Heel Pain: Causes, Treatment, and Exercises

Tired of feeling like you’re walking on eggshells with every step due to persistent heel pain? You’re hardly alone. Heel pain can be stubborn and frustrating, especially if you work in a field that requires you to be on your feet for long periods of time.

But even those who have a more sedentary lifestyle can develop pain at the back of their foot. No matter the cause, heel pain can take a toll on your quality of life, impacting everything from what shoes you wear to how active you are to how frequently you feel able to do basic tasks like run errands. “I hear over and over again from patients that they avoid certain activities because of how intense their heel pain can be,” says Samantha Charlotin, PT, DPT, a physical therapist at Hinge Health.

Thankfully, there’s a lot you can do to manage heel pain, especially when it comes to movement and exercises from our Hinge Health physical therapists. Read on to learn how you can alleviate your heel pain and finally put some spring back in your step.

What Is Heel Pain?

Heel pain is pain that affects the bottom or back of your heel. It’s usually not serious, but it can

interfere with activities as simple as walking. The pain can be found either under your heel, or behind it. You may also notice a bump on the back of your heel that feels tender and even warm. 

The pain usually worsens with activity and gets better when you're not on your feet as much. Anyone can develop heel pain, but you’re more at risk if you are overweight, have flat feet, spend a lot of time on your feet, or don’t wear well-fitting shoes, notes Dr. Charlotin. But there’s good news: Sore heels usually get better on their own, or with conservative treatment.

Heel Pain Symptoms

Symptoms of heel pain can differ depending on the contributing factors, but, in general, they include:

• Pain and stiffness along the back of the heel, worsening with activity

• Pain on the bottom of the foot near the heel

• Pain in the heel brought on after exercising

• Thickening of the Achilles tendon in the back of the heel

• Swelling, which may get worse as the day progresses or with activity

• Burning or tingling in the bottom of the foot

• Pain with the first few steps after getting out of bed in the morning

• Pain after sitting for a long period of time

• Pain at the back of the heel when wearing shoes

Heel Pain: A Hinge Health Perspective

We know the last thing you want to do when your heel hurts is spend time on your feet, but hear us out: As counterintuitive as it may seem at first, movement is one of the best things you can do to help ease the pain. 

While weight-bearing movements may feel scary or uncomfortable at first (your heel has to absorb a lot when you stand and move), they’re key to your recovery. When you do exercises that are designed to strengthen all the muscles, tendons, and ligaments that support the heel (more on that below), you’re actually setting yourself up for less pain and lower risk of heel pain in the future. 

Causes of Heel Pain

There are a few different culprits behind sore heels. Common heel pain causes include:

Plantar fasciitis. This condition occurs when your plantar fascia, the strong band of tissue that supports your foot arch, becomes inflamed. “The pain is usually centered where the plantar fascia attaches, right underneath the heel,” says Dr. Charlotin. Plantar fasciitis is often worse in the morning, right after you get out of bed, and improves once you start moving around. It’s a common condition among runners, but it’s also seen often among women in the last trimester of pregnancy. “Your foot ligaments can become more relaxed during this time, thanks to hormones, which can put more strain on your plantar fascia,” explains Dr. Charlotin.

Fat pad impingement. At the very bottom of the heel is a fat pad that acts as a cushion. “Its purpose is to decrease friction between your tendons, bones, and bursa, the fluid-filled pads that cushion your joints,” explains Dr. Charlotin. But if you put too much pressure on the fat pad, it can become irritated. “We see this a lot in people who begin a new activity program that puts stress on the feet in a way they’re not used to yet, like running or even pickleball,” she says.

Heel bursitis. Heel bursitis occurs when the bursa, located in the back of the ankle in the space between the heel bone and the Achilles tendon, becomes inflamed. It’s usually triggered by a change, like a change in footwear or a change in activity (such as a new exercise or running regimen). With heel bursitis, you may notice some swelling and pain when performing simple movements, like walking, reaching for something on your toes, or going up or down stairs.

Achilles tendinitis. This is inflammation of the Achilles tendon, the fibrous tissue that connects the calf muscle to the heel bone. It usually presents as pain behind the heel, right where the Achilles tendon inserts into the heel bone. With Achilles tendinitis (tendonitis), pain builds up over time. You may also notice that the skin behind your heel is slowly turning thick and red, and it may even be swollen. While it can happen to anyone, Achilles heel pain is particularly common among runners and basketball players, says Dr. Charlotin.

Posterior tibial tendinitis. The posterior tibial tendon (PTT) runs from the backside of the lower part of the calf right into the arch of the foot. When that tendon becomes inflamed, it can lead to tendinitis know as posterior tibial tendinitis. This can cause pain in the arches of your feet, your heel, and your ankle. 

