What Causes Heel Pain? The Most Common Causes Explained
Heel pain is one of the most common reasons people seek foot care — and it's also one of the most misunderstood. Many people assume their heel pain is 'just' plantar fasciitis, when there are actually several different conditions that can cause heel pain, each requiring a different approach.
At Finest Feet Footcare in Shifnal, we see patients with heel pain of all types and severities. This guide explains the most common causes, how to distinguish between them, and when it's time to get professional help.
1. Plantar Fasciitis
This is the most common cause of heel pain in adults. Plantar fasciitis involves inflammation of the plantar fascia — the thick band of tissue connecting the heel bone to the toes.
Key symptoms: Sharp pain at the inner heel with the first steps in the morning or after rest. Pain eases after a few minutes of walking but may return after prolonged activity.
Common triggers: Increased activity, poor footwear, tight calf muscles, flat feet, prolonged standing.
2. Achilles Tendinopathy
The Achilles tendon connects the calf muscles to the heel bone. When it's overloaded or repeatedly stressed, it can become inflamed or develop degenerative changes — a condition known as Achilles tendinopathy.
Key symptoms: Pain at the back of the heel and up the tendon, particularly in the morning or after exercise. The tendon may feel stiff, swollen or tender to touch.
Common triggers: Sudden increase in running or jumping activity, tight calf muscles, worn footwear, changes to training surface.
3. Heel Bursitis
A bursa is a small fluid-filled sac that cushions areas of friction around joints and tendons. The heel has two bursae, and either can become inflamed — a condition called bursitis. Retrocalcaneal bursitis (behind the heel) and subcutaneous calcaneal bursitis (at the back of the heel, beneath the skin) are the most common types.
Key symptoms: Pain, swelling and tenderness at the back of the heel. The area may feel warm and look visibly swollen.
Common triggers: Stiff-backed shoes (particularly court shoes or dress shoes), Achilles tendon problems, abnormal foot biomechanics.
4. Sever's Disease (In Children and Teenagers)
Sever's disease is the most common cause of heel pain in children, typically affecting those aged 8–14. It occurs when the growing heel bone (calcaneal growth plate) is stressed by the pull of the Achilles tendon during periods of rapid growth.
Key symptoms: Pain at the back or sides of the heel in a child or teenager, often worse during or after sport.
Common triggers: Growth spurts, running and jumping sports, hard playing surfaces, inadequate footwear.
5. Heel Stress Fracture
A stress fracture is a small crack in the heel bone, caused by repetitive loading rather than a single injury. It's most common in runners, military recruits and others who rapidly increase their level of weight-bearing activity.
Key symptoms: Deep, aching heel pain that worsens with weight-bearing and may improve with rest. Tenderness when squeezing the heel from the sides.
Important: Stress fractures need medical assessment and imaging. If you suspect a stress fracture, see your GP.
6. Fat Pad Atrophy
The heel has a specialised fat pad that acts as a natural shock absorber. With age, this pad thins and loses its cushioning ability — a process called fat pad atrophy. It can also be accelerated by repeated cortisone injections into the heel.
Key symptoms: Generalised heel pain that's worse on hard surfaces. Feels like walking on the heel bone directly. Common in older adults.
Management: Cushioned footwear, heel pads and insoles to replace the lost natural cushioning.
7. Tarsal Tunnel Syndrome
The tarsal tunnel is a narrow channel on the inside of the ankle through which nerves and tendons pass. When the tibial nerve is compressed within this tunnel, it causes nerve pain affecting the heel, arch and sometimes the toes.
Key symptoms: Burning, tingling or shooting pain in the heel and arch. Often described as a pins-and-needles sensation. Can be present at rest.
Note: This condition requires professional assessment to distinguish from other heel pain causes.
How to Know Which One You Have
The location, timing and character of your heel pain are useful clues:
• Pain at the inner heel, worst in the morning: Plantar fasciitis
• Pain at the back of the heel and up the tendon: Achilles tendinopathy or bursitis
• Heel pain in a child during sport: Sever's disease
• Deep heel pain worsening steadily with activity: Possible stress fracture — seek assessment
• Heel pain in an older adult on hard surfaces: Fat pad atrophy
• Burning, tingling pain at rest or at night: Possible nerve involvement
If you're not sure what's causing your heel pain, a professional assessment will identify the cause and ensure you're treating the right thing.
Persistent heel pain? Book a foot assessment at Finest Feet Footcare in Shifnal →
General Treatment Principles for Heel Pain
While treatment varies by condition, these principles apply to most types of heel pain:
• Review your footwear — cushioning and support make a significant difference
• Stretch your calf muscles and Achilles tendon regularly
• Reduce or modify high-impact activity during a flare-up
• Consider insoles or arch supports
• Apply ice to the heel for 15–20 minutes after activity
• Seek professional advice if symptoms persist beyond 4–6 weeks
Frequently Asked Questions
When should I see someone about heel pain?
See a professional if your heel pain has lasted more than 4–6 weeks, is severe, is worsening, is affecting your daily life or work, or if you're unsure what's causing it. Early professional input generally means faster recovery.
Can heel pain go away on its own?
Mild heel pain from overuse sometimes settles with rest and footwear changes. However, conditions like plantar fasciitis, Achilles tendinopathy and bursitis rarely fully resolve without some active treatment. Addressing the cause — rather than just resting — produces better long-term outcomes.
Is it safe to walk on a painful heel?
Gentle walking is generally fine for most types of heel pain — complete rest is rarely recommended. However, prolonged standing and high-impact activity should be reduced during a flare-up. If weight-bearing is severely painful, you should seek assessment to rule out a stress fracture.
Does heel pain mean I need orthotics?
Not necessarily. Many people with heel pain improve with stretching, footwear changes and activity modification alone. Orthotics can be helpful for conditions related to foot biomechanics — flat feet, high arches — but they're not required for everyone. A professional assessment will indicate whether they'd be beneficial in your case.
Book a Heel Pain Assessment in Shifnal
If heel pain is affecting your daily life, don't just put up with it. Our team at Finest Feet Footcare in Shifnal can assess your heel, identify the likely cause and recommend the most appropriate treatment.
We see patients from Shifnal, Telford, Newport and across Shropshire.
💚 Book your appointment at Finest Feet Footcare in Shifnal → — we'll help you get back on your feet.
Disclaimer:This article is general information and not a substitute for a clinical assessment.
Phone: 01952 872526
Email:finestfeetfootcare@gmail.com
Opening Hours: Mon–Fri 9 am–5 pm, Sat by appointment
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