sides of the heel
Deep inside the heel
Only when walking
During sport
First thing in the morning
After long periods of standing
The exact location, timing and nature of the pain provide valuable clues about the underlying cause.
What causes heel pain?
Many different structures are found around the heel, including bones, tendons, ligaments, nerves, muscles and fat pads. Any of these can become injured or irritated.
Some of the most common causes include:
Plantar fasciitis is by far the most common cause of heel pain.
The plantar fascia is a strong band of tissue that runs along the sole of the foot from the heel to the toes. Repeated strain can cause small areas of damage where it attaches to the heel bone.
Typical symptoms include:
Sharp pain underneath the heel
Pain during the first few steps after getting out of bed
Improvement after walking for a few minutes
Pain returning after prolonged standing or activity
Despite the name, inflammation is not always the main problem. Many long-standing cases involve degeneration of the tissue rather than ongoing inflammation.
Heel fat pad syndrome
The heel contains a specialised cushion of fatty tissue designed to absorb impact.
Over time, this cushion can become thinner or damaged, reducing its ability to protect the heel bone.
Symptoms often include:
Deep aching beneath the centre of the heel
Pain that worsens on hard surfaces
Tenderness when pressing directly on the heel
Increased pain during prolonged standing
This condition becomes more common with age as the natural fat pad gradually loses thickness.
Pain behind the heel may be related to the Achilles tendon.
This large tendon connects the calf muscles to the heel bone and is heavily involved in walking, running and jumping.
Symptoms often include:
Pain at the back of the heel
Morning stiffness
Pain during exercise
Thickening of the tendon
Tenderness when squeezing the tendon
This condition commonly develops after increasing exercise levels or changing training
routines.
Retrocalcaneal bursitis
Small fluid-filled sacs called bursae help reduce friction around joints and tendons.
Inflammation of the bursa behind the heel can cause:
Pain behind the heel
Swelling
Redness
Pain when wearing shoes with firm heel counters
Many people worry that a heel spur is causing their pain.
In reality, heel spurs are very common and are often discovered accidentally on X-rays in people with no pain at all.
Most heel pain is not caused by the spur itself. Instead, the pain usually comes from damage to the surrounding soft tissues, particularly the plantar fascia.
Stress fractures
A stress fracture is a tiny crack in the heel bone caused by repeated loading rather than one major injury.
Risk factors include:
Suddenly increasing running distance
Military training
Osteoporosis
Reduced bone density
Symptoms often include:
Pain that gradually worsens
Swelling
Pain even at rest
Pain when squeezing the heel from both sides
Stress fractures require prompt assessment and should not be ignored.
Tarsal tunnel syndrome
The tibial nerve travels through a narrow tunnel on the inside of the ankle.
Compression of this nerve can lead to:
Burning pain
Tingling
Pins and needles
Numbness
Heel pain that may radiate into the foot
Sever's disease (children)
Children and teenagers can develop heel pain during periods of rapid growth.
Despite the name, Sever's disease is not actually a disease.
It occurs because the growth plate at the back of the heel becomes irritated during sport and physical activity.
It most commonly affects children between 8 and 15 years of age.
Morning heel pain is one of the biggest clues that plantar fasciitis may be the cause.
While you sleep, the plantar fascia shortens slightly. When you stand up and put weight through your foot, the tissue suddenly stretches again, causing pain during those first few steps.
As you continue walking, the tissue warms up and becomes more flexible, which explains why the pain often eases.
However, after sitting for a long period, the pain may return when you stand up again.
What increases the risk of heel pain?
Several factors increase the likelihood of developing heel pain.
These include:
Spending long hours standing
Sudden increases in exercise
Running on hard surfaces
Poorly supportive footwear
Tight calf muscles
Reduced ankle flexibility
Excess body weight
Flat feet
High arches
Ageing
Previous foot injuries
Having one or more risk factors does not guarantee heel pain, but it can increase the strain placed on the tissues around the heel.
How is heel pain diagnosed?
A podiatrist will usually diagnose heel pain by taking a detailed history and carrying out a physical examination.
This may include assessing:
Where the pain is located
Walking pattern (gait)
Foot posture
Joint movement
Muscle strength
Calf flexibility
Areas of tenderness
Nerve function
In many cases, no scans are needed.
However, imaging such as ultrasound, X-ray or MRI may be recommended if:
A fracture is suspected
A rupture needs to be ruled out
Symptoms are unusual
Treatment has not helped
There are signs of another underlying condition
How is heel pain treated?
