You’re dealing with heel pain that’s disrupting your daily activities, and you need answers. Whether it’s that sharp morning stab when your feet hit the floor or the nagging ache after a long day, heel pain isn’t something you should ignore or simply endure.
Podiatrists have seen countless patients struggle with this condition, and there’s a specific approach to understanding what’s causing your discomfort and how to treat it effectively. Let’s explore this in detail in our latest blog on dealing with heel pain.
Key Takeaways
- Pain location determines diagnosis: under-heel pain suggests plantar fasciitis, while back-heel pain indicates Achilles tendinopathy or bursitis.
- Plantar fasciitis causes sharp stabbing pain, which is worst with the first morning steps, affecting the thick tissue supporting your foot's arch.
- Heel spurs appear on X-rays in many pain-free people and rarely cause symptoms; plantar fascia inflammation is the actual pain source.
- Conservative treatments include custom orthotics, shockwave therapy, stretching programmes, and taping before considering surgical options for persistent cases.
- Seek podiatrist care if heel pain persists beyond 2-4 weeks, causes sleep disruption, or limits walking ability despite self-care measures.
Is Your Pain Under the Heel or at the Back? Identifying the Location
Where exactly does your heel hurt? The location of your heel pain provides essential diagnostic clues.
Identifying whether your pain is plantar or posterior helps determine the underlying cause and appropriate treatment.
Common Causes for Pain Under the Heel
When your heel is in pain, plantar fasciitis stands as the most likely diagnosis, causing that characteristic sharp, stabbing sensation at the bottom of your foot that’s typically worst with your first morning steps.
You might assume heel spurs visible on X-rays are causing your pain, but these bony growths often exist without symptoms and aren’t always the true culprit behind your discomfort.
Alternatively, you could be dealing with a stone bruise or fat pad contusion, which creates a deep, aching pain in the centre of your heel that feels like you’re walking on a pebble.
Plantar Fasciitis: The Most Common Culprit
Most commonly, pain under your heel stems from plantar fasciitis, an inflammatory condition affecting the plantar fascia—the thick band of connective tissue that runs from your heel bone to your forefoot and supports your arch.
You’ll typically experience sharp, stabbing pain at the inner heel that’s worst with your first morning steps or after periods of rest. The discomfort often improves with activity but may return after prolonged standing.
While heel spur formation can accompany this condition, it’s the plantar fascia inflammation and degeneration—not tendinopathy—that causes your pain.
Heel Spurs (and Why They Might Not Be the Real Problem)
You might brush off heel pain as a simple “heel spur“, but this common assumption often leads you down the wrong treatment path.
These bony calcifications develop from repetitive plantar fascia traction, yet 50% of people with heel spurs experience no symptoms. The real culprit is usually plantar fasciitis—degeneration and inflammation of the plantar fascia itself.
| Aspect | Heel Spur | Plantar Fasciitis |
|---|---|---|
|
Nature |
Bony calcification |
Soft tissue inflammation |
|
Pain Source |
Rarely the cause |
Primary problem |
|
Treatment Focus |
Conservative care |
Stretching, orthotics, therapy |
|
Surgery Need |
Almost never – only after failed conservative care |
Also almost never |
Effective treatment targets the underlying soft-tissue pathology, not the spur.
Stone Bruise or Fat Pad Contusion
Step on a sharp rock or land hard on your heel, and you might end up with a stone bruise—a painful contusion of the calcaneal fat pad that creates deep, aching pain directly under your heel bone.
This impact injury damages the protective cushioning beneath your heel, causing localised tenderness that worsens when walking barefoot or applying direct pressure.
You’ll likely notice swelling and bruising in severe cases. Treatment focuses on rest, ice, anti-inflammatory medication, and cushioned insoles or heel cups to offload pressure.
Most stone bruises heal within weeks to months with proper care and activity modification.
Common Causes for Pain at the Back of the Heel
When you experience pain in the back of your heel, you’re likely dealing with one of several distinct conditions that affect the posterior heel region.
Achilles tendinitis causes pain above the heel bone due to inflammation or degeneration of the tendon. In contrast, heel bursitis creates localised swelling and tenderness from irritation of the fluid-filled sacs between structures.
In children and adolescents, Sever’s disease represents a unique cause of posterior heel pain related to growth plate inflammation during periods of rapid development.
Achilles Tendinitis: Pain Above the Heel Bone
While plantar fasciitis affects the bottom of your heel, Achilles tendinitis targets the back portion, specifically the thick tendon that connects your calf muscles to your heel bone.
