Heel Pain: Is It Really Plantar Fasciitis?

One of the most common things I hear in clinic is, ‘I’ve had this for six months and thought it would just go away.’

Heel pain is one of the most common reasons people visit our clinic in Rushden. Many patients arrive convinced they have plantar fasciitis because they’ve searched online, spoken to friends or even been given that diagnosis elsewhere.

However, heel pain is not a diagnosis in itself. It’s simply a symptom, and several different conditions can cause pain in the heel. Although plantar fasciitis (more accurately called plantar fasciopathy) is certainly common, it is far from the only possibility.

One of the most important parts of my job is identifying exactly which structure is causing your pain. Making the correct diagnosis allows us to recommend the treatment most likely to help you recover as quickly as possible.

“One of the most common things I hear in clinic is, ‘I’ve had this for six months and thought it would just go away.'”

The first question I ask

When someone tells me they have heel pain, my first question is always:

“Can you show me exactly where it hurts?”

Patients often point to one of three distinct areas, and each location immediately gives me important clues about the underlying cause.

Pain underneath the inside of the heel

If the pain is located on the inside edge of the underside of the heel, particularly where the plantar fascia attaches to the heel bone, plantar fasciopathy is a likely diagnosis.

Typical symptoms include:

• Pain during the first few steps in the morning.
• Pain after sitting for a while.
• Pain that eases as you walk before returning after prolonged standing or activity.
• Tenderness when pressing on the inside of the heel.

Although this is the most common cause of heel pain, not everyone with these symptoms has plantar fasciopathy.

 

Pain in the centre of the heel

Pain directly underneath the middle of the heel often points towards irritation or thinning of the heel fat pad.

The heel fat pad acts as the body’s natural shock absorber. If it becomes irritated or loses its cushioning ability, walking on hard surfaces can become increasingly uncomfortable.

People with heel fat pad syndrome often describe:

• A deep bruise-like pain.
• Pain that worsens the longer they stand or walk.
• Increased discomfort on hard floors.
• Tenderness in the middle of the heel rather than towards the inside.

Treatment for heel fat pad syndrome is very different from treatment for plantar fasciopathy, which is why an accurate diagnosis is so important.

 

Pain at the back of the heel

Pain at the back of the heel may involve the Achilles tendon or one of the bursae that sit between the tendon and the heel bone.

Common causes include:

• Insertional Achilles tendinopathy.
• Retrocalcaneal bursitis.
• Superficial Achilles bursitis.

These conditions often become painful when:

• Walking uphill.
• Climbing stairs.
• Wearing shoes that rub against the back of the heel.
• Starting new exercise or increasing activity.

Again, these conditions require a different treatment approach from plantar fasciopathy.

 

Looking beyond the pain

The location of your pain is only the beginning.

During your assessment I’ll also ask questions such as:

• What sort of work do you do?
• Are you standing for long periods?
• Have you recently increased your walking or exercise?
• Have you gained weight over the past few months?
• Have you changed your footwear?
• Do you have any medical conditions that may influence healing, such as diabetes or inflammatory arthritis?

These details often provide valuable clues about why the problem developed in the first place.

 

A thorough assessment matters

A proper assessment involves much more than simply pressing on the painful area.

Depending on your symptoms, your examination may include:

• Assessment of your walking pattern.
• Foot posture and biomechanics.
• Joint movement.
• Muscle strength.
• Flexibility.
• Tendon function.
• Footwear assessment.

Where appropriate, diagnostic ultrasound can provide additional information about structures such as the plantar fascia or Achilles tendon, helping to confirm the diagnosis and guide treatment decisions.

 

There isn’t one treatment for all heel pain

One of the biggest misconceptions is that every person with heel pain should receive the same treatment.

The most effective management depends on the underlying diagnosis.

Treatment may include:

• Activity modification.
• Footwear advice.
• Targeted strengthening exercises.
• Stretching where appropriate.
• Taping techniques.
• Orthoses or insoles.
• Shockwave therapy.
• Ultrasound-guided injections in selected cases.

Because different conditions respond to different treatments, identifying the source of your pain is the first and most important step.

 

Don’t ignore persistent heel pain

Many people struggle with heel pain for months before seeking professional advice. During that time they may try internet exercises, buy insoles online or simply hope the problem will settle on its own.

Sometimes it does.

Often it doesn’t.

The earlier the correct diagnosis is made, the sooner treatment can be targeted appropriately, reducing the risk of the problem becoming persistent and affecting your walking, work, exercise or quality of life.

 

Need help with heel pain?

If you’ve been living with heel pain and you’re unsure what’s causing it, we’d be happy to help.

At Rushden Podiatry we carry out a detailed assessment to identify the underlying cause of your symptoms before recommending an evidence-based treatment plan tailored to your individual needs.

Whether your pain is caused by plantar fasciopathy, heel fat pad syndrome, an Achilles problem or another condition entirely, our aim is to help you understand the diagnosis, recover as quickly as possible and get back to doing the things you enjoy.

If you would like to talk to one of the team about heel pain, please call us on 01933 594444, alternatively, you can book an appointment here