Treatment depends entirely on the underlying diagnosis.
Because heel pain has many causes, there is no single treatment that works for everyone.
Rest and activity modification
Completely stopping activity is rarely necessary, unless yuou have sustained a serious injury.
Instead, reducing activities that aggravate symptoms while remaining as active as possible is usually the best approach.
Footwear
Supportive footwear is one of the simplest ways to reduce strain on the heel.
Look for shoes with:
Good cushioning
A supportive heel counter
Stable soles
Appropriate arch support
Enough room for your toes
Very flat shoes, worn-out trainers and unsupportive sandals may make symptoms worse.
Stretching exercises
Stretching the calf muscles and plantar fascia is commonly recommended for many causes of heel pain.
Exercises should be carried out consistently over several weeks rather than expecting immediate improvement.
A podiatrist can advise which exercises are appropriate for your diagnosis.
Strengthening exercises
Research increasingly shows that strengthening the muscles of the foot, calf and lower leg plays an important role in recovery.
Progressive strengthening helps improve the ability of tissues to tolerate everyday loads.
Insoles and orthoses
Some people benefit from supportive insoles or custom orthoses.
These work by altering how forces are distributed through the foot and reducing stress on painful structures.
Not everyone requires custom orthoses, and many people improve with well-selected prefabricated insoles.
Taping
Sports taping or specialist podiatry taping techniques can temporarily reduce strain on painful tissues.
This is often useful while longer-term treatments begin to take effect.
Ice
Applying ice may help reduce pain after activity.
Wrap an ice pack in a towel and apply it for around 15 to 20 minutes.
Do not place ice directly onto the skin.
Pain relief
Over-the-counter pain relief may help some people manage symptoms.
Always follow the manufacturer's instructions and speak to a pharmacist or GP if you are unsure whether these medicines are suitable for you.
Shockwave therapy
For stubborn cases of plantar fasciitis or Achilles tendinopathy, extracorporeal shockwave therapy may be recommended.
This treatment delivers controlled sound waves into the affected tissue and has good evidence for certain chronic conditions.
Corticosteroid injections
Steroid injections can reduce pain in selected cases but are not suitable for everyone.
The benefits and potential risks should always be discussed with a healthcare professional.
Surgery
Most heel pain improves without surgery.
Surgery is generally only considered after prolonged symptoms that have not responded to appropriate conservative treatment.
Can heel pain go away on its own?
Some mild cases improve naturally, particularly if the cause of the problem is removed.
However, many people continue to experience symptoms for months because they unknowingly continue placing excessive strain on the injured tissues.
Seeking an accurate diagnosis early often shortens recovery and helps prevent long-term problems.
Should you keep walking with heel pain?
This depends on the severity and cause of the pain.
For many people, gentle walking remains beneficial.
However, if walking causes severe pain or symptoms continue to worsen, reducing activity and seeking professional advice is recommended.
Continuing intense exercise despite significant pain may delay recovery.
You should arrange an assessment if:
Pain lasts longer than two weeks
Walking becomes difficult
The pain keeps returning
Home treatment has not helped
You are unsure what is causing the pain
Heel pain is affecting work or daily activities
A podiatrist can identify the underlying cause and recommend the most appropriate treatment plan.
When should you seek urgent medical advice?
Seek urgent medical assessment if heel pain is associated with:
Severe swelling
A significant injury
Inability to bear weight
Fever
A wound or infection
Rapidly increasing redness
Numbness affecting the whole foot
Sudden severe pain accompanied by a popping sensation, which could indicate an Achilles tendon rupture
Preventing heel pain
Although heel pain cannot always be prevented, you can reduce your risk by:
Wearing supportive footwear
Replacing worn-out shoes regularly
Increasing exercise gradually
Stretching after activity if advised
Maintaining good calf flexibility
Keeping muscles strong
Managing body weight where appropriate
Avoiding sudden increases in running or walking distances
Final thoughts
Heel pain is one of the most common foot problems seen in podiatry clinics, but it should never be dismissed as something you simply have to live with.
Because heel pain can have many different causes, getting the correct diagnosis is the first and most important step. While plantar fasciitis is the most common reason for heel pain, conditions affecting the Achilles tendon, heel fat pad, nerves, bones and joints can produce similar symptoms but require different treatments.
The earlier the underlying cause is identified, the sooner an appropriate treatment plan can begin. If your heel pain is persistent, worsening or interfering with your daily life, seeing a podiatrist can help you return to comfortable walking and reduce the risk of ongoing problems.
Comments