This overuse injury causes posterior heel pain, stiffness, and swelling 2–6 centimetres above your heel. You’ll notice symptoms worsen during push-off activities like walking or running, particularly in mornings after rest.
Risk factors include sudden activity increases, tight calf muscles, and inappropriate footwear.
Treatment involves relative rest, ice, anti-inflammatories, calf-strengthening exercises, and heel lifts. Most cases improve with conservative care over weeks to months.
Heel Bursitis: Inflammation and Swelling
Heel bursitis acts up when the small, fluid-filled sac between your Achilles tendon and heel bone becomes inflamed, creating a painful condition that’s distinct from but often confused with Achilles tendinitis.
This overuse injury typically develops from repetitive friction caused by tight shoes, excessive running, or sudden training increases.
You’ll experience retrocalcaneal pain with direct pressure and push-off movements, often accompanied by heel swelling, warmth, and visible bumping. Treatment starts conservatively with rest, ice, heel lifts, proper footwear, and calf stretching.
Persistent cases may require steroid injections, shockwave therapy, or surgical removal of the inflamed bursa.
Sever's Disease (in Children and Teens)
Although Sever’s disease sounds alarming, it’s actually a common and treatable overuse injury that affects the growth plate at the back of your child’s heel bone. Also called calcaneal apophysitis, this condition typically strikes physically active children aged 8-15 during growth spurts.
Your child will likely experience heel pain that worsens with running or jumping activities. The diagnosis is straightforward—based on symptoms and a positive squeeze test where pressing the heel causes tenderness.
Treatment focuses on rest from aggravating sports, stretching tight calf muscles, supportive footwear, and a gradual return to activities as symptoms improve.
When Should I See a Podiatrist If My Heel Is in Pain?
If your heel pain persists beyond two to four weeks despite basic self-care measures like rest, ice, stretching, and wearing supportive shoes, you should schedule an appointment with a podiatrist.
Professional assessment becomes essential for accurate diagnosis and treatment of conditions like plantar fasciitis or Achilles tendinopathy.
| Seek Immediate Care | Schedule Soon |
|---|---|
|
Injury with swelling / deformity |
Numbness or tingling |
|
Severe walking limitation |
Pain disrupting sleep |
|
Diabetes with complications |
Recurring heel pain |
Don’t delay if you have risk factors like diabetes, arthritis, or obesity, as these require specialised intervention.
How a Podiatrist Diagnoses Your Heel Pain
When you visit a podiatrist for heel pain, they’ll begin with a thorough history that pinpoints your pain’s exact location, onset, and triggers. They’ll ask about morning stiffness and activity patterns to differentiate plantar fasciitis from Achilles tendinopathy.
The physical exam follows, checking for point tenderness at specific locations—the medial calcaneal tubercle suggests plantar fasciitis, while posterior heel pain indicates Achilles issues. Your podiatrist may perform specialised tests like the windlass test and assess your gait.
Imaging starts with X-rays to rule out fractures, followed by ultrasound for soft-tissue evaluation or MRI for complex cases.
Professional Heel Pain Treatments That Get Results
Once your podiatrist has identified the specific cause of your heel pain, they’ll implement targeted professional treatments designed to address both your symptoms and underlying biomechanical issues.
This evidence-based intervention includes custom orthotics to correct faulty foot mechanics, advanced therapies like shockwave treatment for persistent pain, and specialised mobilisation programmes to restore proper function.
You’ll also benefit from professional taping techniques that provide immediate structural support while your healing progresses.
Custom Foot Orthotics to Correct Biomechanics
Custom foot orthotics step up as a precision treatment when standard shoe inserts can’t address the underlying biomechanical issues driving your heel pain.
These prescription-made devices correct abnormal foot mechanics like overpronation that contribute to plantar fasciitis and Achilles tendinopathy. Podiatrists create them from 3D scans, tailoring arch height and heel lifts to your specific gait patterns.
- Personalised design targets your unique biomechanics through gait analysis and foot posture assessment.
- Clinical effectiveness often surpasses over-the-counter options for persistent heel pain conditions.
- Timeline expectations include 1-3 weeks of fabrication with meaningful pain improvement within 4-8 weeks.
Shockwave Therapy for Chronic Pain
For cases where custom orthotics and conservative measures haven’t provided adequate relief after several months, Extracorporeal Shockwave Therapy (ESWT) emerges as a clinically proven option for chronic heel pain. This noninvasive treatment delivers focused acoustic pulses to the plantar fascia or tendon enthesis, stimulating healing in damaged tissue.
