Heel Pain Causes: Under, Back and Side of the Heel

Quick answer

Pain under the heel is usually plantar fasciitis; pain at the back usually comes from the Achilles tendon

The most common cause of pain under the heel is plantar fasciitis, with sharp pain on the first steps in the morning or after sitting that eases as you walk and returns after long periods on your feet. Pain in the centre of the heel pad, worse on hard floors, can be fat pad syndrome. Pain at the back of the heel comes from the Achilles tendon where it attaches, or from a bony bump (Haglund’s deformity) rubbing on shoes. Children aged 8 to 14 often have heel pain from the growth plate (Sever’s disease). Pain that builds with walking and hurts when you squeeze the heel may be a stress fracture. Burning or tingling suggests a nerve problem. Most heel pain improves over weeks to months with stretching, supportive footwear, load management and strengthening.

Pain under the heel

Plantar fasciitis: the most common cause; sharp pain at the front inner part of the heel with the first steps; see plantar fasciitis symptoms.
Heel spur: a bony growth often found alongside plantar fasciitis; the spur itself is rarely the main cause of pain; see heel spur.
Fat pad syndrome: deep bruised pain in the centre of the heel, worse barefoot on hard floors, as the cushioning thins with age.
Stress fracture: pain that builds with walking or running and hurts when the sides of the heel are squeezed.

Pain at the back of the heel

Insertional Achilles tendinopathy: pain where the tendon joins the heel, worse with uphill walking and after rest; see Achilles tendonitis.
Haglund’s deformity and bursitis: a bony bump at the back of the heel that rubs on shoe counters, with a tender swelling.
Sever’s disease: in active children aged about 8 to 14, pain at the back and bottom of the heel from the growth plate.

Pain on the side of the heel

Tarsal tunnel syndrome: burning, tingling or numbness on the inner heel and sole from a compressed nerve.
Baxter’s nerve entrapment: burning pain on the inner side of the heel that can be mistaken for plantar fasciitis.
Tendon problems: the peroneal tendons on the outer side and tibialis posterior on the inner side.

Heel pain when walking

Pain on the first steps that eases after a few minutes and returns after long periods on your feet points to plantar fasciitis. Pain that steadily builds the more you walk, and is there even at rest later, raises the possibility of a stress fracture, especially after a sudden increase in walking or running.

Pain at the back of the heel when walking uphill or on stairs suggests the Achilles. Burning pain that spreads into the sole suggests a nerve. Pain in both heels with stiffness in the back or other joints can be part of an inflammatory arthritis.

What makes heel pain more likely

A sudden increase in walking, running or standing.
Flat, worn or unsupportive shoes, and walking barefoot on hard floors.
Tight calf muscles and Achilles tendon.
Excess body weight.
Flat feet or very high arches.
Jobs that involve long hours standing.

Treatment that works

Stretching: calf and plantar fascia stretches several times a day, especially before the first steps.
Footwear: cushioned shoes with good arch support; avoid flat shoes and walking barefoot.
Insoles and heel cups: can reduce load on the painful area.
Load management: reduce, rather than stop, activities that provoke pain.
Strengthening: calf raises and foot exercises, progressed gradually.
Ice: roll the foot over a frozen bottle for 10 minutes.

Most heel pain improves within a few months. Persistent cases may benefit from shockwave therapy or, carefully selected, steroid injections. Surgery is rarely needed.

How physiotherapy helps

A physiotherapist identifies the cause through examination, checks calf flexibility, foot posture and walking, and creates a programme of stretching, strengthening, taping and load management. They also advise on footwear and running technique.

Easing heel pain on the first steps

Before getting out of bed, pull your toes back towards you and hold for 30 seconds.
Roll the sole over a ball or a bottle for a minute.
Put on supportive shoes or slippers straight away instead of walking barefoot.
Take the first few steps slowly.

When to see a doctor

Severe pain and swelling after an injury, or you cannot put weight on the foot.
Heel pain with fever, redness and warmth.
Numbness or tingling in the foot, especially with diabetes.
Pain at rest and at night.
Pain that has not improved after 2 to 3 months of treatment.

Key points to remember

Pain under the heel is usually plantar fasciitis.
Pain at the back of the heel usually comes from the Achilles.
Stretching, supportive shoes and load management help most heel pain.
Pain at rest, swelling, fever or numbness need assessment.

Questions about heel pain

These answers are general information and do not replace an examination or individual medical advice.

What is the most common cause of heel pain?

Plantar fasciitis, which causes pain under the heel with the first steps in the morning.

Why does my heel hurt when I walk?

Common causes are plantar fasciitis, Achilles problems and, if pain builds with walking, a stress fracture.

How long does heel pain take to go away?

Many cases improve within a few weeks, but plantar fasciitis can take several months.

Is walking good for heel pain?

Walking in supportive shoes within comfort is fine. Reduce long walks and hard surfaces while it settles.

Can heel pain be a sign of something serious?

Rarely. Heel pain with fever, swelling, numbness or pain at rest needs assessment.

Why does my child have heel pain?

Active children aged 8 to 14 often have Sever’s disease, which settles with rest and stretching.

Sources

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.