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Medically reviewed guide · Last updated: 23 July 2026 · Reading time: approx. 9 min.
Heel pain: spotting the causes and easing it effectively
At a glance
What is it?Pain in the heel — usually on the underside (sole) or at the back near the Achilles tendon, often caused by overloading of the connective tissue
Usually harmless?Yes — the most common cause (plantar fasciitis) is benign and usually improves with stretching, taking the load off and patience
Warning signsA red, overheated heel with fever, or a sudden whip-like pain with loss of strength — seek immediate assessment
Key distinctionPlantar fasciitis (sole) vs. Achilles tendon problem (back) vs. heel spur — where the pain sits tells you a lot
Typical markerThe most intense pain during the first steps in the morning after getting up points to plantar fasciitis
Understand and document your heel pain
Record how your pain develops, its triggers and your stretching exercises in brite — a clear overview that is worth its weight in gold at your doctor's appointment. Free of charge.
Heel pain is discomfort in the area of the heel bone — the largest bone in the foot, which cushions your entire body weight with every step. The pain can sit on the underside of the heel (on the sole of the foot), at the back of the heel (in the area of the Achilles tendon) or on the side. Exactly where it hurts is the most important clue to the cause.
In the vast majority of cases, the underlying reason is an overload of connective tissue, tendons or muscles — not the bone itself. Heel pain is very common: almost one in ten people is affected at some point in life. It particularly tends to hit people who stand or walk a lot, exercise unusually intensely or wear unsuitable footwear.
The most important point first
By far the most common cause is plantar fasciitis — an irritation of the tendon plate on the sole of the foot. It is benign and usually heals, but often needs weeks to months of patience. What matters is where the pain sits and when it is most intense.
2. The three most common causes
To help you better classify your heel pain, it is worth clearly telling apart the three most common causes. They differ above all in the location and the pattern of the pain.
Cause
Where does it hurt?
Typical pattern
Plantar fasciitis
Underside of the heel, towards the sole of the foot
Stabbing pain during the first steps in the morning, eases once you have warmed up
Achilles tendonproblem
At the back of the heel, above the heel bone
Pain and stiffness of the tendon, often after exertion; the tendon may be thickened or tender to pressure
Heel spur
Usually on the sole, at the attachment of the tendon plate
A bony outgrowth — often a consequence, not the cause, of the irritation; frequently causes no symptoms at all
Table scrollable to the right
An important misunderstanding concerns the heel spur: the bony spur on the X-ray is usually not the actual source of the pain. Many people have a heel spur with no symptoms at all. The pain generally comes from the irritated tendon plate (plantar fasciitis), which attaches at the same point. That is why treatment almost always targets the irritation of the connective tissue and not the spur itself.
Less commonly, other causes lie behind heel pain — for instance inflammatory-rheumatic conditions, a gout attack, a stress fracture in athletes or irritation of the heel fat pad. General joint involvement, as in osteoarthritis, can also play a role. These cases need medical assessment.
3. Morning pain as a marker
There is one detail that is particularly helpful for classification: the pain during the first steps in the morning. If, when getting out of bed, you take your first step and feel a stabbing pain on the sole of the foot near the heel that eases after a few metres of "warming up", you very likely have plantar fasciitis.
The reason: overnight, the tendon plate on the sole of the foot contracts slightly while at rest. The first step stretches it abruptly — this irritates the already irritated tissue and causes the typical "start-up pain". The same often happens after sitting for a long time, for example after a long car journey. Once you have been moving for a while, the tissue becomes more supple and the pain subsides.
Recognising start-up pain
The classic morning pain on the sole of the foot points strongly to plantar fasciitis. If, on the other hand, the pain sits at the back of the heel and affects a stiff, thickened tendon, this suggests an Achilles tendon problem instead.
4. Self-check: pinpointing the pain
Before you see a doctor, you can already observe quite a lot yourself. These questions help you and the practice narrow down the cause.
Where exactly does the pain sit? On the sole of the foot under the heel, at the back near the tendon or on the side?
When is it most intense? In the morning during the first steps, after exertion or constantly?
Feel for the pressure point: Can you feel a clear painful spot, for example in the middle of the heel sole?
Check for triggers: New shoes, unaccustomed exercise, more walking, weight gain recently?
Accompanying signs: Is the heel red, overheated or swollen? Is there a fever? That would be a warning sign.
A simple pain and activity log helps to spot patterns: on which days is it worse, which shoes or activities make it worse? Precisely this information makes the diagnosis easier later on.
Your pain history always with you
With brite you record your pain, its triggers and your stretching exercises — the best basis for the practice to quickly get to the root of the cause.
Heel pain often improves with patience and the right measures. But there are situations in which you should have it assessed or act immediately.
You should have it assessed by a doctor promptly if the pain is severe, does not get better after several weeks despite rest and stretching, keeps recurring or noticeably restricts you in everyday life. Early assessment is also sensible if you have a known underlying condition such as diabetes, rheumatism or gout.
Seek medical assessment immediately — in an emergency call 112
If the heel is red, overheated and swollen, especially together with fever (possible infection or gout attack). Likewise with a sudden, whip-like pain in the Achilles tendon with loss of strength, when you can no longer stand on tiptoe (possible Achilles tendon rupture). Numbness in the foot should also be examined by a doctor quickly.
6. Diagnosis
To find the cause, a conversation and a targeted examination of the foot are often enough for the practice. Imaging is only needed in certain cases.