Clinical trials demonstrate that 60-80% of patients with chronic plantar fasciitis experience meaningful pain reduction following ESWT protocols. Treatment typically involves 1-5 sessions spaced weekly, delivering 1,500-3,000 targeted shocks.
You’ll likely experience gradual improvement over 3-12 months, with minimal complications beyond temporary soreness.
Foot Mobilisation and Strength Programmes
Beyond passive treatments, targeted foot mobilisation and strengthening programmes address the underlying biomechanical dysfunction that perpetuates heel pain.
Foot mobilisation techniques restore normal joint function in restricted areas like the subtalar and talonavicular joints, reducing plantar fascia tension.
Progressive strengthening targets both intrinsic foot muscles and the posterior tibialis to improve biomechanics.
- Manual mobilisation of calcaneal and rearfoot joints restores proper movement patterns.
- Eccentric loading protocols strengthen tendon structures through controlled resistance exercises.
- Intrinsic muscle strengthening using short-foot exercises and toe flexor training.
You’ll typically need 6–12 supervised sessions with individualised progression for optimal outcomes.
Taping and Strapping for Immediate Support
When conservative treatments need time to work, taping and strapping techniques step in to provide immediate mechanical support and pain relief for heel conditions:
- Low-Dye taping reduces plantar fascia strain by anchoring strips under your arch, providing 7-10 days of relief.
- ]Rigid zinc-oxide strapping limits excessive pronation and subtalar motion, lessening plantar heel pain immediately.
- For Achilles issues, medial calcaneal sling strapping offloads posterior heel pressure.
- Night splinting maintains ankle dorsiflexion overnight, stretching the plantar fascia to reduce morning pain.
These low-cost, low-risk techniques complement stretching and orthotics while longer-term treatments take effect.
Summing It All Up...
Heel pain can stem from various causes, such as plantar fasciitis, Achilles tendinitis, heel spurs, or stress fractures, but understanding the underlying issues through a podiatrist’s expertise is key to effective treatment.
We have explored common triggers, diagnostic approaches, and conservative options like stretching, orthotics, physical therapy, and lifestyle modifications that often resolve discomfort without invasive measures.
By addressing symptoms early, you can prevent chronic problems and regain your mobility. If you’re experiencing persistent heel pain, don’t wait—contact Bellevue Podiatry today to schedule a consultation and take the first step towards pain-free steps.
If you want the right professional advice on how to treat your foot pain, we currently have a limited offer running to help you out. For just $79 (usually valued at $189), book in online for our Complete Foot Pain Assessment & Treatment Consultation will get:
- Complete In-Depth Foot Pain Examination
- Review of Footwear & Personal Habit Diagnosis
- Treadmill Walking Gait Analysis & Video Assessment
- Complete Foot & Ankle Structural Diagnosis
- Effective Foot Pain Treatment Plan To Get You Walking Pain Free
- Peace of Mind You Know What Is Causing Your Foot Pain & How To Fix It
Check out our heel pain eBook below for further details on this special offer as well as other tips and techniques you can try at home to manage your plantar fasciitis and foot pain.
You don’t need to put up with sore feet any longer. Our team of Podiatrists have the education and experience to get you moving pain free again. Take control today by booking in online or call us today on (03) 8104 9270 to get this issue sorted once and for all.
Heel Pain
Understand what causes your foot pain and what you can do to get rid of it once and for all. Find out what treatments can get you back to walking pain free so you can enjoy living an active life again!
Bellevue Podiatry
Bellevue Podiatry has been serving the people of Rosanna and its surrounding suburbs for over 10 years. We have the qualifications, experience and education to effectively treat any lower limb condition or injury that requires expert podiatry care.
Nicole Hardidge - Principal Podiatrist
Nicole graduated with a Bachelor of Podiatry from Latrobe University in 2009 with a certificate in Advanced Clinical Education. Nicole has completed her post graduate certificate in wound care through Monash University.
If you would like a deeper understanding of the content discussed in this article, please click on the links below:
- https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846 (Mayo Clinic)
- https://www.health.harvard.edu/a_to_z/heel-pain-a-to-z (Harvard Health Publishing)
- https://my.clevelandclinic.org/health/symptoms/heel-pain (Cleveland Clinic)
- https://www.apma.org/heelpain (American Podiatric Medical Association)
- https://orthoinfo.aaos.org/en/diseases–conditions/heel-pain/ (American Academy of Orthopaedic Surgeons)