Heel pain affects around 1 in 10 people at some point in their lifetime. It can range from a dull ache to sharp, debilitating pain that affects your ability to walk, exercise, or carry out daily activities. Because the heel is a complex structure involving bone, fat pad, tendons, nerves, and fascia, accurate diagnosis is essential before beginning treatment.
The most common cause is plantar fasciitis — an overload of the thick band of tissue that runs along the bottom of the foot — but there are several other conditions that can cause identical symptoms and require different treatment approaches.
Plantar Fasciitis
Overload and microtearing of the plantar fascia — the most common cause, typically felt as sharp pain with first steps in the morning.
Heel Fat Pad Syndrome
Thinning or bruising of the protective fat pad under the heel bone, causing a deep bruised sensation.
Heel Spur Syndrome
A bony growth on the heel bone — often present with plantar fasciitis but frequently painless on its own.
Baxter's Nerve Entrapment
Compression of the inferior calcaneal nerve causing burning or shooting pain — often misdiagnosed as plantar fasciitis.
Abductor Hallucis Tendonitis
Inflammation of the tendon on the inside of the heel causing medial heel pain that can mimic plantar fasciitis.
Calcaneal Stress Fracture
A stress fracture of the heel bone — rare but important to rule out, especially in runners with sudden-onset pain.
The plantar fascia is a thick band of connective tissue running from the heel bone to the base of the toes. It supports the arch and acts as a shock absorber during walking and running. When repeatedly overloaded — through a sudden increase in activity, prolonged standing, footwear changes, or biomechanical factors — it develops microtears, inflammation, and gradual thickening.
There are two types: insertional plantar fasciitis (at the heel attachment) and non-insertional plantar fasciitis (along the mid-body of the fascia). The location of pain, pattern of symptoms, and response to loading all help distinguish between them — and treatment differs accordingly.
Sharp pain in the heel or arch, especially with the first steps in the morning
Pain that eases after a few minutes of walking, then returns after prolonged activity
Increased pain after long periods of sitting or standing
Tenderness on the bottom of the heel when pressed
Gradual onset over weeks or months — rarely sudden
Occasional swelling or tightness along the arch
Every heel pain assessment begins with a thorough musculoskeletal and biomechanical evaluation. We take a full history, assess your foot mechanics and loading patterns, and carry out a clinical examination to identify exactly what is causing your pain. Where needed, we can arrange ultrasound or MRI imaging referral to confirm a diagnosis or rule out less common causes.
Getting the diagnosis right from the outset is critical — treating plantar fasciitis with the wrong protocol, or missing a nerve entrapment or stress fracture, leads to prolonged recovery and wasted time.
We use a combination of progressive loading, load management, and hands-on treatment to reduce pain and prevent recurrence. The treatment plan is tailored to your diagnosis, activity level, and goals.
01
Avoid sudden increases in standing, steps, or running distance
02
Wear supportive footwear with a slight heel raise — avoid flat shoes and bare feet on hard floors
03
Use a heel cushion or taping during flare-ups to reduce load on the fascia
04
Complete your prescribed exercises consistently — the evidence strongly supports progressive loading
05
Perform calf and plantar fascia stretches in the morning before getting out of bed
06
Apply ice after activity if swollen — 10–15 minutes wrapped in a cloth
6 – 8 weeks
Mild cases
With early treatment and consistent rehabilitation, many mild cases resolve within 6–8 weeks.
3 – 6 months
Moderate cases
More persistent cases, particularly those left untreated, typically take 3–6 months.
6 – 12 months
Chronic cases
Long-standing plantar fasciitis may take up to 12 months — shockwave therapy significantly improves outcomes.
If your heel pain has lasted more than 2–3 weeks, is worsening, or is affecting your daily activities, book an assessment. The sooner you get an accurate diagnosis, the faster your recovery will be.
Early intervention avoids the cycle of partial recovery and re-injury that makes chronic plantar fasciitis so difficult to treat. Don't wait for it to go away on its own — untreated cases frequently become chronic.
Is it a heel spur causing my pain?
Not usually. Heel spurs are present in around 50% of plantar fasciitis cases but are frequently found in pain-free people too. The pain comes from the plantar fascia and surrounding soft tissues — not the spur itself. Treatment is directed at the fascia.
Can I keep running with plantar fasciitis?
Often yes — with appropriate load management and the correct rehabilitation programme. We will guide you on a safe return-to-running plan that keeps you active without aggravating the tissue. Complete rest is rarely recommended and often counterproductive.
Do I need an MRI or ultrasound?
Most cases are diagnosed clinically from your history and examination alone. Imaging is only required if your symptoms are unusual, not improving with treatment, or if we need to rule out a stress fracture or nerve entrapment.
Will I need a steroid injection?
Steroid injections are a useful tool in specific circumstances — typically where acute inflammation is preventing rehabilitation from progressing. They are not a first-line treatment and are used selectively where clinically appropriate.
Which appointment should I book?
Sports Podiatry & Injury Assessment with Levi: The right starting point for most heel pain and plantar fasciitis presentations. A thorough assessment covering history, examination, biomechanics, and a structured treatment plan.
Advanced Biomechanical Assessment with William: For complex or long-standing cases, or where previous treatment hasn't worked. Includes pre-appointment case review and senior clinical oversight. William specialises in cases that have failed standard treatment pathways.
See current pricing for both on our
fees page.
How much do follow-up appointments cost?
We accept BUPA, Aviva, and WPA with direct billing. All other insurers pay upfront and claim back.
See full fees →
Ready to get rid of your heel pain?
Book an assessment and we'll identify the cause and build a plan to get you back on your feet.
