Reason and treatment for heels pain

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heel pain causes treatment plantar fasciitis Achilles tendinopathy official patient guidance

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Heel pain has several possible causes. The most common is plantar fasciitis, an irritation and micro-injury of the thick band under the foot (plantar fascia).

Common patterns and likely reasons

Pain pattern	Possible cause
Sharp pain under the heel, worst with the first steps in the morning or after sitting	Plantar fasciitis
Pain at the back of heel, especially with running, stairs, or tight shoes	Achilles tendinopathy or heel bursa irritation
Pain after a sudden increase in walking/running, hurts even at rest or when squeezing the heel	Stress fracture of the heel bone
Burning, tingling, numbness	Nerve compression, such as tarsal tunnel syndrome
Sudden “pop,” bruising, weakness pushing off the foot	Achilles tendon tear, needs urgent assessment

Plantar fasciitis is often linked to long standing or walking on hard surfaces, a recent activity increase, tight calves, unsupportive footwear, flat or high-arched feet, and higher body weight. A heel spur on an X-ray is not necessarily the reason for the pain. Miller's Review of Orthopaedics, p. 592.

What to do first for likely plantar fasciitis

Try these measures consistently for 6 to 8 weeks:

Reduce aggravating activity
- Temporarily avoid running, jumping, long walks, and barefoot walking on hard floors.
- Choose cycling, swimming, or other low-impact activity if comfortable.
Wear supportive footwear
- Use cushioned, supportive shoes indoors and outdoors.
- Consider a soft heel cup or arch-support insole.
- Avoid worn-out shoes, thin slippers, and walking barefoot.
Stretch twice daily
- Calf stretch: Lean into a wall with the painful leg behind you, heel down, knee straight. Hold 30 seconds, repeat 3 times.
- Plantar-fascia stretch: Before getting out of bed, pull the toes toward your shin and massage the sole of the foot for 20 to 30 seconds. Repeat several times.
- Rolling the arch over a cold/frozen water bottle or ball for 5 to 10 minutes can combine gentle massage with cooling.
Ice for pain
- Apply an ice pack wrapped in cloth for 15 to 20 minutes after activity, up to 3 to 4 times a day. Do not apply ice directly to skin.
Pain relief if safe for you
- Paracetamol/acetaminophen may help.
- Ibuprofen or naproxen can be used short term only if you do not have kidney disease, stomach ulcer/bleeding, heart failure, are on blood thinners, or have been advised to avoid these medicines. Take with food and follow the package directions or ask a pharmacist.
Night splint or physiotherapy
- A night splint can help if the first steps of the day are especially painful.
- A physiotherapist can guide stretching, gradual strengthening, taping, and return to activity.

Stretching the plantar fascia and calf/Achilles tendon, cushioning, and footwear modification are the main conservative treatments. Most cases improve without surgery, though recovery can take several months. Miller's Review of Orthopaedics, p. 592. The AAOS heel-pain guidance also notes that persistent symptoms may need examination and occasionally imaging.

Treatments to discuss with a clinician

If it has not improved after about 6 to 12 weeks of good self-care, see a doctor, podiatrist, or physiotherapist. They may consider formal physiotherapy, better-fitted orthotics, or shock-wave therapy for persistent cases.

Steroid injections can provide short-term pain relief but should not be routine or repeatedly given, because they can weaken or rupture the plantar fascia and thin the protective heel fat pad. Miller's Review of Orthopaedics, p. 592. Recent reviews of injection and shock-wave options exist, but they apply mainly to long-standing cases after basic treatment has failed, including a 2026 systematic review (PMID: 41691098).

Seek medical care promptly if you have

Sudden severe pain, a popping sensation, bruising, or inability to push off or walk
Marked swelling, redness, warmth, fever, or a wound
Numbness, progressive weakness, or color change in the foot
Pain after a fall or injury
Pain at rest/night, or pain that is steadily worsening
Diabetes, poor circulation, or immune suppression
No improvement after 6 to 12 weeks of appropriate care

If you share where the pain is located, for example under the heel versus behind it, whether it is worst on first steps in the morning, and how long it has been present, I can help narrow the likely cause.

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