Heel Pain in Athletes – What’s Behind It?

When your heel starts to hurt…

Heel pain can be frustrating - it often starts gradually and makes training uncomfortable. For athletes and active people, it’s one of the most common complaints I see in clinic.

Let’s look at the main possible causes and what you can do about them.

1. Plantar Fasciitis

• What it is: Micro tears of the plantar fascia (the thick band of tissue under your foot).

• Typical symptoms: Sharp pain with your first steps in the morning or after rest.

• Common causes: Overuse, over-pronation, flat feet, poor shock absorption, tight calves or limited ankle mobility.

• What helps: Stretching the calves and plantar fascia, rolling underfoot with a ball, and proper footwear and orthotics.

2. Insertional Achilles Tendinopathy

• What it is: Irritation where the Achilles tendon attaches to the back of the heel.

• Symptoms: Pain when going on relevé, jumping or after intense training.

• What helps: Eccentric calf exercises, heel lifts (temporary), reducing load before rebuilding strength.

3. Retrocalcaneal Bursitis

• What it is: Inflammation of the small bursa between the Achilles tendon and heel bone.

• Symptoms: Swelling, tenderness and pain when wearing tight shoes or pointe shoes.

• Common causes: Pressure from tight or new footwear, overuse and repetitive friction at the back of the heel.

• What helps: Avoid compression (loosen footwear or padding), gentle mobility, and anti-inflammatory strategies if needed.

4. Nerve-related heel pain

Sometimes the pain isn’t from tendons or fascia but from nerve entrapment (like Baxter’s nerve).

This type of pain can feel burning, sharp, or radiating.

Practical tips

• Check your footwear fit and replace old insoles.

• Stretch calves and strengthen intrinsic foot muscles regularly.

• Don’t ignore early signs of pain - early treatment makes a huge difference.