What’s Causing Your Heel Pain?

Written By Cathryn Paten

What’s Causing Your Heel Pain?

Written By Cathryn Paten

Heel pain that shows up out of nowhere can be frustrating. You might wake up one morning with a dull ache behind your heel, or notice sharp discomfort that makes your usual walk uncomfortable. The tricky part? Back-of-heel pain can stem from several different conditions, and they're surprisingly easy to confuse. Knowing what might be causing your pain is an important first step toward getting relief and preventing it from coming back.

In this guide, we'll walk you through the five most common causes of pain at the back of the heel, explain the subtle differences between them, and give practical tips on what to do next. By the end, you should have a clearer idea of what's going on with your feet and how to take steps toward feeling better.

How to Use This Guide

Take your time reading through each condition.

Pay attention to the details of your symptoms, especially where the pain is located. This often provides the clearest clue about what’s going on.

If a condition sounds like it could match your experience, follow the links to explore treatment options and next steps.

A simple way to think about it: most pain at the back of the heel happens just above, around, or along the Achilles tendon, while other types of heel pain show up on the bottom of the heel. Use the descriptions below to help pinpoint which type of pain fits your situation.

How to Use This Guide

Take your time reading through each condition.

Pay attention to the details of your symptoms, especially where the pain is located. This often provides the clearest clue about what’s going on.

If a condition sounds like it could match your experience, follow the links to explore treatment options and next steps.

1. Retrocalcaneal Bursitis

What it is: Inflammation of the small, fluid-filled cushion that sits between your Achilles tendon and heel bone.

Where it hurts: At the back of the heel, just above where the heel bone meets the Achilles tendon, often on both sides of the tendon.

What it feels like: A deep, aching discomfort that can sometimes feel like pressure or mild swelling.

When it’s worst: You may notice it first thing in the morning, during walking (especially uphill), or after sitting or resting for a while.

Who typically gets it: Active adults over 40, particularly those who have recently increased their walking or changed their shoes.

What’s causing it: Usually, repeated friction from activity, a tight Achilles tendon, footwear that doesn’t provide enough support, or other inflammatory conditions.

Next step: Retrocalcaneal bursitis responds well to the right approach. Learn about effective treatment options that help reduce inflammation and support your recovery.

2. Achilles Tendonitis

What it is: Inflammation or irritation of the Achilles tendon itself.

Where it hurts: Along the tendon, usually 2–4 inches above the heel. You may notice a tender spot you can feel when you press.

What it feels like: Sharp or burning pain that tends to increase with activity.

When it’s worst: During or after exercise, climbing stairs, or first thing in the morning if your tendon feels stiff.

Who typically gets it: Runners, people who have recently increased activity, or anyone with tight calf muscles.

What’s causing it: Overuse, insufficient stretching, or age-related changes in tendon flexibility.

Next step: Focus on rest, gentle stretching, and a gradual return to activity. If pain persists, it’s a good idea to consult a healthcare provider.

2. Achilles Tendonitis

What it is: Inflammation or irritation of the Achilles tendon itself.

Where it hurts: Along the tendon, usually 2–4 inches above the heel. You may notice a tender spot you can feel when you press.

What it feels like: Sharp or burning pain that tends to increase with activity.

When it’s worst: During or after exercise, climbing stairs, or first thing in the morning if your tendon feels stiff.

Who typically gets it: Runners, people who have recently increased activity, or anyone with tight calf muscles.

What’s causing it: Overuse, insufficient stretching, or age-related changes in tendon flexibility.

Next step: Focus on rest, gentle stretching, and a gradual return to activity. If pain persists, it’s a good idea to consult a healthcare provider.

3. Plantar Fasciitis

What it is: Inflammation of the thick band of tissue that runs along the bottom of your foot, from heel to toes.

Where it hurts: Bottom of the heel, sometimes extending along the arch.

What it feels like: Sharp, stabbing pain that can make those first steps in the morning a challenge.

When it’s worst: First steps after rest or sitting. The pain often eases as you move around.

Who typically gets it: Runners, people who spend long hours on their feet, and those with high arches or flat feet.

What’s causing it: Repetitive strain, inadequate arch support, or tight calf muscles.

Next step: Focus on good arch support, stretching, and wearing appropriate footwear. Unlike back-of-heel pain, this condition is felt under the heel rather than behind it.

4. Haglund’s Deformity (Pump Bump)

What it is: A bony enlargement at the back of the heel bone.

Where it hurts: Right where your shoes press against the heel. You may even notice a small bump.

What it feels like: Pain or irritation from shoe pressure, sometimes with swelling.

When it’s worst: Wearing shoes, especially stiff-backed shoes or high heels.

Who typically gets it: Often hereditary, and worsened over time by shoes that rub or press on the heel.

What’s causing it: The shape of your heel bone, repetitive shoe irritation, or a tight Achilles tendon.

