What Your Heel Pain May Mean—and What You Can Do About It (2025)

The most common cause of heel pain is plantar fasciitis, but Achilles tendonitis, Sever disease, and bursitis are also frequent reasons for heel discomfort. Infections and other minor or severe injuries and disorders can cause throbbing, stabbing, burning, or aching pain in the heel.

Your provider will consider the location of the pain as well as the activity that seems to trigger the pain when trying to diagnose the problem and determine the proper treatment.

1. Plantar Fasciitis

Plantar fasciitis is the inflammation of the band of connective tissue that forms the arch of the foot and connects your heel bone to the base of your toes. It causes stabbing or throbbing pain on the bottom of the heel when weight is placed on the heel after rest.

Plantar fasciitis pain is usually worse during the first few steps of the morning but can also be triggered by long periods of standing.

Risk factors include:

• Higher body mass index (BMI), an imperfect but commonly used health metric to assess weight and obesity
• Occupations or activities that require a lot of weight-bearing
• The size and shape of your foot, including foot arch issues
  

The condition is also referred to as plantar fasciopathy because it's a degenerative process that leads to secondary inflammation. It usually affects one foot, allowing you to bear weight on the other.

2. Achilles Tendonitis

Achilles tendonitis isinflammation of the Achilles tendon, the large, cord-like tendon that attaches the back of your heel bone to the calf muscle. It causes tightening or burning pain in the tendon just over the heel. Mild swelling and morning stiffness of the heel and calf are also common.

Achilles tendonitis is usually due to:

• Overuse, such as from long-distance running
• Wearing ill-fitting shoes
• Not warming up your calf muscles before exercise
• Having arthritis, which may contribute to the condition

In rare cases, the Achilles tendon can rupture. This typically occurs during vigorous physical activity when the foot suddenly pivots (such as with basketball or tennis). Besides severe heel pain, some people report hearing a “popping” or “snapping” sound when the tendon tears.

3. Bursitis

When the soft tissue surrounding the ankle bone gets irritated, a condition called bursitis may develop. Bursitis is the inflammation of a fluid-filled sac between joints, called the bursa. It can occur at the top and side of the Achilles tendon (calcaneal bursitis) or where the Achilles tendon attaches to the back of the heel bone (retrocalcaneal bursitis).

Common causes of bursitis include:

• Repetitive overuse injury or prolonged pressure applied directly to the bursa itself
• An acute injury, such as a bruise
• Systemic inflammatory conditions, such asrheumatoid arthritisorgout

4. Heel Spur

A heel spur refers to a bony growth made of calcium deposits. Also known as a calcaneal spur, the protrusion may have a pointy, hooked, or shelf-like shape. It may be visible and may cause cutting or stabbing pain. In some cases, though, people never even know they have a spur.

Heel spurs are very common in people who have persistent plantar fasciitis, forming where the fascia connects to the heel bone. Having obesity can also cause heel spurs to develop.

5. Sever Disease

Sever disease is the most common cause of heel pain in children and adolescents. Called calcaneal apophysitis, it typically occurs between the ages of 8 and 12 when children are running, jumping, or otherwise active. It can be worse during a growth spurt.

The injury involves bone swelling or inflammation, often due to playing sports like soccer or basketball. Conservative treatment (rest, icing, pain medication) is usually successful.

6. Peroneal Tendonitis

Conditions affecting the peroneal tendon are a common cause of pain on the outside of the heel, where the tendons connect the calf muscles to the foot.

These tendons can rupture, dislocate, or stretch in ways that cause tendonitis.

It's common for peroneal tendonitis to occur due to overuse injuries. Damage to the peroneal nerve can cause other symptoms, including:

• Numbness
• Tingling
• Pain
• Possible foot drop, leading to gait (walking) changes and weakness
  

7. Heel Pad Bruise

A heel pad bruise causes sharp pain over the bottom of the heel. It's a relatively minor injury that can occur after landing hard on your heel or stepping hard on a stone. It can also happen with excessive weight-bearing exercises.

8. Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is a nerve disorder in which a large nerve in the back of the foot, called the posterior tibial nerve, becomes pinched. Although tarsal tunnel syndrome can cause aching or burning heel pain, the pain is more often felt in the bottom of the foot and near the toes.

Tarsal tunnel syndrome is a counterpart to carpal tunnel syndrome of the wrist, causing numbness and tingling with pain that worsens at night.

9. Stress Fractures

Stress fractures of the heel commonly occur in athletes (such as long-distance runners) who overtrain or intensify their workouts over a short period of time. Repeated stress on the heel bone eventually causes a break.

A stress fracture causes significant heel pain that worsens with activity and improves with rest. In addition to pain, swelling and tenderness may be experienced at the fracture site.

10. Fat Pad Atrophy

In older adults, the cushioning fat of the heel can break down and thin over time. This is referred to as fat pad atrophy, with wear on the heel causing pain. The condition can arise due to steroid treatments for plantar fasciitis.

Heel pad syndrome is a related condition in which the thinning of the fat pad is caused by repetitive trauma. Marathon runners and people with obesity are at special risk of this. Heel pad syndrome causes a deep, aching pain in the middle of the heel that worsens with weight-bearing activities.

11. Sinus Tarsi Syndrome

The sinus tarsi, referred to as “the eye of the foot,” is the space on the outside of the foot between the ankle and heel bone. This space, while small, contains several ligaments along with fatty tissues, tendons, nerves, and blood vessels.

