That sharp pain when your feet first meet the floor in the morning can make even a short walk to the kettle feel difficult. Heel pain causes are not all the same, however, and the exact place, timing and character of the pain can offer useful clues. A problem beneath the heel needs a different approach from pain at the back of it, which is why simply resting, stretching or buying new insoles does not always solve the problem.
For people who are active, work on their feet or are trying to stay mobile as they get older, heel pain can quickly affect confidence as well as comfort. The reassuring news is that many causes respond well to a clear diagnosis and a tailored plan.
Why the location of heel pain matters
The heel is a hard-working structure. It absorbs the force of every step, supports the plantar fascia under the foot and provides the attachment point for the Achilles tendon at the back of the ankle. Pain can also come from the heel bone itself, a small fluid-filled bursa, nerves, joints or the thinning of the natural cushioning under the heel.
Before deciding on treatment, a podiatrist will usually ask when the pain began, whether there was a change in activity or footwear, and what makes it better or worse. They will assess how you walk, examine the painful area and, where appropriate, carry out a biomechanical assessment. This helps distinguish between conditions that can feel similar but require different treatment.
Common heel pain causes
Plantar fasciitis
Plantar fasciitis is one of the most common causes of pain underneath the heel. The plantar fascia is a strong band of tissue running from the heel towards the toes. When it is overloaded or irritated, it often produces a sharp, localised pain on the inner underside of the heel.
A classic pattern is pain with the first few steps after getting out of bed, or after standing up following a period of sitting. It may ease as you move around, then return after a long day on your feet. Running, prolonged standing, a sudden increase in walking, hill work or poorly supportive footwear can all contribute.
Plantar fasciitis is sometimes described as inflammation, but persistent symptoms are often more closely linked to changes in the tissue caused by repeated strain. That matters because treatment should focus on managing load and improving support, rather than simply trying to push through the pain.
Heel fat pad pain or thinning
The fat pad under the heel acts as a natural shock absorber. With age, repeated impact or long periods on hard surfaces, it can become less effective. Some people also have a naturally thinner fat pad or notice pain after losing weight.
This pain tends to sit in the centre of the heel and may feel bruised, tender or like walking directly on bone. It is often worse on hard floors, when barefoot or in thin-soled shoes. Unlike plantar fasciitis, it may not be most severe with those first steps in the morning.
Supportive footwear, cushioning and activity adjustments can make a meaningful difference. In some cases, specialist treatments for painful fat pad atrophy may be considered after a full assessment.
Achilles tendinopathy
Pain at the back of the heel may involve the Achilles tendon, which connects the calf muscles to the heel bone. Achilles tendinopathy is common in runners, hill walkers and people returning to exercise after a break, but it can affect anyone whose tendon is being asked to cope with more load than it is currently prepared for.
Symptoms often include stiffness first thing in the morning, pain when walking uphill or climbing stairs, and tenderness or thickening along the tendon. Pain may be directly where the tendon attaches to the heel, known as insertional Achilles tendinopathy, or slightly higher up.
The distinction matters. Some calf stretches and heel-drop exercises may help one type of Achilles problem yet aggravate another, particularly when the tendon is painful at its attachment. A personalised rehabilitation plan is safer and more effective than following a generic exercise video.
Bursitis and shoe pressure
A bursa is a small sac that reduces friction between tissues. At the back of the heel, it can become irritated by pressure from rigid shoe counters, changes in activity or an underlying Achilles issue. The area may look swollen or feel sore when a shoe rubs against it.
A prominent heel bone can make this more likely, but it is not always the whole explanation. Adjusting footwear is often part of treatment, alongside addressing any contributing tendon tightness or altered walking pattern.
Stress injury or fracture of the heel bone
A stress injury develops when repeated impact overloads bone faster than it can repair itself. It may occur after a rapid increase in running, walking holidays, military-style training or a return to exercise. People with reduced bone density may also be more vulnerable.
Pain from a heel stress injury is often more persistent than plantar fasciitis. It can worsen steadily with activity, become painful at rest and cause marked tenderness when the sides of the heel are gently compressed. This needs prompt clinical assessment, as continuing to exercise through it can delay recovery.
Nerve-related pain
Burning, tingling, numbness or electric-shock sensations suggest that a nerve may be involved. One possible cause is irritation of branches of the tibial nerve around the inside of the ankle and heel. Nerve symptoms can coexist with plantar fascia pain, so it is worth describing exactly what you feel rather than assuming every heel problem is plantar fasciitis.
Inflammatory, joint and circulation-related conditions
Less commonly, heel pain is linked to inflammatory arthritis, gout, infection or circulation problems. Pain affecting both heels, prolonged morning stiffness in several joints, warmth and swelling, or a personal history of psoriasis or inflammatory bowel disease may warrant further medical investigation.
People with diabetes should take new foot pain, skin changes, blisters, wounds or reduced sensation seriously. Diabetes can affect feeling, circulation and healing, meaning a small problem may need earlier attention.
What can trigger heel pain?
Heel pain does not always begin after one obvious injury. Often, it follows a gradual mismatch between the demands on your feet and what they can comfortably tolerate. Starting a new fitness routine, increasing mileage too quickly, changing jobs, spending more time on hard flooring or wearing different shoes can be enough to expose a weakness.
Foot posture and walking mechanics may play a part, but there is rarely one single cause. Tight calf muscles, reduced ankle movement, poor recovery between activity sessions, body weight, previous injury and unsuitable footwear can all contribute. The aim is not to blame your feet or stop all activity indefinitely. It is to identify the factors most relevant to you and make practical changes that allow recovery.
What to do when your heel hurts
Avoid trying to run or walk through sharp, worsening pain. Reduce the activities that clearly aggravate symptoms for a short period, while keeping up comfortable movement where possible. Choose cushioned, supportive footwear rather than flat, worn-out shoes or bare feet on hard floors.
Cold therapy may settle symptoms after activity for some people. Gentle mobility work can also help, but avoid forceful stretching into pain. This is particularly relevant if pain is at the back of the heel, where the wrong exercise can irritate an insertional Achilles problem.
A podiatry assessment can provide a more focused plan. Depending on the diagnosis, this might include footwear guidance, exercises to build strength and tolerance, taping, pressure relief, orthoses or other treatments. Orthoses are not a one-size-fits-all answer, but when they are prescribed to address a specific mechanical issue, they can reduce strain and make walking or sport more comfortable.
When to seek prompt advice for heel pain causes
Book an assessment if heel pain is lasting more than a couple of weeks, keeps returning, limits work or exercise, or is not improving with sensible self-care. Earlier assessment is especially useful when you are changing how you walk to avoid pain, as this can create problems elsewhere in the foot, knee, hip or back.
Seek urgent medical advice for sudden severe pain after an injury, an inability to bear weight, significant swelling, redness, heat, fever, an open wound, or a foot that becomes pale, blue or unusually cold. If you have diabetes, reduced circulation or loss of sensation, do not wait for a minor-looking foot problem to become more serious.
At 1st Foot Podiatry, the focus is on listening to what your heel pain is stopping you from doing, identifying the likely cause and building treatment around your goals. Whether that means returning to a favourite walk, getting through a shift more comfortably or taking those first morning steps with less apprehension, the right assessment is a positive first step toward easier movement.