10 Reasons Your Heel and Foot Are Hurting (And What To Do)

Table of Contents

• 1. Plantar Fasciitis
• 2. Heel Spurs
• 3. Achilles Tendinitis
• 4. Nerve Entrapment
• 5. Stress Fractures
• 6. Flat Feet (Fallen Arches)
• 7. Arthritis
• 8. Bunions
• 9. Fat Pad Atrophy
• 10. Poor Footwear
• When to See a Podiatrist
• FAQ

Foot pain is one of the most common complaints we treat, yet it’s one of the most frequently dismissed — people assume it’s “just part of getting older” or that it will go away on its own. In our podiatry clinic, we see patients who have been limping for months, modifying their entire lifestyle around foot pain, only to find that targeted treatment resolves the problem within weeks. Understanding why your heel or foot hurts is the first step to getting better. Here are the 10 most common causes we diagnose — and what can be done about each.

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1. Plantar Fasciitis

Plantar fasciitis is the #1 cause of heel pain, accounting for over 1 million podiatry visits annually in the US. It involves inflammation of the plantar fascia — the thick band of connective tissue that runs from your heel to the ball of your foot. The hallmark symptom is sharp, stabbing heel pain with the first steps in the morning or after periods of rest that warms up with activity and then returns after prolonged standing. Risk factors include tight calf muscles, high-arched or flat feet, obesity, and occupations requiring prolonged standing. The vast majority of cases resolve with stretching, custom orthotics, and physical therapy within 3–6 months.

2. Heel Spurs

A heel spur is a bony growth on the underside of the calcaneus (heel bone), typically at the attachment of the plantar fascia or Achilles tendon. Importantly, heel spurs themselves are often not the direct cause of pain — they develop as a response to chronic tension at the attachment site and may be present in asymptomatic people. When they do cause pain, it is usually because of associated plantar fasciitis or Achilles enthesopathy. Treatment targets the inflammation, not the spur itself.

3. Achilles Tendinitis

Achilles tendinitis causes pain, stiffness, and swelling along the back of the heel and lower leg, particularly in the morning and after activity. It is classified as either insertional (at the heel bone attachment) or midportion (2–6 cm above the insertion). Both types respond to eccentric calf strengthening — a specific loading exercise proven in multiple clinical trials to be the most effective intervention for Achilles tendinopathy. Severe or chronic cases may benefit from shockwave therapy or PRP injection.

4. Nerve Entrapment

Several nerves can become entrapped around the heel and foot, causing burning, tingling, or shooting pain. Baxter’s nerve entrapment (inferior calcaneal nerve) is an underdiagnosed cause of heel pain that mimics plantar fasciitis. Tarsal tunnel syndrome compresses the tibial nerve behind the inner ankle. Morton’s neuroma entraps the interdigital nerve in the forefoot. When heel pain has an electric, burning quality or radiates into the toes, nerve entrapment should be strongly considered — it responds differently to treatment than mechanical heel pain.

5. Calcaneal Stress Fractures

A calcaneal stress fracture causes diffuse heel pain that worsens with activity and improves with rest — similar to plantar fasciitis, but typically without the first-step morning pain pattern. A key clinical test: squeezing the heel from both sides (mediolateral compression) reproduces pain in stress fractures but not plantar fasciitis. Early X-rays may be negative; MRI confirms the diagnosis. Treatment involves non-weight-bearing or protected weight-bearing in a boot for 4–8 weeks.

6. Flat Feet (Posterior Tibial Tendon Dysfunction)

Adult-acquired flatfoot — typically from posterior tibial tendon dysfunction — causes progressive inner ankle and arch pain with collapse of the longitudinal arch. One of the most reliable signs: the patient cannot perform a single-leg heel rise on the affected side. Custom orthotics with medial arch support are the cornerstone of conservative treatment; surgical reconstruction is reserved for advanced, flexible or rigid deformity.

7. Arthritis

Both osteoarthritis (degenerative) and inflammatory arthritis (rheumatoid, psoriatic, gout) commonly affect foot joints. The 1st MTP joint (big toe), subtalar joint, midfoot joints, and ankle are frequently involved. Morning stiffness lasting more than 30 minutes suggests inflammatory arthritis. Gout — caused by urate crystal deposition — classically presents as sudden, severe pain and redness in the big toe joint. Each arthritis type has specific treatment strategies.

8. Bunions

A bunion (hallux valgus) is a structural deformity of the 1st MTP joint causing the big toe to deviate toward the lesser toes and a bony prominence to develop on the inner side of the foot. Pain is from pressure against footwear, arthritis in the joint, and altered weight distribution. Conservative treatment (wide toe box shoes, padding, orthotics) manages symptoms but does not correct the deformity. Surgical correction is effective for painful, progressive bunions.

9. Fat Pad Atrophy

The heel fat pad is a specialized cushioning structure that absorbs up to 110% of body weight with each step. With aging, long-term corticosteroid use, and prolonged athletic training, this pad thins and loses its shock-absorbing capacity — causing a dull, diffuse heel pain that is often worse barefoot or in thin-soled shoes. Cushioned heel cups, silicone heel pads, and thick-soled footwear are the primary interventions.

10. Poor Footwear

Inadequate footwear is the most easily corrected and most commonly overlooked contributing factor to foot and heel pain. High heels chronically shorten the Achilles tendon and load the forefoot. Worn-out athletic shoes lose cushioning and motion control after 300–500 miles. Narrow toe boxes compress the forefoot and accelerate bunion and neuroma development. In our clinic, a footwear assessment is part of every evaluation — and fixing the shoe frequently resolves the symptom.

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Frequently Asked Questions

What is the most common cause of heel pain?

Plantar fasciitis is by far the most common cause of heel pain, responsible for the majority of heel pain diagnoses in both active individuals and the general population. It is characterized by sharp pain with the first steps in the morning and responds well to stretching, orthotics, and physical therapy in most cases.

Can foot pain go away on its own?

Some mild foot pain from temporary overuse resolves with a few days of rest. However, conditions like plantar fasciitis, stress fractures, and tendinopathy require active management to resolve fully. Without proper treatment, most structural foot conditions persist or worsen over time. Seeking care early leads to faster, more complete recovery.

When should I see a podiatrist for foot pain?

You should see a podiatrist if foot pain is limiting your daily activities, has persisted for more than 2–4 weeks despite rest and footwear changes, is accompanied by swelling or bruising after an injury, or involves numbness and tingling. For diabetic patients, any new foot pain warrants prompt evaluation.

The Bottom Line

Heel and foot pain have many causes — and the right treatment depends entirely on the right diagnosis. If you’re dealing with a classic case of plantar fasciitis or something less obvious like nerve entrapment or fat pad atrophy, effective treatment exists for all of these conditions. Don’t let foot pain become your new normal. Our team at Balance Foot & Ankle is here to identify the cause and build a plan to get you back on your feet.

Sources

• Goff JD, Crawford R. “Diagnosis and treatment of plantar fasciitis.” AFP, 2024.
• Neufeld SK, Cerrato R. “Plantar fasciitis: evaluation and treatment.” JAAOS, 2023.
• American Podiatric Medical Association. Heel Pain Clinical Guidelines, 2025.