Heel pain is one of the most common foot complaints seen in physiotherapy and podiatry clinics and can significantly affect a person’s ability to walk, exercise, or even stand comfortably.
It is often caused by repetitive stress or overuse, but can also be associated with underlying conditions. In this blog, we explore what causes heel pain, who it affects, and how physiotherapy and podiatry can assist in diagnosing, treating, and preventing this common but disruptive issue.
Who gets heel pain and why?
Heel pain can affect people of all ages and activity levels. It’s particularly common in runners, people who spend long hours on their feet, and individuals with poor foot mechanics.
The most common cause of heel pain is plantar fasciitis, now referred to as plantar heel pain, a condition that results from aggravation of the plantar fascia – the thick band of tissue running along the bottom of the foot.
Other causes of heel pain include Achilles tendinopathy, heel spurs, stress fractures, and nerve entrapments. Factors such as poor footwear, sudden increases in activity, weight gain, and biomechanical issues like flat feet or high arches can contribute to the development of heel pain.
Heel Anatomy
The heel bone, or calcaneus, forms the foundation of the rear part of the foot. Attached to it are several key structures:
- Plantar fascia: Supports the arch and absorbs shock.
- Achilles tendon: Connects the calf muscles to the heel and enables walking and running.
- Fat pad: Acts as a cushion during weight-bearing activities.
Injuries or inflammation to any of these structures can lead to heel pain.
Signs and Symptoms
Symptoms can vary depending on the underlying cause, but common signs include:
- Sharp or stabbing pain under the heel (often worse in the morning)
- Pain during or after prolonged standing, walking, or running
- Tenderness to touch
- Stiffness and reduced range of motion in the ankle or foot
- Swelling or warmth around the heel
Diagnosing Heel Pain
Diagnosis begins with a comprehensive assessment by a physiotherapist or podiatrist. This includes:
- Detailed history of symptoms and activities
- Gait and posture analysis
- Examination of foot and ankle range of motion, strength, and flexibility
- Palpation of the heel and surrounding structures
In some cases, imaging such as X-ray or MRI may be recommended to rule out fractures and other serious pathologies.
Treatment Options
Most cases of heel pain respond well to conservative treatment. This may include:
- Manual therapy to address stiffness and improve mobility
- Stretching exercises, especially for the calf muscles and plantar fascia
- Strengthening exercises for the foot and lower limb muscles
- Taping techniques or orthotic advice to support the arch
- Education on footwear, load management, and activity modification
In persistent or more complex cases (e.g. stress fracture), referral to a specialist may be necessary.
Prevention Strategies
Preventing heel pain involves addressing the underlying risk factors. Strategies include:
- Wearing supportive and properly fitted shoes
- Gradual progression of training loads
- Maintaining flexibility and strength in the lower limbs
- Using orthotics if needed for biomechanical support
- Avoiding prolonged standing or walking on hard surfaces
Conclusion
Heel pain can be frustrating and limiting, but with the right assessment and treatment plan, recovery is achievable.
Our physiotherapists and podiatrists can play a vital role in identifying the cause, guiding effective rehabilitation, and helping prevent recurrence.
Whether you’re an athlete or someone who spends a lot of time on your feet, don’t ignore persistent heel pain – early intervention is key to getting you back on your feet comfortably and confidently.
Helping the Central Coast Feel Well, Move Well and Perform Well!