Heel Pain & Injury

Heel pain plantar heel palpation during physiotherapy assessment

Assessing plantar heel pain

Heel pain can make walking, standing, work, exercise, and sport frustrating. It may involve the plantar fascia, Achilles tendon, bursae, heel bone, joints, nerves, or nearby soft tissues. For broader context, see our foot pain and ankle pain guides.

Most people feel heel pain either under the heel or at the back of the heel. First-step pain often points toward plantar heel irritation, while back-of-heel pain may involve the Achilles tendon, bursa, or shoe pressure.

Heel pain often improves with the right diagnosis, load management, footwear advice, and targeted exercise. However, different heel conditions behave differently, so identifying the pain source is the key first step.

Heel Pain at a Glance

Under the heel: often linked with plantar fasciitis or heel fat pad irritation.
Back of the heel: commonly linked with Achilles tendinopathy or retrocalcaneal bursitis.
Children and adolescents: often linked with Sever’s disease.
After a training spike: may reflect overload, tendon irritation, or a stress fracture.

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What Is Heel Pain?

Heel pain refers to pain felt under, behind, or around the heel bone. The exact location, pattern, and trigger often guide diagnosis. First-step pain, running pain, swelling, shoe pressure, and impact pain can each point toward different causes.

Common Symptoms of Heel Pain

Pain with first steps after rest
Tenderness under or behind the heel
Pain during walking, running, jumping, or hills
Stiffness in the foot, ankle, or calf
Symptoms that worsen after activity
Difficulty standing for long periods

Why Does Heel Pain Hurt With the First Few Steps?

Heel pain often hurts with the first few steps because irritated tissue can stiffen after rest. This pattern is common in plantar fasciitis and some forms of Achilles tendinopathy, especially when load has increased too quickly.

Heel Pain Location Guide

Pain location	Common possibilities	Typical clue
Under the heel	Plantar fasciitis, fat pad irritation, heel spur	First-step pain or pain after standing
Back of the heel	Achilles tendinopathy, retrocalcaneal bursitis	Pain with hills, stairs, running, or shoe pressure
Child or teenager heel pain	Sever’s disease	Sport-related pain during growth years
Impact-related heel pain	Stress fracture or overload injury	Pain that worsens with impact or walking

What Causes Heel Pain?

Heel pain can arise from several structures around the heel and foot. The main causes include plantar fascia overload, Achilles tendon irritation, bursal irritation, growth-plate irritation in children, heel bone stress, nerve irritation, and referred symptoms from nearby regions.

Plantar Fasciitis

Typical pattern: pain under the heel, often worse with first steps in the morning or after sitting.

Common contributors: overload, calf tightness, prolonged standing, footwear changes, and sudden increases in walking or running. Learn more about plantar fasciitis.

Achilles Tendinopathy

Typical pattern: pain at the back of the heel or lower Achilles tendon, especially with running, jumping, hills, or stairs.

Common contributors: rapid training changes, calf weakness, reduced tendon capacity, and repeated high-load activity. Learn more about Achilles tendinopathy.

Heel Spur

Typical pattern: heel pain associated with a bony growth under the heel bone.

Key point: the spur is not always the true pain source. Learn more about heel spurs or compare heel spur vs plantar fasciitis.

Retrocalcaneal Bursitis

Typical pattern: pain and irritation between the Achilles tendon and heel bone.

Common triggers: shoe pressure, running, hills, and squeezing the back of the heel. Learn more about retrocalcaneal bursitis.

Sever’s Disease

Typical pattern: heel pain in active children and adolescents, especially during growth spurts.

Common triggers: running, jumping, hard surfaces, and high-impact sport. Learn more about Sever’s disease.

Stress Fracture

Typical pattern: gradually increasing pain that worsens with impact and may become painful during walking.

Important note: early assessment matters if a stress fracture is suspected.

Other Causes

Other possibilities include tendon irritation, arthritis, nerve irritation, referred pain, or nearby foot and ankle problems. Related pages include foot pain, ankle pain, and sciatica.

