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Heel Pain: Plantar Fasciitis & Heel Spurs

Plantar fasciitis is one of the most common causes of heel pain — the classic sign is a sharp ache with your first steps in the morning. Heel spurs often show up on X-rays but usually aren’t the cause of the pain. Most people get better with simple, patient home care and stretching.

Get urgent care right away if:

  • You felt a sudden pop or snap at the back of your heel or calf, then severe pain and swelling. This can mean a torn (ruptured) Achilles tendon; you may not be able to walk on that leg or stand on your toes (AAOS OrthoInfo). See a doctor immediately (AAOS OrthoInfo, NHS).
  • You can’t walk or bear weight, can’t walk on tiptoe, or the foot looks misshapen after an injury — possible signs of a broken heel bone or ankle. Don’t treat a possible broken heel yourself (NHS).
  • Your heel is red, hot and swollen and you have a fever or chills. Hot, swollen, painful skin can be cellulitis, which needs prompt treatment, and with a very high temperature NHS advises emergency care (NHS). Bone infections also cause fever, warmth, redness and swelling, and are more likely with diabetes or poor circulation (MedlinePlus).
  • You have diabetes and any wound, crack or blister on your heel. Seek podiatric care immediately for a foot ulcer; because feeling is often reduced, pain may be absent and drainage on your sock may be the first sign (APMA). Call your provider right away about a sore that doesn’t start to heal within a few days, or skin that turns red, warm or painful (NIDDK).

Contact your provider promptly (usually not an emergency) for numbness, tingling or loss of feeling in your foot, or any heel pain if you have diabetes (NHS). Diabetes-related nerve damage can cause numbness and tingling, so injuries go unnoticed (MedlinePlus); see our diabetes guide. Don’t wait for a chiropractic, acupuncture, massage or coaching appointment for any of these signs.

Why heels hurt

Heel problems are common. Often they come from too much stress on the heel bone and nearby tissues — injuries, bruising from walking, running or jumping, poorly fitting shoes, or extra body weight. Treatment is usually rest, medicines, exercises, taping and special shoes; surgery is rarely needed (MedlinePlus). Pain can be at the front, back or bottom of the heel (APMA). For problems elsewhere in the foot, see our foot pain guide.

Plantar fasciitis: the most common cause

The plantar fascia is a strong band of tissue along the sole, from the heel to the front of the foot, that supports the arch. Plantar fasciitis happens when it becomes irritated and inflamed, often after too much pressure strains or tears it (AAOS OrthoInfo). AAOS calls it one of the most common causes of pain under the heel and says approximately 2 million patients are treated for it every year (AAOS OrthoInfo). The American Physical Therapy Association (APTA), in its 2023 guideline on heel pain (PubMed abstract), says it accounts for approximately 15% of foot problems in the general population and is most common between ages 40 and 60 (APTA clinical practice guideline, 2023).

The classic sign is first-step pain: pain under the heel that is worst with the first steps after getting out of bed or after a long rest, and eases after a few minutes of walking. It tends to hurt more after activity than during it (AAOS OrthoInfo), and stretching the sole — raising your toes or climbing stairs — can hurt (NHS).

Risk factors include new or increased activity; running, dancing and other high-impact sports; standing for long periods on hard surfaces; flat feet or a high arch; tight calf muscles; and obesity (AAOS OrthoInfo). Shoes with poor cushioning or support also play a part (NHS), and APTA adds limited ankle motion and weight-bearing work (APTA CPG, 2023). Often there is no clear reason (AAOS OrthoInfo).

Heel spurs: common on X-rays, often not the cause

A heel spur is a bony growth under the heel bone, visible on X-ray (APMA). It can form after years of pull where the plantar fascia attaches. But most people who have heel spurs do not have heel pain, spurs don’t cause plantar fasciitis pain, and the pain can be treated without removing the spur (AAOS OrthoInfo). Spurs are common with age: in a study of 216 people aged 62 to 94, 55% had at least one, and spurs were linked with obesity, osteoarthritis and heel pain (Menz et al., 2008). In adults aged 50 and over, spurs often occurred together with a thickened plantar fascia, and spurs on their own were rare (Menz et al., 2019). So a spur on an X-ray is a clue, not a diagnosis. For spurs elsewhere, see our bone spurs guide.

Pain at the back of the heel: Achilles tendinitis

The Achilles tendon joins the calf muscles to the heel bone. In insertional Achilles tendinitis, the tendon hurts where it attaches to the heel, often with bone spurs at the back of the heel; tight calves are a frequent cause. It brings morning stiffness, pain that worsens with activity, and pain against the back of your shoes (AAOS OrthoInfo). Our ankle guide covers Achilles problems further, and an MBHA Tendonitis guide is on the way.

Other causes

How it’s diagnosed

Usually a history and exam are enough. The doctor checks for the tender spot just in front of the heel bone, your arch shape and ankle motion, and signs of other causes such as Achilles problems, a stress fracture or a trapped nerve (AAOS OrthoInfo). X-rays help rule out fractures or arthritis; MRI and ultrasound are rarely needed unless another problem is suspected (AAOS OrthoInfo). APTA says imaging usually isn’t needed unless conservative care fails, and nerve tests can help sort out nerve causes (APTA CPG, 2023).

