Heel Pain Overview

Heel pain is a problem that compounds every day we walk and is often persistent to the point where depression and lifestyle changes require attention. Along with a variety of foot conditions treatment of rest and foot wear choices is often the 1st choice for relief.

The Problem With Rest

I today's a busy lifestyle we often can't rest and have obligations that range from family life to work.

The information here ranges from education to rehabilitation & should help your journey from heel pain.

Please note conditions that don’t fully resolve fully with rest and advice or can not be given rest typically require investigation in the clinic. - This investigation should lead to a clinical diagnosis.

Heel Pain Diagnosis

This diagnosis is needed to stop the condition from decaying into a worse state. The naming/ diagnosing of the type of heel pain should lead you to the correct heel therapy, exercise or life choice to give your heel the boost into pain resolution.

This diagnosis should be given by people who deal with foot pain conditions. Although this site may help whittle down the heel pain diagnosis options, you may have multiple conditions or compounding issues that warp the condition's ability to heal.

Plantar Fascitiis

Plantar Fasciitis is certainly the most common cause of heel pain.

There's a strand of thick skin called that connects the heel bone (the Calcaneal bone) to the toes in a fan-like pattern called the plantar fascia.

And just like tonsilitis means inflammation of the tonsils, the '-itis' suffix on the end of plantar fascia means inflammation of the Plantar fascia.

The Plantar fasciitis issue builds over time, although the pain often comes late in its development process. 

The common cause is that the foot moves poorly, think flat or rolling feet. this may be subtle, i.e. only happen during walking and running, or maybe more obvious when simply standing.

However, it may happen from a pressure onto the midfoot, think runs or ladder in soft shoes, climbers pushing off an edge or simply a step onto a large stone cause the fascia to stress.

Calcaneal heel spurs, calcaneal cysts and an unstable foot/ ankle may complicate the condition's recovery. Still, regardless of the gold standard, therapy for pain relief is Extracorporeal Shock Wave Therapy.

Supportive exercises and strapping/ orthotics techniques are often used first or in conjunction with Extracorporeal Shock wave Therapy.

Calcaneal Cysts

A calcaneal cyst is cysts in the heel bone, think a mild bone bruise. It is the early signs of boney inflammation. 

They don't normally exist on their own but normally coexist along with other soft tissue components, like plantar fasciitis.

The presence of calcaneal cysts typically means the suffer is striking the heel with some repetitive force or that the foot/ heel bone is rolling off the padding upon the underside of heel (heel fat pad).

Clients that fall into this rolling heel bone, called calcaneal inversion or eversion typically need to be stabilised using a specist taping technique or if very athletic a support (posted insole/orthotic or specialised calcaneal brace during the performance). This support strategy stops the condition re-occuring.

TIP: It's often worth noting; a lack of Vit D is a very common driver of this condition. We see a lot of this issue post-COVID lockdowns. This condition nutritional condition (lack of sunlight) makes the heel bone more susceptible to cyst formation.

Clients will need an evaluation to see whether these calcaneal cysts are likely playing a role in slow recovery or chronic pain. Either way they respond well to focused ESWT (extracorporeal shock wave therapy).

Tarsal Tunnel Syndrome

The tarsal tunnel can give not only pain but also numbness.

This numb feeling going into the toes as the 'tarsal tunnel' gets narrowed from poor foot movements.

This narrowing causes the nerve to get squeezes as well as the tendons causing tendonitis (tibialis posterior tendon typically) but also a nerve gets impinged/ squeezed. The heel pain condition not only creates both the tingle and pain but also the narrowing also needs release.

Insertional Tendonitis

Both the tibialis posterior tendon (the cord that runs along the outside of the heel) and the Achilles tendon (the cord that runs down below the calf muscle and into the heel bone) are sites of heel pain.

These cords' inflammation is often associated with heel pain in very stoic or warrior individuals (stong minded enough to battle through pain).

Typically the cord normally gets inflamed through some injury, and then you have a natural heal period of 4 weeks.

After this period, the body can reduce its healing potential. Basically, in light of the client battling through the healing process, the body gives up! Albeit it gives up slowly, this is known as tendonosis after 8 weeks of suffering. and is often a blight for runners who get the condition when pumped full of adrenalin enabling the pain to be ignored. 


Stress fractures of the calcaneus (the bone of the heel) are uncommon.

However, it should be considered, especially in athletes such as long-distance runners or people who walk or stand for a living like postmen or women when heel pain is persistent. 

We supply specialist boot rest for this so clients can rest and function. But for those who want to reduce healing time we use laser and ESW Therapy choices to stimulate repair.


Bursa's are lubricating sacks of fluid that oil the cords of the heel.

Perplexing as it may sound even these oiling units (bursas) of the foot can be irritated. But they only truly get aggroed from very obscure events like a single strike to the foot or altered walk/ gaiting patterns.

We most often see bursitis from either tight footwear or where clients footwear is rigid. in the latter the foot within moves a lot. This culminates in a lot of rubbing causing the sacs of fluid to irritate

Heel Spurs

Heel Spurs can cause sharp stinging pain on heel strike but equally can give little to no symptoms. They are typically spikes that grow on the heel bone (calcaneal bone). As you can imagine, these can become quite uncomfortable.

They are quite annoying as they develop slightly and only give symptoms when they grow to a size where their enlargement means they take up the foot's max space.

There are two types. 

  1. Calcific Enthesopathy (Calcific Plantar Fasciolosis) 
  2. Calcaneal spurs (Haglungs heel or planar spurs)

The Enthesopathy type is a type of chronic Plantar Fasciitis and responds well to a therapy called ESWT (Extracorporeal Shock Wave Therapy), which we can treat very well within the practice.

The Latter (calcaneal spurs) are slightly different. Although they look similar on x-ray, they don't respond as well, and their treatment depends on the size and direction of growth to the prognosis of the condition.

X-ray  analysis can be taken within the clinic to establish a prognosis if there is a suspect of heel spur pain.

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