Where it hurts is a clue, not a diagnosisStrong evidence
The NHS says heel pain can be caused by exercising too much, standing on hard surfaces for too long or being overweight, and asks you not to try to diagnose the cause yourself. It sorts the causes by what you notice: sudden sharp pain, swelling, a popping or snapping sound and difficulty walking point to a broken heel bone or a ruptured Achilles tendon; sharp pain between the arch and the heel that is worst when you start walking to plantar fasciitis; pain in the back of the heel, ankle and calf to the Achilles tendon; and redness and swelling with a dull ache to an irritated fluid sac (bursitis).
Heel pain is the most common problem affecting the foot, the American Academy of Orthopaedic Surgeons (AAOS) says. A family-medicine review uses the exact spot to guide the diagnosis, and its December 2025 update keeps the same map by location: under the heel, at the back, and on the inner and outer sides. So this guide says a spot points to a cause rather than proving it, and an examination decides. Most new foot problems should begin to settle within 6 weeks, NHS inform says.
Sources 1, 2, 3, 4, 5
Under the heel: plantar heel pain is the commonest causeStrong evidence
Plantar heel pain, usually called plantar fasciitis, hurts on the bottom of the foot around the heel and arch. It is worst on the first steps after sleeping or resting, eases as you get moving, and gets worse again with long standing, walking or running; raising your toes or climbing stairs can hurt too. The NHS says it is more likely between 40 and 60, with new exercise on hard surfaces, a tight calf, much more standing, walking or running than usual, poorly cushioned shoes or being overweight.
It is common. In a UK survey of 5,109 people aged 50 and over, 9.6% had plantar heel pain in the past month, and it was commoner with manual and routine work, being overweight and being less active. Dutch family doctors recorded it in about 3.8 people per 1,000 a year, more often in women, and handled it in many different ways. The 2025 review links heel pain with a higher body weight, manual jobs and an inactive lifestyle.
Sources 6, 3, 7, 8, 4
Heel spurs: common, and a poor explanation for the painEmerging evidence
A heel spur is a hook of bone under the heel that shows on an X-ray. In one study, spurs were found in 15.5% of 400 people without heel pain and in 65.9% of 82 with it. Across 23 imaging studies, spurs were more common in people with heel pain (an odds ratio of 8.52), and a plantar fascia thicker than 4 mm on ultrasound supported plantar fasciitis.
But about half of people with plantar fasciitis have a spur and it matches their symptoms poorly, the family-medicine review says, and in a hospital cohort a spur at the start made no difference to how plantar fasciitis went over 5 to 15 years. The AAOS says most people with heel spurs have no heel pain, that a spur is usually the result of the problem rather than the cause of the pain, and that spurs aren't removed to treat plantar fasciitis. So a spur on an X-ray is a sign the heel has been under strain, not the thing to treat.
Sources 9, 10, 3, 11, 12, 2
The centre of the heel pad: the fat padEmerging evidence
The fat pad is the thick cushion under the heel bone. Fat pad pain is a deep, bruise-like ache in the middle of the heel, worse standing and walking barefoot on hard floors and usually less marked on the first steps than plantar fasciitis. A scoping review found only 7 original studies of it; two suggest it may be the second commonest cause of pain under the heel, and a thin pad on ultrasound can support it.
A stone bruise is a bruise of the same pad after stepping hard on something, which can be tender without any colour change and settles with rest, the AAOS says. A very small pilot trial in 2026 tested taping for fat pad pain (see what helps); before that, no trial had tested any treatment.
Sources 13, 14, 3, 2
One spot on the heel bone: a stress fractureEmerging evidence
The heel bone is the second commonest site of a stress fracture in the foot, and its pain can be similar to plantar fasciitis, the AAOS says. It usually follows more walking, running or marching than usual, or a change to a harder surface; it hurts with activity at first and later at rest, and squeezing the sides of the heel hurts. A review calls it a frequently unrecognised cause of heel pain that can even improve a little with treatment aimed at plantar fasciitis.
Early X-rays often look normal: in Finnish military recruits, only 15% of the heel bone stress injuries found on magnetic resonance imaging (MRI) showed on plain X-rays, and the 2025 review rates MRI the preferred test. Health New Zealand says the pain can be pointed to with a fingertip, can become a constant ache even at night, and shouldn't be pushed through: as long as you can feel it, the bone is still fragile.
Sources 15, 3, 16, 17, 18, 4
The back of the heel: the Achilles tendon and Haglund'sStrong evidence
The Achilles tendon can hurt in its middle, a few centimetres above the heel, or where it joins the heel bone (insertional Achilles tendinitis), which the AAOS says can happen at any activity level, though it is most common in runners, often with a bony spur at the back of the heel and pain and stiffness in the morning. Haglund's deformity is a bump of bone at the back of the heel that shoes rub, often with an irritated fluid sac.