Standing on tiptoe, flexibility of the calf and Achilles tendon, gait pattern
Ultrasound
Thickening of the tendon plate or the Achilles tendon, signs of inflammation
X-ray
If a heel spur, bone changes or a stress fracture is suspected
Blood test
If rheumatism, gout (uric acid) or an inflammation is suspected
Table scrollable to the right
Because plantar fasciitis follows such a typical course, the practice usually makes the diagnosis from the description and the palpation findings alone. A well-kept pain log — when, where, how severe, which trigger — makes the classification even easier.
7. What you can do yourself
With plantar fasciitis in particular, you can achieve a lot yourself. Patience is important: the irritation needs time, but a consistent self-help routine makes clear progress for most people.
Stretch the calf muscles and sole of the foot: Stand with your toes on a step and let your heel slowly sink downwards — hold the stretch for 20 to 30 seconds, several times a day. In addition, stretch the sole of the foot by pulling your toes back with your hand.
Fascia rolling: Gently roll the sole of the foot over a spiky ball or a chilled bottle for one to two minutes several times a day — this loosens the irritated tendon plate.
Adjust the load: Temporarily cut back on high-impact sports (running, jumping) and switch to cycling or swimming.
Pay attention to good footwear: Stable shoes with a slightly raised heel and good cushioning take the strain off the heel. Avoid flat, hard soles and constant barefoot walking on hard ground.
Insoles and heel pads: Soft heel cushions or individually fitted insoles can noticeably reduce the pressure.
Cooling and, if needed, painkillers: Cooling eases the irritation. In the short term, anti-inflammatory medicines such as Ibuprofen or Diclofenac can help — please only briefly and after consulting your doctor or pharmacy.
Keep an eye on your weight: Every kilo less takes strain off the heel with every step.
Stick with your stretching routine, see your progress
brite helps you document stretching exercises, pain and triggers over time — free of charge and ad-free.
Heel pain often improves slowly — which is exactly what makes it hard to stay on track and recognise progress. Recording your pain, triggers and exercises over time gives the practice the crucial clues and keeps you motivated. brite makes that easy.
Health history — document pain intensity, location, possible triggers (shoes, load, exercise) and your stretching exercises over time, and bring an overview to your appointment. Track your history
Intake reminder — if anti-inflammatory medicines are prescribed for a limited time, brite reliably reminds you to take them. Set up a reminder
Interaction check — checks whether painkillers such as Ibuprofen or Diclofenac combine unfavourably with your other medicines. Check now
Digital medication plan — all your medicines clearly in one place for your GP, orthopaedics and pharmacy. Go to medication plan
Overnight, the tendon plate on the sole of the foot contracts slightly while at rest. The first step in the morning stretches it abruptly and irritates the already irritated tissue — this causes the typical stabbing start-up pain. After a few steps the tissue becomes more supple and the pain subsides. This pattern points strongly to plantar fasciitis.
Plantar fasciitis is an irritation of the tendon plate on the sole of the foot and the actual source of the pain. The heel spur is a bony outgrowth at the attachment of this tendon plate, which often develops as a consequence. Many people have a heel spur with no symptoms at all — which is why treatment almost always targets the irritated tendon plate and not the spur itself.
The location is decisive: with plantar fasciitis the pain sits on the underside of the heel towards the sole of the foot and is most intense in the morning. An Achilles tendon problem makes itself felt at the back of the heel above the heel bone, often with a stiff, thickened tendon that is tender to pressure. With a sudden, whip-like pain with loss of strength in the Achilles tendon, you should seek medical help immediately.
Plantar fasciitis is benign, but needs patience. With consistent stretching, taking the load off and good footwear, the symptoms improve over weeks to a few months in most people. It is important to stick with the stretching routine, even if things improve in between. If the pain persists over months despite consistent measures, the practice should look into further options.
Stretching the calf muscles has proven effective: stand with your toes on a step and let your heel slowly sink downwards, hold for 20 to 30 seconds. In addition, stretch the sole of the foot by pulling your toes towards you with your hand. Gently rolling the sole of the foot over a spiky ball or a chilled bottle further loosens the irritated tendon plate. Practise several times a day.
Good options are stable shoes with a slightly raised heel, a cushioned sole and sufficient support for the heel. Unfavourable are flat, hard soles, worn-out shoes and constant barefoot walking on hard ground. Soft heel pads or individually fitted insoles can further reduce the pressure on the irritated spot.
Anti-inflammatory painkillers such as Ibuprofen or Diclofenac can ease the symptoms in the short term, especially in the acute phase. However, they do not treat the cause — stretching, taking the load off and good footwear remain crucial. Only take such medicines briefly and after consulting your doctor or pharmacy, especially if you have stomach, kidney or cardiovascular problems.
Have it assessed if the pain is severe, does not get better after several weeks despite rest and stretching, keeps recurring or noticeably restricts you. You need immediate medical help with a red, overheated heel with fever, with a sudden whip-like pain with loss of strength in the Achilles tendon, or with numbness in the foot.
Yes. More body weight means a higher load on the tendon plate on the sole of the foot with every step and thus favours plantar fasciitis. Prolonged standing, unusually intense exercise and shortened calf muscles also increase the risk. Losing weight takes strain off the heel and, together with stretching and good footwear, supports healing.
German Society for Orthopaedics and Trauma Surgery (DGOU): Guidelines on foot and heel complaints. dgou.de
German Society for Orthopaedics and Orthopaedic Surgery (DGOOC): Plantar fasciitis and Achilles tendon complaints. dgooc.de
This article is for general information and does not replace medical advice, diagnosis or treatment. With a red, overheated heel with fever or a sudden whip-like pain with loss of strength, please seek medical help without delay — in an emergency call 112.
