Heel Pain
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Heel pain is pain at or around your heel, often underneath or at the back. It is very common. The most common cause in adults is plantar fasciitis (also called plantar fasciopathy), which affects about 1 in 10 adults at some point. Other common causes are Achilles tendinopathy and, in active children, Sever's disease. Overusing the heel is often behind it. Almost all people improve with simple care that doesn't involve surgery, such as stretching, supportive shoes and easing off the activities that set it off. Recovery can be slow, and the pain can come back.
What is it?
Heel pain is pain at or around your heel. You may feel it underneath, or at the back. It is very common, and overusing the heel is a frequent reason. Activities such as running and dancing can strain it.
Heel pain is a symptom, not a diagnosis. Several different conditions can cause it, and the best treatment depends on which one you have. Where the pain is, and when it hurts most, give your podiatrist useful clues.
What can cause it?
Plantar fasciitis is the most common cause in adults. The plantar fascia is a thick band of tissue under your foot. Plantar fasciitis is now often called plantar fasciopathy, and exactly why it develops isn't fully understood. The typical pain is under the heel. It is worst with your first steps after getting out of bed or after a long rest, and it gets worse after long periods of standing. There is often a tender spot on the underside of the heel, towards the inside of your foot. It usually affects one heel, but as many as 30 per cent of people have it in both.
Achilles tendinopathy causes pain at the back of the heel. The Achilles tendon is the thick cord at the back of your ankle that joins your calf muscles to your heel. The pain is often worse when you rise onto your toes, and there may be swelling or a bony lump.
Sever's disease (also called calcaneal apophysitis) is the most common cause of heel pain in active children and teenagers. It makes up to 16 per cent of the muscle and bone problems seen in children in outpatient clinics.
A heel spur is a bony point on the heel bone that can show up on an X-ray. Spurs are often found in people who have no heel pain, so a spur is unlikely to be the cause of your pain on its own.
Other causes include:
- a heel bump
- an irritated nerve in the heel (heel neuritis)
- bursitis (irritation of a small fluid-filled sac that cushions the heel)
- a stress fracture of the heel bone
- a problem in the lower back that irritates the S1 nerve, which can cause pain and numbness running from your lower back to your heel
- inflammatory types of arthritis, such as reactive arthritis and spondyloarthritis, which usually cause symptoms elsewhere in the body too
- a torn Achilles tendon, which causes sudden pain in the calf or heel during exercise
Who gets it?
Plantar fasciitis is very common. About 1 in 10 adults will have heel pain from it at some point in their lives. People who run or dance a lot can strain the heel, and active children and teenagers are prone to Sever's disease.
Some things are linked with plantar fasciitis: a stiff ankle that doesn't bend upwards well, carrying extra weight, work that keeps you on your feet, and weak muscles in the feet or legs. A stiff ankle appears to be the most important of these.
How is the cause found?
Your podiatrist works out the cause mostly by talking with you and examining your foot. They will ask when the pain started, what sets it off, what eases it, and how it affects your walking, work or sport. They will look at how you walk, how your feet line up, any swelling or change in shape, tender spots, and how well your foot and ankle move. They may use a few simple hands-on tests as well.
Plantar fasciitis is usually diagnosed from your story and the examination alone. Tell your podiatrist if your pain is at the back of your heel, or if you have back pain with numbness or pain running down your leg. Both point away from the typical plantar fasciitis picture.
If your story and examination fit plantar fasciitis, you probably won't need a scan. An X-ray is advised if the pain followed an injury, seems out of proportion to what you'd expect, or isn't responding to treatment. It helps rule out other causes.
Before your appointment, it helps to write down when the pain began, what sets it off, what eases it, and how it affects your day.
Treatment
Almost all people respond to treatment that doesn't involve surgery. Care starts with explaining what is going on and with things you can do yourself.
Looking after it at home
Ease off the activities that bring on the pain, such as running, or a lot of walking or standing. Calf stretches and stretches for the plantar fascia are a key part of home care. Stretching the Achilles tendon, alone or together with stretches for the band under your foot, can reduce pain within about 4 weeks.
Wear supportive shoes with a cushioned heel and good arch support. A laced sports shoe is probably better than an open sandal. Avoid flat or slip-on shoes. Shoes with a stiff or curved (rocker) sole may help too.
