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Heel Pain

Heel pain is one of the most common reasons people see a foot and ankle specialist. It can make standing, walking, and exercising difficult, especially when pain is worse with the first steps in the morning or after long periods of activity. Most heel pain improves with conservative care once the cause is found.

Woman sitting on her bed holding her heel, the morning heel pain of plantar fasciitis
Medical illustration of plantar fasciitis with inflammation and tearing of the plantar fascia

What Causes Heel Pain?

The heel absorbs the impact of every step. Pain can come from the plantar fascia on the bottom of the foot, the Achilles tendon at the back of the heel, the heel bone itself, or the nerves nearby. Where the pain is felt, and when it is worst, help point to the cause.
 
Pain on the bottom of the heel is most often plantar fasciitis. Pain at the back of the heel is often from the Achilles tendon. See Achilles tendonitis and foot and ankle conditions for more.

Treatments For Heel Pain

Treatment depends on the cause, but most heel pain improves with conservative care.

Conservative care

  • Stretching. Calf and plantar fascia stretches, especially before the first steps of the day.
  • Supportive footwear. Cushioned shoes with good arch support.
  • Custom orthotics. Reduce strain on the heel and arch.
  • Physical therapy. Flexibility, strengthening, and activity guidance.
  • Night splints. Keep the plantar fascia gently stretched overnight.

When pain persists

Surgery is considered only when heel pain has not improved after months of consistent conservative care.

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How Heel Pain Is Diagnosed

Diagnosis begins with where and when your heel hurts, your activity and footwear, and an examination of the heel, arch, and Achilles tendon. Weight-bearing X-rays show heel spurs, stress fractures, and alignment. Ultrasound or MRI can show the plantar fascia and tendons when the cause is unclear.
 
If heel pain has lasted more than a few weeks or is changing how you walk, an evaluation can find the cause.
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Diagram of plantar fasciitis at the heel bone and plantar fascia

Common Causes Of Heel Pain

Heel pain has several common causes. Each is treated a little differently:

Plantar fasciitis

Irritation of the band of tissue along the bottom of the foot; sharp pain with the first steps.

Heel spurs

A bony growth on the heel bone, often linked to long-term plantar fascia strain.

Achilles tendonitis

Pain and stiffness at the back of the heel. See Achilles tendonitis.

Haglund's deformity

A bony bump on the back of the heel that rubs against shoes.

Stress fractures

Small cracks in the heel bone from repetitive impact.

Nerve irritation

Such as tarsal tunnel syndrome, with burning or tingling.

Where Does Your Heel Hurt?

The location of the pain is one of the best clues to its cause.

Bottom of the heel

Often plantar fasciitis

Sharp pain under the heel or arch.

  • Worst with the first steps in the morning
  • Returns after standing or resting
  • May be linked to a heel spur

Back of the heel

Often the Achilles tendon

Pain where the tendon meets the heel.

  • Stiffness that eases as you warm up
  • A tender or swollen tendon
  • May involve a bump (Haglund's deformity)

Pain with numbness, burning, or tingling may come from a nerve, and pain after an injury may be a fracture. Both need an evaluation.

Frequently Asked Questions

What is the most common cause of heel pain?

Plantar fasciitis is the most common cause. It causes sharp pain on the bottom of the heel, especially with the first steps in the morning.

What is the difference between plantar fasciitis and a heel spur?

Plantar fasciitis is irritation of the band of tissue along the bottom of the foot. A heel spur is a bony growth on the heel bone, often linked to long-term plantar fascia strain. The spur itself is not always the source of pain.

Why does my heel hurt in the morning?

The plantar fascia tightens overnight. The first steps stretch it suddenly, causing sharp pain that often eases as you move, then returns after rest or long periods on your feet.

What causes pain at the back of the heel?

Pain at the back of the heel is often from Achilles tendonitis or Haglund's deformity, a bony bump that rubs against shoes and can irritate the tendon and bursa.

Can heel pain go away on its own?

Many cases improve with stretching, supportive shoes, and rest, but heel pain can take months to settle. Pain that lasts more than a few weeks should be evaluated.

Do orthotics help heel pain?

Yes. Arch supports and custom orthotics reduce strain on the plantar fascia and are a mainstay of treatment for many causes of heel pain.

When is surgery needed for heel pain?

Surgery is reserved for heel pain that has not improved after months of conservative care. For persistent plantar fasciitis, endoscopic plantar fascia release is a minimally invasive option.

Why does my child have heel pain?

In active children and teens, heel pain is often Sever's disease, irritation of the heel growth plate. It usually improves with rest, stretching, and supportive shoes.