See a provider soon (not an emergency) if heel pain is severe, stops your normal activities, keeps coming back, or hasn’t improved after 2 weeks of home care (NHS).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Rest and activity changes, calf and plantar fascia stretching, supportive shoes, heel pads and inserts, night splints, ice, NSAIDs, physical therapy; injections or shock-wave therapy if pain lasts; surgery rarely. Physical therapy about $50–$350+ a session without insurance ($10–$75 copay with); Medicare Part B covers medically necessary PT (20% after the deductible). Other costs being researched. More than 90% of people with plantar fasciitis improve within 10 months of starting simple treatment. Steroid shots carry real risks, including rupture of the fascia.
Chiropractic Joint mobilization or manipulation of the foot and ankle and soft-tissue work, usually with stretching — never on a possible fracture or torn tendon. About $50–$200 a visit without insurance ($15–$75 with); first evaluations $100–$250. Physical therapy guidelines strongly support manual therapy as part of care; research on chiropractic care specifically is limited and mostly short-term.
Acupuncture Fine needles at acupuncture points; dry needling of tight muscle “trigger points” in the calf and foot is a related technique used by some physical therapists. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Reviews suggest short-term pain relief; dry needling has a moderate guideline recommendation, with temporary soreness common. Extra caution with diabetes.
Herbal medicine No herb is shown to treat plantar fasciitis or dissolve spurs. Anti-inflammatory gels are a medicine option; arnica gel is sometimes tried. Cost estimate being researched. We found little research on herbs for heel pain. Check any herb or supplement for drug interactions.
Massage therapy Self-massage by rolling the sole over a cold water bottle; soft-tissue mobilization and massage as part of physical therapy. Private therapists about $60–$120 for 45–60 minutes; massage-school clinics about $30–$40 an hour. May ease pain and tightness alongside stretching; massage on its own has limited evidence.
MBHA Wellness Coach A daily stretching routine, supportive shoes (no bare feet on hard floors), gradual training changes, weight, standing-job strategies and patience. Cost estimate being researched. Supports — never replaces — medical care. Steady daily habits are the backbone of recovery, which can take months.

Approach 1 of 6

Conventional medicine (AMA)

Nearly all heel pain is treated without surgery. AAOS says more than 90% of people with plantar fasciitis improve within 10 months of starting simple treatments (AAOS OrthoInfo) — steady daily care matters more than any single treatment.

First-line care

If pain lasts several months

  • Steroid (cortisone) injections — with caution. They can reduce pain, but they can weaken the plantar fascia and lead to a rupture that flattens the foot and causes chronic pain, so doctors may limit or avoid them (AAOS OrthoInfo). APTA lists possible harms including a painful flare, fat pad atrophy (thinning of the heel’s cushion), nerve injury and fascia rupture (APTA CPG, 2023). Injections into the Achilles tendon are not recommended because they can make it tear (AAOS OrthoInfo).
  • Shock-wave therapy (ESWT) uses sound-wave pulses to stimulate healing. Results are mixed, but it is low-risk and sometimes tried before surgery (AAOS OrthoInfo, NHS). Platelet-rich plasma (PRP) injections need more research and can be expensive (AAOS OrthoInfo).
  • Surgery, rarely — generally only after 12 months of aggressive nonsurgical treatment. A partial release of the fascia or lengthening of a tight calf muscle may be done; the spur usually isn’t removed, since it doesn’t cause the pain. Surgery can leave chronic pain, so it comes only after all other options (AAOS OrthoInfo).

What it costs

  • Physical therapy: about $50–$350 or more a session without insurance, or a $10–$75 copay or 10%–50% coinsurance with it (CostHelper). Medicare Part B covers medically necessary outpatient PT; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • Office visits, X-rays, inserts, splints, injections, ESWT and surgery: MBHA cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Some chiropractors treat heel pain with mobilization or manipulation of the foot and ankle joints, soft-tissue work on the calf and sole, and stretching.

What the research says

Safety and cost

Mild soreness or stiffness after manipulation is common and usually passes within 24 hours; serious problems are very rare (NCCIH). MBHA advises having a sudden “pop” or possible stress fracture checked by a doctor before any hands-on treatment (AAOS OrthoInfo, AAOS OrthoInfo). Visits cost about $50–$200 without insurance and $15–$75 with it; first evaluations about $100–$250 (MedicalCostInfo).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture uses fine needles at specific points. Dry needling, often done by physical therapists, places needles into tight, tender spots in muscles (“trigger points”).