If you are carrying extra weight, losing some gradually is advised. If your BMI (body mass index) is over 30, your GP can refer you to a weight management service.
Pain relief medicines and ice massage over the sore area can help. Your podiatrist or GP can advise what suits you. Don't put ice on numb skin or an open wound, and stop if your pain, swelling or skin soreness gets worse.
Treatment from your podiatrist
Your podiatrist will usually build on the steps above with a stretching program that suits you and advice on footwear. They may also suggest:
- Taping to support your foot. It can reduce pain. Tell your podiatrist about any skin allergies first.
- Insoles or heel raises, usually 5 to 10 mm.
- Orthoses (shoe inserts made to support your foot), chosen according to the shape of your foot, after activity changes, stretching and better shoes.
Your physiotherapist may also be part of your care.
Other options
If home care and treatment from your podiatrist haven't helped, go back to your podiatrist, physiotherapist or doctor. They can review the diagnosis and your plan before anything more is tried.
Shockwave therapy is sometimes used as a second step. How well it works isn't yet clear.
Steroid injections are sometimes offered. They may lower heel pain slightly for a short time, under 1 month, and the benefit may be small. Rare but serious problems have been reported, including a torn plantar fascia, infection and thinning of the fat pad under the heel. One guideline says injections should not be used as a first or second step.
Surgery is the last option, used only if everything else has failed.
Will it get better?
The outlook is good. Almost all people improve with treatment that doesn't involve surgery. It can take time though, and plantar fasciitis often drags on or comes back.
Sticking with your stretches, footwear changes and activity changes gives you the best chance. If your pain isn't improving, go back to your practitioner rather than putting up with it.
Preventing it
The things linked with plantar fasciitis, such as a stiff ankle, extra weight and long hours on your feet, are only links. They don't prove that changing them will stop the pain coming back. Even so, it makes sense to keep up the stretches and the supportive shoes that helped you.
If you are carrying extra weight, talk with your GP about gradual weight management. If heel pain returns or doesn't go away, see a health professional early rather than waiting.
When to see a podiatrist
Book an appointment if
Your heel pain isn't getting better with home care, keeps coming back, or is getting in the way of walking, work or sport. Your child has heel pain, because a health professional should assess it. Your symptoms are still there after 12 weeks of looking after it yourself: some areas let you refer yourself to physiotherapy, orthotics or podiatry services.
Seek prompt assessment if
Call your local emergency number if you have a wound or infection on your heel and also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine: this could be sepsis. Go to the nearest emergency department if you have had an injury and your heel or foot is at an odd angle. See your GP or another doctor today if you have sudden pain in your calf or heel while exercising, because an Achilles tendon can tear. Also see your GP or another doctor today if your heel pain came on suddenly after an injury, you suddenly can't put weight on your foot, a joint is swollen for no clear reason and the swelling doesn't settle (an inflammatory type of arthritis can cause this), or you have new, sudden pain after a steroid injection, because the plantar fascia can tear or the area can become infected. If your GP can't see you today, go to an urgent care clinic or an after-hours GP. See your GP soon if you have numbness or weakness in your foot or leg that is new or getting worse, or symptoms elsewhere in your body along with the heel pain. Also see your GP soon if the pain seems far worse than it should be, you have a sore on your heel that isn't healing, you have had a bone infection or a complex fracture in the foot before, or your arch has suddenly collapsed.
Frequently asked questions
What should I ask if I'm offered a steroid injection?
Ask how much pain relief you can expect, how long it is likely to last, and what the risks are. Ask whether your diagnosis and your first-line care have been reviewed first. It is also fair to ask whether other options could be tried before an injection.
What can an ultrasound or MRI show?
An ultrasound can support a diagnosis of plantar fasciitis if the plantar fascia is thicker than 4 mm, looks less dense than normal, or has fluid around it. An MRI isn't needed when your story and examination point to plantar fasciitis. It may be considered if pain lasts a long time without responding to treatment, or if another cause is suspected.
Why did my podiatrist bend my big toe upwards?
This is called the windlass test. Bending the big toe upwards tightens the plantar fascia and can bring on your pain, which helps to confirm plantar fasciitis. Your podiatrist may also squeeze the sides of your heel, which helps rule out a stress fracture of the heel bone.