Heel Pain
Heel pain has a small number of common causes and a long tail of unusual ones. Plantar fasciitis is the most frequent — classic first-step pain in the morning — but several other conditions present similarly.
Heel pain has a small number of common causes and a long tail of unusual ones. Plantar fasciitis is the most frequent — classic first-step pain in the morning — but several other conditions present similarly.
Foot & Ankle · Professor Nima Heidari
Heel pain has a small number of common causes and a long tail of unusual ones. Plantar fasciitis is the most frequent — classic first-step pain in the morning — but several other conditions present similarly.
The most common cause of heel pain is plantar fasciitis — irritation of the plantar fascia, the thick band of tissue that runs along the sole of the foot and supports the arch. The pain is usually felt under the heel, builds over time, and is classically at its worst with the first few steps in the morning or after a period of rest, easing a little as the foot warms up.
Not all heel pain is plantar fasciitis, however. Pain at the back of the heel can come from the Achilles tendon or an inflamed bursa; pain that is sharp, burning or tingling may be nerve-related; and a heel that hurts constantly, even at rest, can occasionally signal a stress fracture. Getting the diagnosis right is what determines the right treatment.
Heel pain is more common in people who spend long periods on their feet, who have recently increased their activity, who wear unsupportive footwear, or who have a tight calf or an unusually high or flat arch. It is rarely serious, but it can be persistent and genuinely limiting if it is not addressed properly.
The great majority of cases settle without surgery. A structured programme of calf and plantar-fascia stretching, supportive footwear or orthotics, activity modification and targeted physiotherapy resolves most heel pain. Where symptoms are stubborn, options such as a corticosteroid injection or shockwave therapy can help; surgery is reserved for the small number who do not respond to a fair trial of these measures.
If your heel pain has lasted beyond a few weeks, or is stopping you doing the things you want to, it is worth a proper assessment to confirm the cause and put a clear plan in place.
Patients come in having been told “plantar fasciitis” for years. Sometimes that is right. Sometimes the real diagnosis was sitting under it the whole time.
Professor Heidari
Clinical approach
Plantar fasciitis is common, but it is not the only cause of heel pain. Calcaneal stress fracture, Baxter’s nerve entrapment and insertional Achilles tendinopathy all overlap clinically.
Calf and plantar fascia stretching, gel heel-cup, footwear advice. Most heel pain settles in 6–9 months with a structured loading programme.
Shockwave or an ultrasound-guided injection for the cases that don’t settle. Surgery for plantar fasciitis is reserved for a small minority.
Treatments considered
It can be that your heel pain will dissipate without treatment, provided that you rest your heel and follow some simple stretching exercises, together with wearing supportive shoes, like running shoes for example, to cushion your feet.
Common questions
A consultation is a structured conversation, not a sales pitch. The diary holds while you decide.
Book a Consultation →Signed off on 30 July 2026