What the research says

Safety and cost

Complications are relatively few; they have come from non-sterile needles and poor technique, and the FDA requires sterile, single-use needles (NCCIH). With diabetes, numb feet may not feel an injury (MedlinePlus); as a precaution, MBHA suggests telling your practitioner, avoiding needles in numb, broken or infected skin, and checking your feet afterward. A first private visit costs about $125–$230 and follow-ups $90–$185; community clinics about $50–$90 (The Pricer). Dry needling is usually part of a PT visit.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb has been shown to treat plantar fasciitis or dissolve heel spurs, and we found little research on herbal remedies for heel pain. Spurs usually aren’t the source of the pain anyway (AAOS OrthoInfo).

Anti-inflammatory gels

Not herbal, but often the first thing to try: NHS suggests ibuprofen gel before tablets (NHS). APTA says physical therapists may use ultrasound to help ketoprofen gel soak in (a weaker grade C recommendation) (APTA CPG, 2023). Ask a pharmacist which product suits you. We don’t list doses.

Arnica gel

A few trials suggest topical arnica may help osteoarthritis, but one small study found it increased pain after calf exercises, and heel pain isn’t among its studied uses. It can irritate the skin, shouldn’t be used if you’re allergic to sunflowers, marigolds or ragweed, may raise bleeding risk with blood thinners such as warfarin, and is harmful taken by mouth (Memorial Sloan Kettering).

Herbs and your other medicines

Ginkgo taken with warfarin is linked to a higher risk of major bleeding, and St. John’s wort has a high overall risk of drug interactions (NCCIH). Tell your doctor or pharmacist about every herb and supplement you use, especially if you also take an NSAID.

Approach 5 of 6

Massage therapy

Soft-tissue work can ease tight calves and a sore sole, and massage can be part of a physical therapy program for heel pain (AAOS OrthoInfo).

Self-massage at home

Rolling your foot over a cold water bottle combines ice and massage (AAOS OrthoInfo). Keep it gentle, and stop if the pain sharpens.

What the research says

APTA counts soft-tissue mobilization and massage as forms of manual therapy, which it recommends as part of care (APTA CPG, 2023). Evidence for massage on its own is limited: in one small trial in the guideline, self-stretching did better than foam rolling on some measures of calf tenderness, with no difference in pain scores (APTA CPG, 2023), and in another small study, friction massage of the fascia plus calf stretching did best of three approaches, with no untreated comparison group (Yelverton et al., 2019).

Safety and cost

Massage is low-risk, but rare serious problems — a blood clot, nerve injury or broken bone — have been reported, sometimes with vigorous deep-tissue work or in older adults (NCCIH). MBHA suggests skipping massage on a heel that is red, hot, swollen or possibly fractured, and never massaging over cracks or sores if you have diabetes. Private therapists charge about $60–$120 for 45–60 minutes; massage-school clinics about $30–$40 an hour (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Heel pain usually improves through small things done every day. An MBHA Wellness Coach can help you build those habits, alongside — never instead of — your medical care.

Another approach

Stretches and daily habits that help

These are the stretches AAOS describes for plantar fasciitis. Ask your doctor or physical therapist whether they suit you, and stop if they cause sharp pain.

  • Calf stretch. Lean against a wall with one knee straight and that heel on the ground, the other leg in front with the knee bent, and push your hips toward the wall until you feel a strong pull in the calf (AAOS OrthoInfo).
  • Plantar fascia stretch. Sitting, cross the sore foot over the other knee and slowly pull your toes toward you (a towel around the big toe helps); you should feel a tight band along the sole. Best done in the morning, before standing (AAOS OrthoInfo).
  • AAOS describes holding each stretch for 10 seconds and repeating it 20 times for each foot (AAOS OrthoInfo).
  • For Achilles pain, heel-drop exercises off a step are only for pain in the middle of the tendon — not where it meets the heel — and should be learned with a physical therapist (AAOS OrthoInfo).

Every day: rest and raise your foot when you can, use soft insoles or heel pads (NHS), choose low-impact exercise such as swimming (NHS), and replace athletic shoes before they wear out (AAOS OrthoInfo). NHS offers free exercise videos on its heel pain page (NHS).

Another approach

Heel pain in children

Sever’s disease (calcaneal apophysitis) is one of the most common causes of heel pain in growing children. It is irritation of the growth plate at the back of the heel, where the Achilles tendon attaches, from repeated stress — most often during growth spurts and in children who run and jump, though less active teens in very flat shoes can get it too (AAOS OrthoInfo).

  • Signs: heel pain, tenderness and mild swelling, often after sports, sometimes in both heels (AAOS OrthoInfo).
  • Diagnosis: the doctor presses on the heel and may watch your child walk, run or jump; X-rays may rule out a fracture (AAOS OrthoInfo).
  • Treatment: rest from painful activity, heel pads in sports shoes, a slightly raised heel, NSAIDs such as ibuprofen, then calf stretches and leg strengthening; sometimes a walking boot. A child without much pain or a limp may keep playing (AAOS OrthoInfo). Ask your child’s doctor about any medicine.
  • Outlook: it can return when sports pick up, but not once the child is fully grown (AAOS OrthoInfo).

A child with heel pain after a fall, a limp that doesn’t improve, or a red, hot, swollen heel with fever should be seen promptly — see the warning signs at the top of this page.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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