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Heel Pain: Causes, Symptoms and What to Do About It

Heel pain is one of the most common musculoskeletal complaints seen by GPs and physiotherapists in the UK. It can range from a mild ache after a long day on your feet to a sharp debilitating pain that affects every step. Understanding what is causing your heel pain is the first step to getting the right treatment. This guide covers every common cause of heel pain, how to tell them apart, and what the NHS recommends for each.

Is Your Heel Pain Plantar Fasciitis?

Plantar fasciitis is by far the most common cause of heel pain, accounting for the majority of heel pain cases seen in NHS clinics. Before exploring other causes it is worth checking whether your pain fits the classic plantar fasciitis pattern.

Classic Plantar Fasciitis Indicators

  • Pain is on the underside of the heel — not the back of the heel
  • Pain is worst with your very first steps in the morning
  • Pain eases after a few minutes of gentle walking
  • Pain returns after sitting or resting for a long period
  • There is a specific tender spot when you press the underside of your heel
  • Pain worsens after prolonged standing or activity

If most of these apply to you, plantar fasciitis is the most likely cause. See our complete plantar fasciitis guide for detailed information and the full NHS-backed exercise programme.

Go to Plantar Fasciitis Guide

Common Causes of Heel Pain

If your pain does not exactly match the plantar fasciitis pattern, one of the following conditions may be the cause. Some people also have more than one condition at the same time — for example plantar fasciitis and Achilles tendinitis often occur together.

Plantar Fasciitis

📍 Underside of heelMost common

Inflammation or degeneration of the plantar fascia — the thick band of tissue connecting the heel bone to the toes. Causes sharp pain on the underside of the heel that is worst with first steps in the morning.

Affects up to 15% of the population at some point. Twice as common in women than men. Most prevalent in people aged 40 to 60.

Key difference from other causes: The morning start-up pain pattern and the specific tender spot on the underside of the heel.

Treatment summary: Daily stretching exercises, foot taping, footwear changes. See our full guide.

Read the full plantar fasciitis guide

Achilles Tendinitis

📍 Back of the heelVery common

Inflammation of the Achilles tendon where it attaches to the back of the heel bone, or further up the tendon. Causes pain and stiffness at the back of the heel, particularly in the morning and after exercise.

Unlike plantar fasciitis, Achilles tendinitis pain is at the back of the heel rather than the underside. You may also notice the tendon feels thickened or tender when you press it.

Commonly caused by a sudden increase in running or jumping activity, tight calf muscles and inadequate footwear. Runners are particularly affected.

Treatment summary: Eccentric calf strengthening exercises are the gold-standard treatment. Rest from aggravating activity. Physiotherapy.

Heel Spur

📍 Underside of heelCommon

A heel spur is a small bony growth that develops where the plantar fascia or Achilles tendon attaches to the heel bone. It is visible on X-ray and is often found alongside plantar fasciitis.

Importantly the Royal Orthopaedic Hospital NHS FT is clear that heel spurs are not themselves the cause of heel pain. Many people have heel spurs with no symptoms at all. When a heel spur is found alongside heel pain, treatment is aimed at the underlying plantar fasciitis or tendinitis — not the spur itself.

Removing a heel spur surgically does not reliably resolve heel pain.

Treatment summary: Same as plantar fasciitis — exercises, footwear, insoles. Surgery is not recommended for heel spurs alone.

Heel Bursitis

📍 Back or underside of heelLess common

Bursitis is inflammation of the bursa — a small fluid-filled sac that cushions the heel bone. The retrocalcaneal bursa at the back of the heel is most commonly affected, causing pain and swelling at the back of the heel near the Achilles tendon.

Heel bursitis pain tends to be more constant than plantar fasciitis and may be accompanied by visible swelling or redness at the back of the heel. It is often tender to the touch from both sides.

Caused by repeated friction, pressure from tight footwear, or inflammatory conditions such as rheumatoid arthritis.

Treatment summary: Rest, ice, anti-inflammatory medication, footwear changes. Physiotherapy if persistent. GP referral if swelling or redness is significant.

