Why Does My Heel Hurt When I Walk? Common Causes and Treatments Gotham Footcare

Heel pain is one of the most common foot problems and can affect people of all ages. Because the heel is the first part of the foot to strike the ground when walking, it absorbs a tremendous amount of force with every step. When the heel becomes painful, walking can feel uncomfortable, limited, or even impossible. Many individuals dismiss heel pain as something that will pass on its own, but in reality, it often signals an underlying condition that needs attention. Whether caused by overuse, structural imbalances, or injury, heel pain can interfere with daily activities and quality of life. Understanding why your heel hurts when you walk is the first step toward finding effective relief.

The Role of the Heel in Walking

The heel plays a crucial role in supporting body weight and absorbing impact forces. The calcaneus, or heel bone, is the largest bone in the foot and forms the foundation for movement. Surrounding it are strong ligaments, tendons, and soft tissues such as the plantar fascia and Achilles tendon. Together, these structures distribute pressure, stabilize the foot, and allow for smooth transitions during walking. Each time the heel strikes the ground, it bears forces far greater than body weight, particularly when running or carrying heavy loads. Because of this constant demand, even minor problems in the heel can quickly turn into significant sources of pain.

Plantar Fasciitis

The most common cause of heel pain during walking is plantar fasciitis. The plantar fascia is a thick band of connective tissue that runs along the bottom of the foot from the heel to the toes. It helps maintain the foot’s arch and acts like a shock absorber. When the fascia is overstretched or develops small tears, inflammation occurs, leading to stabbing or sharp pain near the heel. This pain is typically most severe during the first steps in the morning or after sitting for long periods, and while it may ease with activity, it often returns after extended walking. Plantar fasciitis is frequently linked to improper footwear, overuse, flat feet, or obesity. Left untreated, it can become a chronic and debilitating condition.

Achilles Tendonitis

Another frequent cause of heel pain is Achilles tendonitis. The Achilles tendon connects the calf muscles to the heel bone and is the strongest tendon in the body. Despite its strength, it is prone to irritation and inflammation due to repetitive stress. When the tendon becomes inflamed, pain and stiffness appear at the back of the heel, especially after activity or first thing in the morning. Walking uphill, climbing stairs, or standing on tiptoe may worsen the discomfort. Athletes, runners, and people who suddenly increase their level of physical activity are particularly at risk. Without treatment, Achilles tendonitis can progress to tendon degeneration or even rupture, which requires surgical repair.

Heel Spurs

Heel spurs are small, bony growths that develop on the underside of the heel bone. They are usually associated with long-term strain on the plantar fascia, which pulls on the heel and causes calcium deposits to form. Many people with heel spurs have no symptoms, but when painful, they create a sensation similar to stepping on a sharp object. Pain often worsens during activity or prolonged standing, and in some cases, heel spurs coexist with plantar fasciitis, compounding the discomfort.

Bursitis

The heel contains fluid-filled sacs known as bursae that cushion the tendons, muscles, and bones. When these sacs become inflamed, a condition called bursitis develops. Heel bursitis produces aching pain and tenderness either at the back or underside of the heel. Walking or standing aggravates the discomfort, and swelling or redness may appear around the heel. Repetitive stress, poorly fitting shoes, and overuse are common causes of bursitis in the heel.

Stress Fractures

Stress fractures are tiny cracks in the heel bone that develop gradually due to repetitive impact. They are particularly common in athletes, military recruits, and individuals who increase physical activity too quickly. Unlike acute fractures, which occur suddenly, stress fractures cause persistent, deep pain that worsens with weight-bearing activities like walking. Rest usually brings temporary relief, but resuming activity often reactivates the pain. Without proper management, stress fractures can progress to complete fractures, significantly prolonging recovery.

Nerve Entrapment

Not all heel pain comes from bone or soft tissue problems. Nerve entrapment can also cause discomfort when walking. One example is tarsal tunnel syndrome, in which the tibial nerve becomes compressed near the ankle. This condition produces burning, tingling, or shooting pain that radiates into the heel and sometimes into the arch or toes. Unlike the stabbing pain of plantar fasciitis, nerve-related pain often feels electric or fiery. Walking, standing, or wearing tight shoes may make symptoms worse, and in severe cases, numbness may develop.

Arthritis

Arthritis is another possible source of heel pain, particularly in older adults. Osteoarthritis, caused by wear and tear of the joints, can affect the subtalar joint near the heel. This leads to stiffness, aching, and difficulty walking long distances. Inflammatory forms of arthritis, such as rheumatoid arthritis or psoriatic arthritis, may also involve the heel, producing swelling, warmth, and tenderness. Because arthritis is a chronic condition, heel pain related to it often requires ongoing management rather than short-term treatment.