When Should You Take Heel Pain Seriously?

Take heel pain seriously if it is worsening, changing your walking, causing limping, linked with swelling or bruising, painful at night, or stopping work, sport, or daily activity. Earlier assessment can help identify whether the issue is overload, tendon irritation, plantar fascia pain, or something that needs closer review.

Is Heel Pain Serious?

Most heel pain is not serious and improves with the right management. However, symptoms that persist, worsen, or affect walking should be assessed early. This helps reduce the risk of longer recovery times, repeated flare-ups, or avoidable changes in walking pattern.

Barefoot heel pain assessment with physiotherapist observing Achilles tendon during standing test

Checking foot posture and Achilles loading

How Is Heel Pain Diagnosed?

A physiotherapist will assess your pain location, symptoms, strength, flexibility, walking pattern, footwear, and activity history. Imaging may be recommended if the diagnosis is unclear or if a fracture, significant tendon injury, or other condition needs to be ruled out.

How Is Heel Pain Treated?

Heel pain treatment depends on the diagnosis. Many people need a staged plan that reduces irritation first, then rebuilds tissue capacity and confidence with walking, work, exercise, or sport.

Load management and activity modification
Calf, foot, and ankle strengthening
Stretching and mobility work where appropriate
Taping or short-term support
Footwear and training advice
Gradual return to walking, running, work, or sport

Your Heel Pain Recovery Path

Clarify the diagnosis so the pain source is clear.
Reduce aggravating load without stopping all activity unnecessarily.
Rebuild strength and movement with targeted foot, ankle, and calf exercises.
Progress back to normal walking, work, and sport with better confidence and lower flare-up risk.

Tip: Complete rest is rarely the best long-term answer. A structured rehabilitation plan usually gives better results because it controls load while rebuilding strength, tolerance, and confidence.

When Should You Seek Professional Advice for Heel Pain?

Seek professional advice for heel pain if symptoms are not settling, keep returning, or affect how you walk. It is also worth booking an assessment if pain follows a training spike or a change in footwear, sport, work demands, or walking volume.

Pain lasting more than 1 to 2 weeks
Difficulty walking or limping
Swelling, bruising, or sharp pain
Pain affecting sport, work, or daily activity
Heel pain in a child that keeps returning
Concern about a tendon rupture or stress fracture

Heel Pain FAQs

What is the most common cause of heel pain?

Plantar fasciitis is one of the most common causes of pain under the heel. It often causes first-step pain after sleep or sitting. Pain at the back of the heel more commonly involves the Achilles tendon, retrocalcaneal bursa, or shoe pressure.

Can I keep exercising with heel pain?

You can often keep exercising with heel pain if the activity does not significantly worsen symptoms during or after exercise. However, running, jumping, hills, and long walks may need temporary changes. A physiotherapist can help match activity to tissue irritability and recovery stage.

Do I need a scan for heel pain?

You do not always need a scan for heel pain. Many cases are diagnosed through history and physical assessment. Imaging may help when symptoms are severe, unusual, persistent, or when a stress fracture, significant tendon injury, or other condition needs to be ruled out.

Will heel pain go away on its own?

Some heel pain improves with time, especially if the aggravating load reduces. However, persistent symptoms often need targeted treatment. Strength exercises, footwear changes, taping, and load management may help recovery and reduce the chance of flare-ups returning.

What type of clinician should assess heel pain?

A physiotherapist can assess heel pain by checking the pain location, loading pattern, strength, mobility, walking style, and activity history. This helps identify likely contributing factors and guide a treatment plan matched to the diagnosis and your goals.

Related Heel and Foot Conditions

What to Do Next

If your heel pain is not improving, the next step is to clarify the diagnosis and start a treatment plan matched to the true cause. Guessing can lead to the wrong exercises, the wrong footwear changes, or too much rest.

A physiotherapist can help you reduce pain, improve walking comfort, and return to work, exercise, or sport with more confidence.