Next step: Adjusting footwear is essential. A healthcare provider can confirm the diagnosis with imaging if needed.

4. Haglund’s Deformity (Pump Bump)

What it is: A bony enlargement at the back of the heel bone.

Where it hurts: Right where your shoes press against the heel. You may even notice a small bump.

What it feels like: Pain or irritation from shoe pressure, sometimes with swelling.

When it’s worst: Wearing shoes, especially stiff-backed shoes or high heels.

Who typically gets it: Often hereditary, and worsened over time by shoes that rub or press on the heel.

What’s causing it: The shape of your heel bone, repetitive shoe irritation, or a tight Achilles tendon.

Next step: Adjusting footwear is essential. A healthcare provider can confirm the diagnosis with imaging if needed.

5. Sever’s Disease (ages 15 and under), or Achilles Tendon Strain (ages 15 and over)

What it is:

Adolescents - Inflammation of the growth plate where the Achilles attaches to the heel.
Adults - Partial tendon injury or strain.

Where it hurts:

Adolescents - At the back of the heel where the tendon connects.
Adults- Along the tendon, sometimes with a “popping” sensation.

What it feels like:

Adolescents - Aching during or after activity.
Adults - Sudden, sharp pain if the tendon is strained.

When it’s worst:

Adolescents - During sports or active play.
Adults - With specific movements or stretching of the tendon.

Who typically gets it:

Adolescents - Active kids ages 8–15.
Adults - Anyone experiencing sudden forceful movement or overuse of the tendon.

What’s causing it:

Adolescents - Rapid growth spurts.
Adults - Overload or sudden stress on the tendon.

Next step:

Adolescents - Rest and modify activities until pain eases.
Adults - Seek medical assessment, especially if pain is severe or persistent.

When to See a Doctor

It’s usually fine to start with home care for back-of-heel pain, but it’s a good idea to consult a healthcare provider if you notice any of the following:

Pain that is severe or makes walking difficult
A popping sound in your heel or ankle
Swelling that is extreme or getting worse
Signs of infection, such as redness, warmth, or fever
Pain that hasn’t improved after about two weeks of self-care
Uncertainty about which condition you might have

Most back-of-heel issues can be managed conservatively, but getting an accurate diagnosis helps ensure you’re addressing the right problem and sets you on the fastest path to relief.

When to See a Doctor

It’s usually fine to start with home care for back-of-heel pain, but it’s a good idea to consult a healthcare provider if you notice any of the following:

Pain that is severe or makes walking difficult
A popping sound in your heel or ankle
Swelling that is extreme or getting worse
Signs of infection, such as redness, warmth, or fever
Pain that hasn’t improved after about two weeks of self-care
Uncertainty about which condition you might have

Most back-of-heel issues can be managed conservatively, but getting an accurate diagnosis helps ensure you’re addressing the right problem and sets you on the fastest path to relief.

Your Next Steps for Heel Pain Relief

Back-of-heel pain can stem from several different causes, but paying attention to where and when the pain occurs usually helps narrow it down. If your symptoms match something like retrocalcaneal bursitis, following a structured treatment guide can provide practical, evidence-based ways to ease discomfort.

Taking the time to understand what's causing your pain is the first step toward finding relief that lasts and keeping your feet feeling their best.

Continue Learning

Retrocalcaneal Bursitis Treatment - Natural and medical options

How Long Does Retrocalcaneal Bursitis Take to Heal? - Week-by-week recovery expectations and timeline factors

What is Retrocalcaneal Bursitis? - Understand the anatomy, causes, and why this happened

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Frequently Asked Questions

What is the most common cause of heel pain?
The most common cause of heel pain is Plantar fasciitis. This condition occurs when the plantar fascia (the thick band of tissue running along the bottom of your foot) becomes inflamed. It often causes sharp pain near the heel, especially with the first steps in the morning or after long periods of sitting. Overuse, unsupportive footwear, tight calf muscles, or increased physical activity can all contribute to developing plantar fasciitis.
Could my heel pain be caused by a heel spur?
Yes, heel pain can sometimes be linked to Heel spur, which is a small bony growth on the underside of the heel bone. However, heel spurs don’t always cause pain. Many people have them without symptoms. When pain is present, it’s often due to inflammation of the surrounding soft tissues rather than the spur itself. A proper evaluation can help determine whether a heel spur is contributing to your discomfort.
When should I see a doctor for heel pain?
You should consider seeing a healthcare provider if your heel pain:
- Lasts more than a few weeks
- Gets worse over time
- Makes it difficult to walk or bear weight
- Is accompanied by swelling, redness, or numbness
Persistent heel pain may be related to conditions such as Achilles tendinitis or other structural issues. Early diagnosis and treatment can prevent the problem from becoming chronic and help you return to normal activity more quickly.