Heel Pain

Heel pain can start under the heel, behind the heel, along the inside ankle, or deep in the heel bone. Those locations point to different diagnoses and different next steps. Plantar fasciitis is common, but it is not the only reason a patient develops heel pain.

The condition page helps patients understand the diagnostic map: fascia, Achilles tendon, heel bone, bursa, nerve, growth plate, fat pad, or referred pain. The related heel pain treatment page covers the treatment pathway in more detail. At Mountain Spine & Orthopedics, foot and ankle specialists evaluate the specific heel structure involved before recommending care.

Symptoms are most useful when described by exact location and timing.

Common Symptom Patterns

• Bottom-inside heel pain with first steps: Common with plantar fasciitis
• Back-of-heel pain: May indicate Achilles tendinopathy, Haglund's deformity, or retrocalcaneal bursitis
• Deep heel pain that worsens with impact: Raises concern for calcaneal stress fracture or bone injury
• Burning, tingling, or numbness: May indicate Baxter's nerve entrapment or tarsal tunnel syndrome
• Bruised or cushion-like pain under the heel: Can suggest fat-pad irritation or atrophy
• Heel pain in children or adolescents: May involve the growth plate, such as Sever's disease

Warning Signs Requiring Prompt Evaluation

• Severe pain after a fall, jump, or injury
• Inability to bear weight
• Heel swelling, redness, warmth, fever, or drainage
• Numbness, tingling, or progressive weakness
• Pain that is constant at rest or worsening despite reduced activity

Multiple factors contribute to heel pain development:

• Overuse and overtraining: Sudden increases in activity intensity or duration
• Improper footwear: Shoes with inadequate support or worn-out cushioning
• Biomechanical issues: Flat feet, high arches, or overpronation
• Obesity: Increased heel loading with excess body weight
• Occupational factors: Jobs requiring prolonged standing on hard surfaces
• Tight calf muscles: Increase tension on the Achilles and plantar fascia
• Age: Heel fat pad atrophy and reduced tissue elasticity with aging
• High-impact sports: Running, basketball, and jumping sports

Accurate diagnosis starts with a detailed history and physical exam: exact pain location, first-step symptoms, activity threshold, footwear, recent training changes, injury history, nerve symptoms, and whether pain improves or worsens as the day goes on.

• X-rays: Evaluate fracture, alignment, arthritis, and heel spurs
• Ultrasound: Dynamic evaluation of plantar fascia, Achilles tendon, and bursae
• MRI: Detailed evaluation for stress fracture, fascia tear, tendon disease, nerve-adjacent masses, and deep soft-tissue injury; complimentary MRI reviews are available
• Neurologic exam: Helps identify tarsal tunnel, Baxter's nerve irritation, or referred nerve pain

Heel pain treatment depends on the diagnosis. Plantar fascia pain, Achilles insertion pain, stress fracture, fat-pad pain, nerve entrapment, and bursitis should not all receive the same plan.

Initial care may include activity modification, footwear changes, orthotics or heel cups, medication when appropriate, stretching or strengthening guidance performed outside the practice, and image-guided injections for selected inflammatory or nerve-related pain sources. Surgery is reserved for confirmed structural problems that remain disabling after appropriate non-surgical care. The detailed treatment decision pathway is covered on our heel pain treatment page.

Heel pain from fascia overload typically hurts with first steps. Achilles-related pain is usually behind the heel and aggravated by push-off. Bone stress pain often worsens steadily with weight-bearing. Nerve pain may burn, tingle, or radiate. Fat-pad pain can feel like walking on a bruise.

Those differences matter because the wrong diagnosis can lead to months of ineffective self-care.

Keeping your heels healthy requires attention to footwear, stretching, and training habits.

• Wear supportive footwear: Replace worn shoes regularly
• Stretch daily: Calf and Achilles stretching reduces heel stress
• Progress activities gradually: Avoid sudden increases in training
• Maintain healthy weight: Reduces heel loading
• Use cushioned insoles: Especially on hard surfaces
• Vary your activities: Cross-training reduces repetitive stress
• Address biomechanical issues: Custom orthotics for flat feet or high arches
• Strengthen foot muscles: Towel curls and marble pickups build intrinsic foot strength

If heel pain is limiting walking, work, training, or sleep, schedule an appointment with Mountain Spine & Orthopedics. Bring prior imaging or request a complimentary MRI review when symptoms are persistent, atypical, or injury-related.