Symptoms To Watch For

Heel pain is usually mild at first. Have it evaluated if you notice:

  • Pain with your first steps in the morning or after sitting.
  • Pain that lasts more than a few weeks despite rest and stretching.
  • Swelling, redness, or warmth around the heel.
  • Numbness, burning, or tingling in the heel or foot.
  • Pain after an injury or difficulty bearing weight.
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Person holding the painful ball of the foot

Related Conditions

Achilles Tendonitis

Achilles tendonitis is irritation of the tendon at the back of the heel, often from overuse. Learn the symptoms, causes, and treatment options.

Flatfoot Correction

Flatfoot, also known as fallen arches or adult acquired flatfoot deformity, occurs when the arch of the foot collapses. This condition can cause pain, swelling along the inside of the ankle, and difficulty walking or standing for long periods. Over time, the deformity may worsen, leading to joint arthritis, tendon damage, and impaired mobility.

Foot and Ankle

Total Spine & Orthopedics treats common foot and ankle conditions with conservative and minimally invasive care in Melbourne and Orlando, FL.

Ankle Sprains

An ankle sprain is a stretched or torn ligament, usually from rolling or twisting the ankle. Learn the grades, symptoms, and treatment, and when a sprain needs a specialist.

Ankle Fractures

Ankle fractures are common orthopedic injuries that occur when one or more bones in the ankle break. They can result from a traumatic event, such as a fall or a sports injury, or from gradual wear and tear over time. If left untreated, ankle fractures can lead to chronic pain and decreased mobility, making it important to seek prompt medical attention if you suspect you have sustained an ankle fracture.

Hammertoe Correction

Toe deformities such as hammertoe, claw toe, and mallet toe are common conditions that can lead to pain, corns, calluses, and difficulty finding shoes that fit comfortably. These deformities are often caused by imbalances in the muscles and tendons that control toe movement, sometimes worsened by arthritis, genetics, or wearing tight footwear.

Bunions

Bunions are a common foot condition that can be treated with minimally invasive surgery to minimize disruption to daily life.

Charcot Foot

Charcot foot is a serious condition most often seen in people with diabetes or peripheral neuropathy. It occurs when the bones, joints, and soft tissues of the foot weaken, leading to fractures, dislocations, and significant deformity. If not addressed, Charcot foot can result in severe instability, ulceration, and even amputation.

Diabetic Foot Care

Our team of expert physicians provide comprehensive diabetic foot care including infection treatment, wound care, debridement, and more.

Wound Care

Foot wounds and ulcers need careful care, especially with diabetes, neuropathy, or poor circulation. Learn how foot wounds are treated and when to be seen.

Nail Fungus

Nail fungus (onychomycosis) causes thick, brittle, discolored toenails. Learn the symptoms, risk factors, and treatment options.

When Heel Pain Needs Surgery

The Minimally Invasive Advantage

How minimally invasive foot and ankle surgery compares with traditional open surgery.

Traditional open surgeryMinimally invasiveOffered at Total Spine
IncisionA longer incision to expose the bones and joints.Small incisions, often just a few millimeters.
Soft tissueMore disruption of skin and soft tissue.Less disruption of the surrounding tissue.
SettingMay involve a hospital stay.Usually an outpatient, same-day procedure.
RecoveryOften more swelling and a longer recovery.Typically less pain and swelling and a faster return to walking.
ScarringA larger, more noticeable scar.Smaller scars.

For persistent plantar fasciitis, endoscopic plantar fascia release is performed through small incisions on an outpatient basis.

Our Patients Stories

Hear our patients share their experience with us, All in their own words.

Why Choose Total Spine and Orthopedics

Expert, ultra-minimally invasive spine and orthopedic care, close to home.

  • Ultra-minimally invasive and endoscopic techniques

    We specialize in procedures performed through incisions smaller than a dime, sparing muscle and supporting a faster recovery.

  • Same-day, outpatient procedures

    Most patients walk in and return home within hours, rather than facing an overnight hospital stay.

  • Board-certified, fellowship-trained surgeons

    Our team includes early leaders in endoscopic spine surgery.

  • A complimentary MRI review

    Understand your diagnosis and options from a board-certified specialist before committing to any treatment.

  • Trusted by our community

    More than 1,100 patient reviews at a 4.6-star average, and over 50,000 patients treated.

  • Foot and ankle specialists

    Our foot and ankle team treats heel pain from plantar fasciitis to Achilles problems, with conservative care first.

  • Comprehensive spine and orthopedic care

    From injections to advanced procedures, your full continuum of care is handled in one place.

  • Convenient locations across the Space Coast and Orlando

    Care close to home in Melbourne, Orlando (Lake Nona), and Titusville.

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