Why Does My Heel Hurt? A Houston Podiatrist’s Guide to Heel Pain Causes and Treatments
Heel pain is one of the most common reasons patients seek podiatric care — and one of the most frequently misunderstood. Many people assume that heel pain is simply an inevitable part of aging, or that the only solution is surgery. Neither is true. The vast majority of heel pain conditions respond well to conservative, non-surgical treatment when properly diagnosed and addressed early. The key is understanding what’s causing your pain, which is not always as simple as it seems.
At In Motion Foot & Ankle in Houston, TX, heel pain is one of the most common conditions we treat. Here’s what you need to know about its most common causes — and what modern podiatric care can do about it.
Plantar Fasciitis: The Most Common Cause
When podiatrists talk about heel pain, plantar fasciitis is almost always the first condition on the differential. It accounts for approximately 11% to 15% of all foot symptoms requiring professional medical care according to the National Institutes of Health, and affects roughly 1 in 10 people at some point in their lives. The condition involves degenerative micro-tearing of the plantar fascia — the thick band of connective tissue that runs along the bottom of the foot from the heel bone to the base of the toes — at the point where it attaches to the heel.
The hallmark symptom is sharp, stabbing pain on the bottom of the heel that is worst with the first steps in the morning or after periods of rest, and tends to ease somewhat with continued movement. Biomechanical risk factors include flat feet and overpronation, tight calf muscles, high arches, obesity, and occupations that require prolonged standing on hard surfaces. Runners are particularly susceptible — published research in PMC places plantar fasciitis prevalence among runners as high as 22%.
At In Motion Foot & Ankle, we confirm plantar fasciitis with in-office diagnostic ultrasound, which allows us to directly visualize the fascia, measure its thickness, and identify areas of degeneration. Treatment is staged and evidence-based: stretching protocols, custom orthotics to correct biomechanical contributors, night splinting, laser therapy for inflammation and tissue repair, and — for resistant cases — advanced interventions including corticosteroid injections, platelet-rich plasma (PRP), or surgical plantar fascia release.
Heel Spurs: The Misunderstood Companion
Heel spurs are calcium deposits that develop on the underside of the heel bone in response to chronic pulling of the plantar fascia at its attachment point. They are frequently found on X-ray in patients with plantar fasciitis — but they are widely misunderstood as the cause of pain. In reality, heel spurs themselves rarely generate pain directly. Many people have large heel spurs visible on X-ray with no discomfort whatsoever. The pain of “heel spur syndrome” originates in the inflamed and degenerated fascia, not the spur itself.
This distinction matters for treatment. Removing a heel spur surgically — once a common recommendation — does not address the underlying fascial pathology and is rarely necessary. Treating the fascial inflammation and correcting the biomechanical factors that created the stress in the first place is the appropriate approach.
Sever’s Disease: The Cause of Heel Pain in Children
In children and adolescents — particularly those aged 8 to 14 who participate in running or jumping sports — heel pain has a distinctly different most-common cause: Sever’s disease, also known as calcaneal apophysitis. This condition involves irritation of the growth plate at the back of the heel from the tension of the Achilles tendon during periods of rapid skeletal growth. It is the most common cause of heel pain in this age group and is entirely distinct from plantar fasciitis.
Despite its alarming-sounding name, Sever’s disease causes no permanent damage when managed appropriately. The National Institutes of Health confirms that growth plate-related pain in this condition resolves once the growth plate matures. Treatment focuses on activity modification, calf stretching, heel cups, and in some cases custom orthotics. If your child is complaining of heel pain during or after sports, a podiatric evaluation is important — don’t dismiss it as growing pains.
Achilles Tendonitis: Heel Pain from the Back
While plantar fasciitis causes pain on the bottom of the heel, Achilles tendonitis presents as pain, stiffness, and swelling at the back of the heel and lower calf. The Achilles tendon — the largest tendon in the body — connects the calf muscles to the heel bone and transmits the force of every step. Repetitive overloading, sudden increases in training intensity, tight calf muscles, and poor footwear all contribute to tendon degeneration over time.
Early-stage Achilles tendonitis responds well to eccentric stretching exercises, load modification, custom orthotics (particularly heel lifts during the acute phase), and laser therapy. More advanced cases — particularly insertional Achilles tendinopathy with associated calcification — may require a more aggressive treatment approach. The key is not waiting until the pain becomes debilitating.
Other Causes: Stress Fractures, Nerve Entrapment, and Arthritis
Not all heel pain is plantar fasciitis. Baxter’s nerve entrapment (compression of the first branch of the lateral plantar nerve) produces heel pain that can mimic plantar fasciitis but responds differently to treatment. Stress fractures of the calcaneus — caused by repetitive impact loading — present with diffuse heel pain that worsens with activity and is reproduced by compressing the heel from both sides. Inflammatory arthritis, gout, and systemic conditions can also produce heel symptoms.
This is precisely why accurate diagnosis — using in-office digital X-rays and diagnostic ultrasound — is so important before treatment begins. Treating the wrong condition with the wrong protocol wastes time and delays real relief.
Getting the Right Diagnosis and Treatment in Houston, TX
If you’ve been living with heel pain — whether it’s been two weeks or two years — the first step is an accurate diagnosis from an experienced podiatric team. At In Motion Foot & Ankle, we use same-visit imaging to identify your specific condition and build a personalized treatment plan designed to address the root cause, not just the symptom. Call us at (281) 955-5500 or visit our New Patients page to schedule your appointment. Relief is closer than you think.
