Heel pain is one of the top reasons people visit a podiatrist, and for good reason — the heel absorbs more force per step than almost any other part of the foot. But not all heel pain is the same, and treating one condition as if it were another is a surefire way to stay stuck in a cycle of discomfort.
If you've been searching the internet and landed on "plantar fasciitis," you're not wrong that it's common — but it is far from the only answer. Here's a plain-English overview of the conditions that can cause heel pain, what distinguishes each, and why an accurate diagnosis matters so much.
Plantar Fasciitis — The Most Common Culprit
Plantar fasciitis accounts for roughly 80 percent of heel pain cases. It involves inflammation of the plantar fascia, the thick band of tissue that runs along the bottom of the foot from heel to toes. The hallmark symptom is sharp, stabbing pain at the bottom of the heel that is worst with the first steps out of bed in the morning, eases slightly after moving around, then returns after prolonged sitting or at the end of a long day on your feet.
Achilles Tendonitis
The Achilles tendon connects the calf muscles to the back of the heel bone. When it becomes irritated from overuse or sudden increases in activity, pain concentrates at the back of the heel or just above it. The area is often tender to the touch, and you may notice stiffness first thing in the morning. Unlike plantar fasciitis, the pain is at the rear of the heel rather than the bottom. Persistent Achilles or rear-foot pain is also addressed through our ankle pain services.
Heel Spur Syndrome
Heel spurs are calcium deposits that form on the underside of the heel bone, often as a result of long-standing plantar fasciitis. The spur itself may not cause pain — many people have spurs and feel nothing — but the surrounding inflamed tissue does. The symptoms overlap significantly with plantar fasciitis, and both conditions are often present simultaneously.
Stress Fractures
A stress fracture of the calcaneus (heel bone) results from repetitive impact that the bone cannot adequately handle — common in runners who have increased mileage too quickly or in those with lower bone density. Unlike the diffuse ache of fasciitis, a heel stress fracture produces pain that is localized to a specific spot and intensifies sharply with weight-bearing. Squeezing the heel from both sides often reproduces the pain. X-rays may miss early fractures, and an MRI is sometimes needed for a definitive diagnosis.
Retrocalcaneal Bursitis
A small fluid-filled sac (bursa) sits between the Achilles tendon and the heel bone. When it becomes inflamed — from friction, pressure from stiff shoes, or repetitive ankle movement — it causes pain and swelling directly at the back of the heel. This condition is sometimes confused with Achilles tendonitis because of its location, but the treatment approach differs.
Tarsal Tunnel Syndrome
Just as the wrist has a carpal tunnel, the ankle has a tarsal tunnel — a narrow passage through which the posterior tibial nerve travels. When that nerve is compressed or irritated, it can cause burning, tingling, or shooting pain that radiates into the heel, arch, or toes. Symptoms often worsen with prolonged standing and may be accompanied by numbness.
Sever's Disease (Children and Adolescents)
Despite the alarming name, Sever's disease is not a true disease but a growth plate irritation at the back of the heel. It is the most common cause of heel pain in active children and adolescents, typically between ages 8 and 14. During growth spurts, the heel bone can grow faster than the Achilles tendon, creating traction stress on the growth plate. Pain is typically felt at the back and bottom of the heel and worsens during sports.
Nerve Entrapment
Several branches of nerves run around the heel and can become entrapped by tight tissue, scar tissue, or anatomical variations. The medial calcaneal nerve and the first branch of the lateral plantar nerve are common culprits. Nerve entrapment pain often has a burning, electric, or shooting quality that distinguishes it from the mechanical ache of fasciitis.
Why Accurate Diagnosis Matters
Each of these conditions calls for a different treatment approach. Anti-inflammatory strategies, stretching, orthotics, physical therapy, injections, and in rare cases surgery all have different indications depending on the underlying cause. Treating Achilles tendonitis with the plantar fasciitis stretching protocol, for example, can actually make things worse. And missing a stress fracture entirely risks turning a healing bone injury into a complete fracture.
A podiatrist can perform a thorough physical examination, review your activity history, and order imaging when appropriate — giving you a clear diagnosis and a treatment plan built around what you actually have.
If heel pain has been limiting your activity or lingering beyond a few weeks, learn more about our heel pain treatment services or contact us to schedule an evaluation.
Big Sky Foot & Ankle treats heel pain at our Butte, Anaconda, and Bozeman locations. Montana residents don't have to live with chronic foot pain — help is closer than you think.