Start with where it hurts
Heel Pain: Working Out What You Have
Six conditions cause most heel pain and they hurt in different places, at different times of day, in different patterns. Locate yours here, then read the page that matches.
“Heel pain” is not a diagnosis. It is a location. The conditions that produce it need genuinely different treatment — and a couple of them get actively worse under the advice that helps the others. So the first job is not treatment. It is working out which one you are dealing with.
Three questions do most of the sorting: exactly where does it hurt, when is it at its worst, and did it come on gradually or suddenly.
The map
| Where it hurts | Pattern that goes with it | Usual cause |
|---|---|---|
| Underneath, toward the inner front of the heel | Worst on the first steps in the morning; eases with walking; back after a long day | Plantar fasciitis |
| Back of the heel, in the cord above the bone | Stiff and sore first thing; warms up with activity; worse the next morning | Midportion Achilles tendinopathy |
| Back of the heel, right on the bone, often with a bump | Shoes rub it; deep stretching makes it worse, not better | Insertional Achilles tendinopathy, often with a Haglund’s prominence |
| Middle of the underside of the heel | Like a deep bruise; much worse barefoot on hard floors; no clear morning spike | Fat pad problem — thinning or bruising of the heel’s shock absorber |
| Deep and diffuse in the heel bone | Builds with activity rather than warming up; sore when the heel is squeezed side to side; may ache at night | Calcaneal stress fracture |
| Underside, burning or tingling, sometimes into the arch | No classic first-step pattern; can be worse the longer you stand | Nerve entrapment — commonly the first branch of the lateral plantar nerve, or tarsal tunnel syndrome |
| Back and sides of the heel in a child aged roughly 8–14 | Sore after sport; squeezing the sides of the heel hurts; comes and goes with activity | Calcaneal apophysitis (Sever’s disease) |
| Both heels, in a younger adult | Morning stiffness lasting a long time; other joints, the back, eyes, skin or gut involved | Enthesitis from an inflammatory arthritis — needs a medical opinion, not just a foot one |
The distinctions that matter most
Underneath versus behind
This is the biggest fork in the road. Pain under the heel is usually a plantar fascia problem. Pain behind it is usually an Achilles problem. They share almost nothing in treatment: the arch support and fascia stretch that help one do very little for the other, and heel lifts that relieve an insertional Achilles do nothing much for a fascia.
First-step pain versus building pain
Pain that is worst at the start and eases as you move is characteristic of tendon and fascia problems. Pain that is fine at the start and builds the longer you are on it is a different animal, and it is the pattern that should make you think about a bone stress injury. That distinction is worth taking seriously, because a calcaneal stress fracture treated as plantar fasciitis simply does not get better, and the treatment for it — genuine offloading — is nearly the opposite of the loading programme for a fascia.
Gradual versus sudden
Almost everything on this page comes on over weeks. A sudden pop, snap, or a feeling of being kicked in the back of the leg is a rupture question and needs same-day assessment. A sudden severe pain under the heel after a hard landing can be an acute fascial tear.
Ache versus burn
Nerve pain is described differently: burning, tingling, electric, numb. If those words fit better than “sore” or “bruised”, a nerve problem should be on the list — and it commonly is not, which is why a proportion of “treatment-resistant plantar fasciitis” was never fasciitis.
When to be seen quickly, not eventually
- Fever, spreading redness, or heat in the heel.
- You cannot put weight on the foot.
- A sudden pop or snap, or sudden weakness pushing off.
- Numbness, or a break in the skin that is not healing.
- Pain that wakes you at night or is steadily worsening.
- You have diabetes or a known circulation problem and any new heel symptom.
What to do in the meantime
While you are working out which one you have, a short list is safe for almost all of them:
- Put shoes on indoors. Barefoot on hard floors aggravates every cause on this page except, arguably, none of them.
- Take the spike out. Whatever load changed shortly before it started — reduce it for a few weeks. Reduce, not stop.
- Work the calf gently. A tight calf is implicated in most of these. Comfortable range only; if a stretch hurts sharply at the back of the heel, stop — that is the insertional Achilles pattern.
- Give it two weeks of that, honestly done. If nothing has moved, or if any red flag above applies, get it examined rather than adding a seventh gadget.
Read next
If your pain is at the back of the heel, there is one more distinction the map above does not make: which of the two bursae is inflamed. One sits in front of the Achilles tendon and hates the ankle bending upward; the other sits behind it and hates the back of your shoe. They need different first moves.
Plantar fasciitis
Pain under the heel, worst on the first steps of the day. The most common cause by a distance.
Plantar fasciitis treatment
The stepwise plan — what to do in the first three months, and what the second-line options really offer.
Achilles tendonitis
Back-of-heel pain, and why the standard heel-drop exercise is wrong for one of the two types.
Heel spurs
The X-ray finding that looks like an answer and usually is not.
Shoes and inserts
What actually matters in a shoe when your heel hurts, and how to judge an insert.
Michigan heel pain care
If you are local and it has not settled, see somebody who can put hands on it.
Common questions
Why does my heel hurt when I walk?
The timing tells you more than the fact. Pain that is worst on the first steps and settles after a few minutes of walking is the classic plantar fascia pattern. Pain that is fine at first and builds the longer you walk points toward a bone stress problem or a fat pad that has thinned. Pain that burns or tingles as you stand suggests a nerve. Same symptom in plain language, three different problems.
Is heel pain ever serious?
Usually not, but there is a short list that is: infection in the heel, a calcaneal stress fracture, a ruptured Achilles, an inflammatory arthritis presenting at the heel, and any heel problem at all in someone with diabetes or poor circulation, where a small skin problem can escalate quickly. Those are the reasons the red-flag list above exists. Everything else is a matter of getting the diagnosis right and being patient.
Which doctor treats heel pain?
A podiatrist or a foot and ankle surgeon deals with this every day and is the most direct route. Primary care can start the process, orthopaedic foot and ankle surgeons cover the same ground, and physical therapists deliver the loading programmes that resolve most cases. What matters more than the specialty is that somebody examines the foot properly rather than diagnosing from the symptom name.
Why is my heel pain worse in the morning?
Overnight the foot rests slightly pointed, so the fascia and calf settle in a shortened position. The first steps stretch a structure that has been short for hours and has some tissue damage in it. Within a few minutes of walking the tissue lengthens and the pain eases. It is such a characteristic pattern that it is one of the most useful pieces of information you can give the person examining you.
Heel pain in Michigan?
Most heel pain is worked out by examination in a single visit — where it is tender, how it behaves, what the calf and the gait are doing. Dr. Tom Biernacki treats heel pain at Balance Foot & Ankle.
Howell — 4330 E Grand River Ave, Howell, MI 48843
Bloomfield Township — 43494 Woodward Ave #208, Bloomfield Township, MI 48302
Monday to Friday, 9:00am–4:30pm · (810) 206-1402
This page is education, not a diagnosis — it cannot examine your foot. See our editorial policy for how it was written.