03 / Understand the area
Under & behind the heel
Pain under the heel on the first steps and pain behind the heel near the Achilles tendon can point to different assessments.
An educational guide that covers the left and right sides alike. Where it hurts is a useful clue, but only a clue.
A useful starting point
What this area can tell you.
The exact spot matters: under the heel, at the back of it, or on the sides. Plantar heel pain can be especially noticeable when you get up after resting, while other patterns may involve a tendon, an injury or another cause. It also helps to know how it changes over the day, and after a change in walking or running. Any exercise or loading plan should follow what the exam actually found under or behind the heel.
Notice the pattern
Three questions to bring with you.
You don't need to know what it is before you come in. These are details that help when you tell us what you're feeling.
- Is the pain underneath the heel or at the back near the Achilles tendon?
- Are the first steps after rest the worst, and what happens as you keep walking?
- Was there a sudden pop or injury, or a recent change in running, walking or time on your feet?
When to get help sooner
A sudden pop with difficulty walking or pushing off, severe pain after injury or inability to bear weight needs urgent assessment. Foot pain with a wound, redness or swelling needs prompt review, especially with diabetes.
Follow the connection
Possible explanations. Better questions.
These guides cover conditions and patterns that may overlap with this area. Think of them as a place to start our conversation: no body map can tell you which one, if any, you have.
Plantar heel pain
Pain under the heel, especially with your first steps after rest, and a gradual way back to loading the foot.
Read the guide Condition guideAnkle sprains
Getting it checked early, rebuilding balance and confidence, and when a rolled ankle may be a fracture.
Read the guideWhat the studies found, and where they stop
How the research fits this area.
The stretching trial involved long-standing plantar fasciitis under the heel, and both groups also got other care. It doesn't tell us how to treat an Achilles rupture, a fracture, or every other kind of heel pain.
How we select and explain sources ↗Follow the evidence
Research, with context.
Selected published sources behind what we've written, each with what it found and what it can't tell us. We give you both halves because no paper can diagnose you or predict how your own care will go.
Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study
101 patients with plantar fasciitis lasting at least ten months.
What it foundPlantar fascia-specific stretching improved worst pain and first-step pain more at eight weeks than Achilles stretching.
What it can't tell usOnly 82 patients came back for follow-up, and the two groups differed at the start in how long they'd had symptoms. Both groups also got insoles, medication and education, so the results can't be put down to stretching alone, or applied to every heel problem.
Publication details & citation
DiGiovanni et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. Journal of Bone and Joint Surgery. 2003. DOI: 10.2106/00004623-200307000-00013.
Read the publication record
Our editorial policy explains how to read these sources and what our clinical-review labels mean.
Your next step
Bring your questions.
We’ll start there.
Your answers to those three questions are where we start. We go over your history and symptoms, examine you, and explain what we found before we recommend anything. If it turns out to be something another doctor should look at, we'll tell you.
Anatomy: BodyParts3D, © DBCLS, CC BY 4.0. Model & rendering credits. Return to the full body explorer.