Stone bruise. If you step on a sharp, hard object like a stone, it can temporarily bruise the fat padding under your heel. This can cause pain when you walk or do activities.

Heel spurs. If you have chronic plantar fasciitis or Achilles tendinitis, a calcium deposit can form where your fascia tissue band connects to your heel bone. Heel spurs usually develop gradually over the course of a few months. 

Whether you know the underlying cause of your heel pain or not, take heart: There’s always something you can do to help alleviate the pain and make it easier to be on your feet.

Treatment for Heel Pain

Most heel pain treatment can be done at home with conservative measures, such as ice and specific stretches and exercises. But it is important to see your doctor if you can’t bear any weight on your heel at all, which may indicate something more serious, warns Dr. Charlotin. Otherwise, if you can walk around, but are experiencing pain, swelling, or other symptoms, she recommends the following for heel pain relief:

Range of motion exercises. When you first notice heel pain, gentle exercises can help encourage blood flow and healing nutrients to the area. “Every 30 to 60 minutes, roll your ankle up and down, then side to side,” suggests Dr. Charlotin.

Ice. Roll your foot over a frozen water bottle for 10 to 15 minutes at a time, several times each day, advises Dr. Charlotin. The ice will help with swelling and irritation, while the rolling helps to stretch out the muscles that surround your heel.

Taping. You can tape the affected foot with a specific technique known as “low-dye taping.” “You can do this during the day to provide support, or at night, to help stretch tendons and ligaments,” says Dr. Charlotin. A 2022 study in the journal Archives of Rehabilitation found that taping at night is an effective way to help reduce heel pain. 

Here’s how to do it: You’ll need four strips of tape (you can use sports tape, which you’ll find in pharmacies). Wrap a strip of tape around the ball of your foot. Then, wrap a second strip of tape around your heel. Start just below your pinky toe, around the sides of your heel, and back up to the first strip of tape. Now, wrap a third strip of tape around your heel, starting just below your pinky toe, but this time, circle your heel and wrap the tape in a crisscross so that it ends just below your big toe. (Does this sound too confusing? This demo can help, or a physical therapist can show you how to do it, too.)

Break in shoes carefully. When you get a new pair of shoes, take time to break them in so they’re less likely to cause heel pain. You want to give your heel time to adjust to new footwear instead of making an abrupt change, cautions Dr. Charlotin. Start by wearing your new shoes for an hour a day, then gradually increase your usage until you’re wearing them the whole time. A physical therapist may also recommend over-the-counter inserts, like orthotics, to take pressure off the heel.

Stay physically active. While you work on strengthening and stretching your heel muscles, continue to prioritize exercise. It may help to start with low-impact options and gradually work up to higher-impact activities, advises Dr. Charlotin. That may mean switching to biking and the elliptical for a couple weeks, for example, as your pain subsides. “I tell my patients that it’s okay to slowly ramp up workouts as long as there’s no increase in heel pain symptoms,” says Dr. Charlotin. 

These heel pain exercises are recommended by Hinge Health physical therapists. As you’ll see, they aren’t just specific to your heel. Instead, they focus on all the areas that support your foot and heel, including your ankle, calf muscles, and Achilles tendon. When the structures around your heel are strong and stretched, you're making the heel’s job easier by not requiring it to compensate for other parts of the body. This, in turn, can help alleviate heel pain now and prevent it from recurring in the future. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Don’t Delay Treatment 

Whether you know what’s brought on your heel pain or not, it’s natural to feel discouraged by the sudden onset of discomfort. But don’t let that sideline you. “Quick and early intervention is vital if you want to restore function and improve long-term outcomes,” says Dr. Charlotin. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Thomas, M. J., Whittle, R., Menz, H. B., Rathod-Mistry, T., Marshall, M., & Roddy, E. (2019). Plantar heel pain in middle-aged and older adults: population prevalence, associations with health status and lifestyle factors, and frequency of healthcare use. BMC Musculoskeletal Disorders, 20(337). doi:10.1186/s12891-019-2718-6

2. Young, C.C. March 23, 2023. Plantar Fasciitis. Medscape. https://emedicine.medscape.com/article/86143-overview?form=fpf 

3. Akhavan-Boroujeni, B., & Sadeghi-Demneh, E. (2022). The Effectiveness of Two Types of Night Splints on the Range of Motion of the Ankle Joint, Pain Intensity, and Quality of Life (QoL) in Patients With Plantar Fasciitis: A Pilot Study With Parallel Groups. Journal of Rehabilitation, 23(2), 204–217. doi:10.32598/rj.23.2.1775.7

4. Buchbinder, R. March 11, 2022. Patient education: Heel and foot pain (caused by plantar fasciitis) (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/heel-and-foot-pain-caused-by-plantar-fasciitis-beyond-the-basics