Sever's Disease

📍 Back of heelChildren and teenagers

Sever's disease is the most common cause of heel pain in children and young teenagers, typically affecting those aged 8 to 15. It is caused by inflammation of the heel growth plate — an area of cartilage at the back of the heel that is vulnerable during periods of rapid growth.

The pain is at the back and sides of the heel and is typically worse during and after sport. It is not serious and always resolves once the growth plate hardens, usually by the mid-teens.

It is important to distinguish Sever's disease from plantar fasciitis — the two conditions require different management.

Treatment summary: Rest from aggravating sport, heel padding, gentle stretching. Always see a GP for heel pain in children to confirm the diagnosis.

Tarsal Tunnel Syndrome

📍 Inside of heel and archLess common

Tarsal tunnel syndrome is caused by compression of the posterior tibial nerve as it passes through a narrow passage on the inside of the ankle called the tarsal tunnel. It causes burning, tingling or shooting pain along the inside of the heel and arch, and sometimes into the toes.

Unlike plantar fasciitis, tarsal tunnel syndrome often causes numbness or tingling rather than purely mechanical pain. It may be worse at night. The nerve compression can be reproduced by tapping over the tarsal tunnel — a clinical test called the Tinel sign.

It is important to distinguish tarsal tunnel syndrome from plantar fasciitis as the two conditions require different treatment.

Treatment summary: Physiotherapy, orthotics to correct foot alignment, anti-inflammatory medication. GP or specialist referral for diagnosis and management.

Stress Fracture of the Heel

📍 Heel — all aroundLess common — needs assessment

A stress fracture of the heel bone (calcaneum) is a small crack caused by repetitive impact rather than a single injury. It is most common in runners who have rapidly increased their mileage, military recruits and people with osteoporosis.

The pain of a heel stress fracture tends to be more diffuse than plantar fasciitis — surrounding the heel rather than being concentrated under it. It is typically worse with any weight bearing and does not ease with gentle walking the way plantar fasciitis does.

If a stress fracture is suspected you should see your GP promptly. An X-ray may not always show the fracture — an MRI is more sensitive. Continuing to exercise on a stress fracture can make it significantly worse.

Treatment summary: See your GP promptly. Rest from weight-bearing activity. Do not self-treat. Imaging required for diagnosis.

If your heel pain is severe, constant, not improving with rest, or accompanied by significant swelling — see your GP. Do not assume all heel pain is plantar fasciitis.

Where Exactly Is Your Pain?

The location of your heel pain is one of the clearest clues to its cause. Use this guide to narrow down the most likely condition.

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Pain Under the Heel

Pain on the flat underside of the heel, particularly toward the inside edge.

Most likely cause: Plantar fasciitis

Also consider: Heel spur, fat pad atrophy

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Pain at the Back of the Heel

Pain at the very back of the heel, where the Achilles tendon meets the heel bone, or slightly above it.

Most likely cause: Achilles tendinitis or retrocalcaneal bursitis

Also consider: Sever's disease (in children)

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Pain on the Inside of the Heel

Pain on the inner side of the heel extending toward the arch, possibly with tingling or burning.

Most likely cause: Tarsal tunnel syndrome

Also consider: Plantar fasciitis affecting the medial arch

When to See Your GP About Heel Pain

Many cases of heel pain can be managed at home with stretching exercises and footwear changes. However some situations require professional assessment.

See Your GP if:

  • Pain is severe and stopping you from walking normally
  • Pain has not improved after 2 to 3 weeks of home treatment
  • You are not sure what is causing your heel pain
  • The heel is visibly swollen, red or warm to touch
  • You have numbness or tingling in the foot
  • You have heel pain in both feet and pain in other joints
  • The pain came on suddenly after an injury
  • You are a child or teenager with heel pain
  • You have diabetes or a circulatory condition

You Can Usually Manage at Home if:

  • The pain matches the classic plantar fasciitis pattern
  • Symptoms have only been present for a few weeks
  • Pain is manageable and not stopping daily activities
  • There is no swelling, redness or numbness
  • You are otherwise fit and well

NHS Physiotherapy Self-Referral: In many parts of England you can refer yourself to NHS physiotherapy without needing to see your GP first. This is often the fastest route to professional assessment and a personalised exercise programme. Search for NHS physiotherapy self-referral in your local area.