Heel Pain in Children and Adolescents

While most adults associate heel pain with overuse or chronic conditions, children can also experience discomfort in this area. The most common cause in young people is Sever’s disease, a condition affecting the growth plate at the back of the heel. It usually occurs in children between ages eight and fourteen who participate in sports involving running and jumping. Pain appears during activity and improves with rest. Although temporary, it can interfere with participation in sports and physical activities until the growth plate closes.

Risk Factors for Developing Heel Pain

Several factors make individuals more likely to develop heel pain when walking. People with flat feet or very high arches place extra strain on the heel and plantar fascia. Those who wear shoes without adequate cushioning or arch support also increase their risk, especially if they spend long hours on their feet. Excess body weight contributes additional stress, amplifying the chances of developing pain. Occupations that require prolonged standing, such as teaching, nursing, or retail work, are also linked to higher rates of heel discomfort. Athletes and active individuals face risks due to repetitive strain and sudden increases in activity. Recognizing these risk factors helps explain why heel pain occurs and highlights the importance of prevention.

Diagnosing Heel Pain

Because heel pain has many potential causes, diagnosis requires a careful evaluation by a healthcare professional. A podiatrist or orthopedic specialist will begin by taking a detailed history of symptoms, activity levels, and footwear habits. During the physical examination, the doctor will assess tenderness, swelling, and foot structure, and may observe gait patterns while walking. Imaging tests such as X-rays can reveal bone spurs or fractures, while ultrasound and MRI scans are useful for identifying soft tissue injuries like plantar fascia tears or tendon inflammation. Accurate diagnosis ensures that treatment targets the correct underlying problem, improving the chances of successful recovery.

Treatment Options

Treatment for pain varies depending on the underlying cause, but most cases improve with conservative measures. Rest is usually the first step, as reducing weight-bearing activities allows inflamed tissues to recover. Applying ice for short intervals several times a day can decrease swelling and discomfort. Over-the-counter anti-inflammatory medications such as ibuprofen may provide additional relief, especially in cases of plantar fasciitis, bursitis, or tendonitis.

Supportive footwear plays an essential role in managing pain. Shoes with good cushioning and proper arch support help redistribute pressure across the foot, easing strain on the heel. In some cases, custom orthotics designed by a podiatrist are recommended to correct biomechanical imbalances. Stretching exercises for the calves, Achilles tendon, and plantar fascia are another key component of treatment. Gentle stretching improves flexibility, reduces tension on the heel, and prevents recurrent injury. Physical therapy programs often combine stretching with strengthening exercises, massage, and other modalities to promote healing.

Night splints can benefit individuals with chronic plantar fasciitis. These devices keep the foot in a slightly stretched position while sleeping, preventing the plantar fascia from tightening overnight. For stubborn cases that do not respond to basic measures, corticosteroid injections may be used to reduce inflammation and provide temporary pain relief. Platelet-rich plasma injections, which use the patient’s own healing factors, are sometimes offered as an alternative treatment.

In more advanced cases, other interventions may be considered. Shockwave therapy uses sound waves to stimulate blood flow and promote tissue repair in chronic plantar fasciitis. Surgery is generally reserved for rare cases that do not respond to months of conservative treatment, such as severe plantar fascia tears or persistent heel spurs.

Preventing Heel Pain

Prevention is an important aspect of managing heel health. Wearing well-fitted shoes that provide proper support and cushioning helps reduce stress on the heels during daily activities. Maintaining a healthy weight also decreases the load on the feet. Incorporating regular stretching and strengthening exercises into a daily routine can improve flexibility and resilience in the foot and calf muscles. Gradually increasing physical activity rather than making sudden changes helps the feet adapt to new stresses. Paying attention to early signs of heel discomfort and addressing them promptly prevents minor issues from turning into chronic conditions.

When to Seek Medical Help

While many cases of heel pain improve with self-care, persistent or severe pain should not be ignored. If heel discomfort lasts more than a few weeks despite rest and home treatment, or if the pain is sharp, sudden, or accompanied by swelling and bruising, medical evaluation is recommended. Difficulty bearing weight on the foot or numbness and tingling in the heel also warrant professional assessment. Early intervention can prevent complications and promote faster recovery.

Conclusion

Heel pain when walking is a common but disruptive problem that can arise from many different causes. Conditions such as plantar fasciitis, Achilles tendonitis, heel spurs, bursitis, stress fractures, nerve entrapment, and arthritis all play a role in heel discomfort. Risk factors like poor footwear, excess weight, and repetitive strain increase the likelihood of developing pain. Fortunately, most heel problems respond well to conservative treatments such as rest, supportive footwear, stretching, and physical therapy. More advanced therapies like injections or shockwave therapy are available for stubborn cases. Prevention through proper footwear, healthy weight management, and gradual activity increases remains essential. Recognizing the signs of heel pain early and seeking appropriate care helps ensure that walking remains comfortable and pain-free. Call the Gotham Footcare team today at (212) 921-7900!