Plantar Heel Pain

Updated: April 2021

Overview:

Plantar heel pain occurs in a band of tissue that runs from under your heel to the ball of the foot. It's often called plantar fasciitis, a heel spur or a stone bruise. It usually hurts under the heel when first standing in the morning and symptoms may last 3 to 12 months.

Signs or symptoms you may experience:

Pain when first standing or walking after a period of rest, often when first getting out of bed in the morning.
The pain usually settles or reduces after 5-10 minutes of walking.
The pain may be worse the next day or at the end of the day after an increase in standing, walking or running.
A recent increase in standing especially on a hard surface or increase in walking or running before the pain began.
Occurs more frequently in people over the age of 40.
More common in only one heel not both heels.

If it's not plantar fasciitis, what else might it be?

Not all plantar heel pain is caused by plantar fasciitis, other causes for heel pain include:

The fat pad becoming thinner under the heel.
Lumps in the plantar fascia (plantar fibromas) can cause pain or the feeling of walking on a stone.
Some types of arthritis can cause pain under the heel such as rheumatoid arthritis, fibromyalgia, psoriatic arthritis, gout or spondyloarthritis.
Lower back pain or sciatica can cause plantar heel pain as the nerves from your lower back extend to your feet.
Squeezing of the nerve behind your ankle joint on the inside of your foot (also called tarsal tunnel syndrome) or squeezing of the nerve under your heel.
A tear in the plantar fascia may occur with persistent plantar fasciitis (when symptoms last more than 3 months) which may increase symptoms and the time required for them to settle.

What causes plantar fasciitis?

Current research suggests plantar fasciitis may be a degeneration of the plantar fascia and may be associated with one or more of the following:

Being over 40 years of age.
A recent history of increased standing (especially on a hard surface like concrete) or increased walking or running.
Being overweight (BMI over 25) or obese (BMI over 30).

Treatment options:

The aim of treatment is to reduce your symptoms, strengthen the plantar fascia and address any related issues. Usually a combination of treatments will be required. While the aim of treatment is to resolve symptoms, some individuals may have no benefit or increased symptoms from some treatments. Cease these treatments and contact Inform Podiatry.

An x-ray or ultrasound is usually not required unless there are unusual signs or symptoms or treatment is not reducing symptoms.
Footwear that provides good heel cushioning, reduces heel loading and supports the foot.
Foot tape and heel padding.
Stretches and exercises.
Modify exercise program eg replace walking with swimming or cycling in the short term.
Dry needling.
Shoe inserts to modify foot function such as prefab or custom orthoses.
Injection therapies.
Moon boot when symptoms are severely impacting daily activities.

Information sources:

Disclaimer:

Inform Podiatry provides these webpages for general advice. Please book an appointment at Inform Podiatry for individual assessment and treatment of your foot or lower leg condition.

Key words:

Heel spur - plantar | Plantar heel pain | Plantar heel spur | Plantar fasciitis