Sinus tarsi syndrome is usually caused by a traumatic injury, leading to ongoing pain in the front and sides of the ankle. The pain tends to increase with weight-bearing activities. There may also be a sensation of ankle looseness and heel pain when walking on uneven surfaces.

12. Piezogenic Papules

These are painful bumps that develop when fat bulges from the heel capsule, most often due to connective tissue diseases like Ehlers-Danlos syndrome.

13. Heel Bone Infection

This is a form of osteomyelitis (bone inflammation) that causes constant heel pain, often with fever and fatigue. People diagnosed with diabetes face a higher risk.

14. Heel Bone Tumors

These typically benign (non-cancerous) growths can cause deep, boring heel pain that worsens at night.

Pain is the common symptom among conditions that cause heel pain, but when and where it occurs helps to differentiate the exact cause. So do other factors, like the activities that lead to heel pain.

Symptoms of heel pain include:

• Dull, sharp, or stabbing heel pain
• Aching or burning along the arch of the foot
• Pain that increases when you first stand up or after a time of rest
• Climbing stairs or other activities when pain increases with exercise
  

Heel pain can occur on the inside of the foot or the outside of the foot. The pain of Achilles tendonitis is most likely felt at the back of the foot, but heel pain also occurs with other symptoms. Some examples of heel pain at specific sites include:

• Pain and tenderness on the inside of the heel with plantar fasciitis
• Bruise-like pain at the center of the heel with heel pad syndrome
• Pain affecting the Achilles tendon with Sever disease

In some cases, an accident or injury can damage nerves in the foot that contribute to heel pain.

When to See a Healthcare Provider

If you are unsure of the cause of your heel pain or don't know the specific treatment for your condition, seek medical treatment.

You should see a healthcare provider if:

• You are unable to walk on your heel.
• The heel pain interferes with your sleep.
• The heel pain persists for more than a few days.
• There is visible discoloration or disfiguration of the heel.
• There are signs of an infection, including fever and increasing pain, warmth, swelling, and redness.

Diagnosing the Cause of Heel Pain

Most heel conditions can be diagnosed with a medical history and physical examination. In certain cases, imaging studies and blood tests may be needed.

• A detailed medical history
• Physical exam
• Blood tests that may include: Complete blood count (CBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR)
• Imaging studies such as an X-ray or, less commonly, a magnetic resonance imaging (MRI) to diagnose a soft-tissue injury or infection.
  

Differential Diagnoses

While it is reasonable to assume that heel pain must stem from your heel, this is not always the case. There are other conditions that can mimic plantar fasciitis, Achilles tendonitis, and other causes of heel pain.

These include:

• Radiculopathy: This occurs when a pinched spinal nerve causes referred pain in another part of the body. When the lower back is involved, the pain may shoot down the calf muscle into the heel.
• Peripheral neuropathy: This is burning or pins-and-needle sensations caused by damage to the nerves serving the limbs. Causes include diabetes, alcohol abuse, and certain medications.
• Skin problems: Heel pain can also be caused by plantar warts, fungal foot infections (like athlete’s foot), eczema, or psoriasis.
• Systemic inflammatory diseases: These include “whole-body” diseases like sarcoidosis and rheumatoid arthritis that can cause heel pain in some people.

Treatment

Treatment depends entirely on the cause of your heel pain. But a common initial recommendation for pain is the R.I.C.E. method. The acronym stands for rest, ice, compression, and elevation of an injured body part, like the heel.

Other recommended treatments may include:

• Physical therapy: Specific exercises and stretches are designed to relax the tissues that surround the heel bone, such as calf raises or rolling an ice-filled plastic bottle beneath the foot. Massage and ultrasound therapy may also be used to relax muscles and break up scar tissue.
• Footwear modifications: various foot supports: A splint may be worn at night to keep your foot straight. Sturdy heel wedges or shoe orthotics may be recommended for Achilles tendonitis.
• Foot taping: Taping the foot with sports tape is useful for certain conditions like plantar fasciitis, heel pad bruise, and heel pad syndrome.
• Surgery: For plantar fasciitis, one of two surgical procedures may be recommended if conservative options have failed: plantar fascia release, in which the plantar fascia is surgically detached from the heel bone, or a gastrocnemius resection that lengthens the calf muscle to relieve plantar fasciitis pain.

Risk Factors for Heel Pain

There are conditions that make your chances of heel pain more likely. Some, you cannot control. For instance, females are more likely to have foot pain.

Other risk factors include:

• Having overweight or obesity
• Having other underlying health conditions such as diabetes, arthritis poor circulation, stroke, and osteoporosis
• High arches
• Flat feet
• Improperly fitted shoes
• Family history of foot problems
• Running for exercise or competition
• Standing for long periods of time
  

Summary

Heel pain can have a number of causes, and specific features of the pain can help a healthcare provider diagnose the pain. For example, pain on the side of the heel may be due to sinus tarsi syndrome, while pain behind the heel suggests Achilles tendonitis.

When and how the pain occurs also will help you to understand its cause. Once your healthcare provider makes a diagnosis, they can discuss treatment options with you. In many cases, conservative treatment options, including rest or foot taping, can bring relief. Physical therapy and, rarely, surgery may be needed.