A sudden pain at the back of the heel or calf, sometimes with a snap or pop, often described as if someone had kicked the back of the leg, then walking flat-footed and not being able to push off or stand on tiptoe, is different: an NHS hospital leaflet says an acute Achilles injury should be treated as a complete rupture until it has been checked.
Sources 19, 3, 20
Children: Sever's diseaseEmerging evidence
In an active child aged about 8 to 15, heel pain during and after running and jumping, with a heel that is tender when squeezed, is usually Sever's disease, an irritated growth area at the back of the heel bone. Dutch family doctors saw it in 3.7 per 1,000 registered children and teenagers aged 6 to 17 a year, and the 2025 review calls it the most common cause of heel pain in active children and teenagers.
An X-ray isn't usually needed to diagnose it. An NHS hospital leaflet says it stops once the heel bone finishes growing, can come back with a growth spurt, and that there's no evidence sport causes long-term damage. Heel pain that isn't clearly linked to activity, or comes with swelling, redness or a fever, needs a GP.
Sources 21, 3, 22, 4
Burning or tingling: a nerve, or the backEmerging evidence
Burning, tingling or numbness points to a nerve rather than the plantar fascia, the family-medicine review says: branches of the tibial nerve at the heel, a small nerve to a muscle of the little toe, or a nerve root in the lower back, with or without back pain. A review calls nerve entrapment at the heel a recognised but controversial cause, and another says entrapment of a small branch of the nerve under the heel (sometimes called Baxter's nerve) is often misdiagnosed as plantar fasciitis at first.
The evidence is reviews and one surgeon's series: 89% of 69 heels did well after the nerve was released, after an average of 14 months of non-surgical care. No study opened for this guide measures how often a nerve is the cause.
Sources 3, 23, 24, 25
Both heels, or other joints too: inflammatory arthritisStrong evidence
Pain where tendons attach to the heel can be part of an inflammatory arthritis (spondyloarthritis). NICE asks for a rheumatologist's assessment when that kind of pain has no mechanical cause and lasts, is in several places, or comes with back pain without a mechanical cause, eye inflammation (uveitis), psoriasis, a gut or urinary infection, inflammatory bowel disease, or a close relative with spondyloarthritis or psoriasis. The family-medicine review suggests thinking of a body-wide condition when both heels hurt.
Sources 26, 3
A red, hot or swollen heel, or diabetesStrong evidence
A joint infection (septic arthritis) causes sudden severe pain in a joint, trouble moving it or putting weight on it, hot, swollen or red skin and often a high temperature, and needs an urgent GP appointment or NHS 111, the NHS says. A skin infection (cellulitis) makes the skin painful, hot and swollen and needs the same; call 999 or go to A&E if it comes with a very high temperature, a fast heartbeat or breathing, purple patches, dizziness or confusion.
With diabetes, a hot, swollen foot with a change in colour, painful or not, is an active foot problem that NICE asks to reach a specialist foot service within 1 working day, kept off weight until it has been checked. Diabetes UK says see your foot team within 24 hours for any new problem, including new or unexplained pain.
Sources 27, 28, 29, 30
When a scan or test helpsStrong evidence
Plantar fasciitis is diagnosed from the story and an examination, and imaging isn't required; an ultrasound showing a plantar fascia over 4 mm thick supports it when the picture is unclear. X-rays are kept for pain that lasts or doesn't fit, and MRI is rarely needed, the AAOS says.
A suspected stress fracture is different: X-rays are often normal early on, and an MRI, a bone scan or a computed tomography (CT) scan finds it. After a fall from a height, the heel usually needs an X-ray and a CT scan, and the back needs checking. Sever's disease doesn't usually need an X-ray. Both heels with other joints or back pain may need blood tests and a rheumatologist.
Sources 3, 2, 9, 16, 4, 26
How it usually goesEmerging evidence
Plantar fasciitis often takes months. The AAOS says more than 90% of people improve within 10 months of simple treatment. One study followed 174 hospital patients for 5 to 15 years: about half still had symptoms 5 years after they began, and women and people with both heels affected did worse. Hospital patients are likely to include harder cases than people treated by a GP, so read that as the slow end of the range. In a 12-week trial of heavy heel raises, only 4 of 70 people felt their heel was acceptable by the end.
Most stress fractures heal in 6 to 8 weeks. Sever's disease stops when the heel bone finishes growing. Nobody has followed fat pad pain over time. The NHS asks for a GP visit if heel pain hasn't improved after 2 weeks of looking after it at home. No one can promise a date.
Sources 12, 11, 31, 18, 22, 1
