Stabbing heel pain in the morning after a night’s rest. A reoccurring ache that comes on after activity and sticks around for a couple days. A new, painful bump on the back of your heel. Are your heels just sore? Or is something else causing your heel pain?

You use your feet a lot every day. So occasional aches and pains are pretty common. But if pain is coming and going, or sticking around for a bit, there may be something else going on. And the one thing all heel pain has in common is this: It’s a signal that your heel needs healing.

Read on to learn the top causes of heel pain and when to get help.

The most common cause of heel pain: Plantar fasciitis

Plantar fasciitis is caused by inflammation or damage to the plantar fascia, which is the ligament that runs along the bottom of your foot and attaches to your heel. This condition is usually caused by repetitive motion or anything that puts a lot pressure on the arch of your foot.

When and where does your heel hurt with plantar fasciitis?

Plantar fasciitis pain can flare up at any time. Sometimes you’ll get heel pain during or after exercise, or from being on your feet for a long time. If your heels hurt after walking or other exercise, you’ll likely feel a sharp stabbing pain in the arch of your foot or the bottom of your heel. This signals that the plantar fascia is inflamed or damaged from overuse, and probably needs some rest and care.

One of the most common signs of plantar fasciitis is heel pain after long periods of rest. In the morning, the muscles in your feet might feel tight while lying in bed. Then, when you put your foot on the ground, it’s the worst kind of shooting, stabbing pain. So why does this happen? Why is heel pain worse in the morning?

The way people rest their feet in bed causes the plantar fascia ligament to tighten during sleep. This is the same reason you’re likely to experience heel pain after sitting for a while. The good news is the rest is probably helping your foot heal. Once you get up and walk around a bit, the tissue will stretch out and feel better.

How is plantar fasciitis diagnosed and treated?

Plantar fasciitis can be officially diagnosed by a podiatrist, a doctor who specializes in foot and ankle conditions. Fortunately, there are at-home treatments for plantar fasciitis that are very effective for managing and healing pain. These include investing in more supportive footwear, rest, hot and cold therapy, and targeted stretches and exercises.

Another thing that can help? Avoiding bare feet, even at home. Going barefoot puts additional strain on your feet. So, slip on supportive slippers or shoes instead.

If your heel pain gets worse or begins to impact daily activities, a podiatrist may recommend a cortisone injection. In more serious cases, surgery can be an option if conservative treatments have lost their effectiveness.

Other common heel pain causes

Achilles tendonitis

If you’re consistently experiencing pain above your heel, or in the back of your ankle during and after activity, Achilles tendonitis may be the cause.

This condition happens when the Achilles tendon becomes inflamed, usually due to overuse or when there is a big increase of frequency or intensity of exercise. This condition is especially common in runners.

You’ll likely notice a mild ache that gets more intense with continued activity. For example, you may experience tenderness or stiffness after long periods of rest or after working out. However, the pain usually starts getting better with mild activity or stretching throughout the day.

Like with other overuse injuries, the best treatment for Achilles tendonitis is usually rest, and avoiding or modifying activities to reduce strain. But if you have small tears in your Achilles tendon, there’s a chance you may need surgery.

If you think you have Achilles tendonitis, a podiatrist can give you an official diagnosis. They can also recommend additional treatments such as physical therapy, or wraps, braces or splints to reduce strain and help the tendon heal.

Haglund’s deformity

People with Haglund’s deformity have a bony enlargement on the back of their heel. Haglund’s deformity is often called the “pump bump” because it can be very common for people who wear high heels. However, any shoes with a rigid back, including men’s dress shoes and ice skates, can irritate the back of the heel.

Beyond the painful bump, symptoms of Haglund’s deformity include:

  • Pain in back of heel where your Achilles tendon attaches to your heel
  • Swelling in the back of your heel
  • Skin redness and inflammation on the back of your heel

One of the best things you can do to relieve any pain is to invest in supportive shoes that have soft backs. Taking over-the-counter anti-inflammatory medications and icing your heel can also help.

But it’s also a good idea to make an appointment with a podiatrist – especially since Haglund’s deformity can lead to another painful condition called bursitis.

Heel bursitis

Heel bursitis is another reason for pain in the back of your heel. Bursitis is inflammation of the bursa, which is a small sack of fluid that cushions and lubricates areas where the tissues rub against each other. You have bursae throughout your body, both in and on the joints that are at risk for rubbing and pressure. There are two types of heel bursitis, and they are related to the locations of specific fluid pockets.

  • Subcalcaneal bursitis – The calcaneal bursa is located between the Achilles tendon and the skin at the back of the heel. Calcaneal bursitis is often linked to Haglund’s deformity and usually comes from wearing ill-fitting shoes that dig into the back of the heel. Women who wear high heels or athletes who wear shoes with the wrong fit are at most risk for this type of inflammation. You may have calcaneal bursitis if you notice pain, redness and swelling on your heel that make it hard to put on your shoes.
  • Retrocalcaneal bursitis – The retrocalcaneal bursa is located between the heel bone and the Achilles tendon, just above where the Achilles tendon meets the heel bone. This type of bursitis happens after repeated irritation of the bursa and can be related to both Achilles tendonitis and Haglund’s deformity. It’s also common for those who have posterior calcaneal bone spurs, which may need to be surgically removed to get relief. You may have this type of bursitis if you have severe pain and swelling where the Achilles tendon joins the heel bone.

Bursitis treatments are similar to other heel conditions – rest, anti-inflammatory medications, and applying heat or ice packs. It’s also best to avoid activities that would make pain worse – like another round of tennis or slipping into uncomfortable shoes. If the pain doesn’t go away or if your heel is hot to the touch, talk to a podiatrist.

Heel fracture

It’s also possible to fracture the large bone of your heel called the calcaneus. Sometimes this happens suddenly, following a traumatic event. At other times, a heel fracture develops more slowly as a result of overuse.

Calcaneus fracture following a traumatic event

If you fracture your heel – for example, after a fall or jump from a great height or in a car accident – you’ll probably know it by the sudden pain you feel in your heel. To diagnose your condition, the doctor will do a physical examination and take X-rays to determine the severity of the problem, which will determine the type of treatment you need.

Heel fracture resulting from overuse

Stress fractures typically begin with a small hairline fissure in the bone, so pain can come on slowly.

Symptoms of a stress fracture can vary based on the location and the severity of the fracture. There’s a good chance you’ll experience heel pain when walking, but it may or may not go away while you’re resting. Pain may be more manageable in the morning and worse at night.

If you think you have a stress fracture in your heel, hold off on physical activity and try to limit the amount of weight you place on your heel. You’ll also want to make an appointment with a podiatrist. Without treatment, the pain will become more severe and possibly lead to a complete fracture.

The most uncommon cause of heel pain: Plantar bone spurs

Long-term, repetitive straining of the ligaments that connect your heel to your toes can cause a bone spur to develop on your heel. And actually, these bony growths form as your foot tries to heal itself.

Plantar bone spurs are relatively common – about one in 10 people have one. But only 5% experience foot pain because of bone spurs. If you have heel pain, it’s more likely from another condition, like plantar fasciitis. Many people with plantar fasciitis have plantar bone spurs.

Getting help for heel pain is a step in the right direction

If your heel is hurting, it wants your attention. There are a lot of ways to treat heel pain at home, including rest, ice or heat therapy, stretching and investing in supportive shoes. But if your pain continues, make an appointment with a podiatrist.

Podiatrists specialize in all things foot and ankle. They can treat certain conditions in the office, as well as recommend products, pain medications and therapies to help relieve or heal pain. Most are also foot and ankle surgeons who can provide more advanced care when needed.