General Advice for Heel Pain

Whatever the cause of your heel pain, the following general measures are recommended by NHS clinicians as helpful first steps while you work out the specific cause and treatment.

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Change Your Footwear

Switch to well-cushioned, supportive shoes immediately. Never walk barefoot on hard surfaces. This single change makes a difference for almost every type of heel pain.

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Apply Ice

Ice the painful area for up to 20 minutes several times a day, particularly after activity. Wrap the ice pack in a towel — never apply directly to skin.

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Relative Rest

Reduce activities that aggravate the pain. Complete rest is rarely the right answer — gentle movement helps most conditions. Stop only the activities that significantly worsen your pain.

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Pain Relief

Paracetamol or ibuprofen can help manage pain while you begin treatment. Check with your GP or pharmacist before taking ibuprofen especially if you have any stomach, kidney or heart conditions.

🧘

Gentle Stretching

Calf stretches are beneficial for almost all types of heel pain as tight calves increase load on the heel regardless of the underlying cause.

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Weight Management

Reducing body weight directly reduces the mechanical load on the heel with every step. Even a modest reduction in weight can make a meaningful difference to heel pain symptoms.

Frequently Asked Questions About Heel Pain

How do I know if my heel pain is serious?
Most heel pain is not serious and resolves with conservative treatment. See your GP promptly if your heel is swollen or red, if you have numbness or tingling, if the pain came on suddenly after an impact, if you have pain in other joints too, or if you have diabetes or a circulation condition.
Can heel pain go away on its own?
Some mild heel pain does resolve with rest and time. However many conditions — particularly plantar fasciitis — do not reliably self-resolve and can persist for months or years without the right treatment. Starting appropriate exercises and footwear changes early gives the best chance of a faster recovery.
Why is my heel pain worse in the morning?
Morning heel pain is the hallmark symptom of plantar fasciitis. During sleep the plantar fascia shortens and tightens. The first steps in the morning suddenly load and stretch the fascia, causing the characteristic sharp pain. Doing the plantar fascia stretch before your first steps can significantly reduce this morning pain.
Can new shoes cause heel pain?
Yes. Shoes that are too flat, lack arch support or do not fit well can trigger or worsen heel pain very quickly. This is one of the reasons plantar fasciitis is common in people who change their footwear significantly — such as starting a new job that requires different shoes or switching to summer sandals.
Is heel pain linked to back problems?
Occasionally. Nerve pain originating in the lower back can sometimes radiate down the leg and into the heel — a condition called radiculopathy. If your heel pain is accompanied by back pain, leg pain or sciatic nerve symptoms, mention this to your GP as the treatment approach is different from plantar fasciitis.

Free Plantar Fasciitis Exercise Programme — PDF

If your heel pain is plantar fasciitis, this free PDF gives you the complete NHS-backed 10-exercise programme. No sign-up required.

Download Free PDF

Related Pages

What Is Plantar Fasciitis?

The complete guide to the most common cause of heel pain.

Read more

Plantar Fasciitis Symptoms

Check whether your pain matches the classic plantar fasciitis symptom pattern.

Read more

Is It Plantar Fasciitis?

A self-assessment guide to help identify the likely cause of your heel pain.

Read more

Clinical Sources

  • • Royal Orthopaedic Hospital NHS FT
  • • Kingston and Richmond NHS Foundation Trust
  • • Hull University Teaching Hospitals NHS Trust
  • • Rotherham Doncaster and South Humber NHS Foundation Trust
  • • Royal Berkshire NHS Physiotherapy Department
  • • NIHR Evidence — Best Practice Guide for Plantar Heel Pain (2021)
  • • NICE Clinical Knowledge Summary — Plantar Fasciitis (2020)
  • • NHS.uk — Heel Pain
⚕️ This website provides general health information only. Always consult your GP, NHS physiotherapist or podiatrist for personal health guidance.