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Method Health
Oct 216 min read

Heel Pain

Used to be called plantar fasciitis/fasciopathy or heel spur syndrome.


  • Clues or common symptoms? 

    • Pain around the inside part of the heel where the arch of your foot meets the heel bone. It is often painful when walking first thing in the morning, during “warm-up” throughout the day, and then can be sore again in the evening. Other conditions with similar presenting symptoms, such as a stress fracture, traumatic fracture, or a ligament sprain around the foot or heel, should be ruled out. Imaging is unnecessary for diagnosing plantar heel pain and only necessary if we suspect another diagnosis that will respond better to extreme rest or surgery. 


How common is it? It will affect about 10% of the global population at one time.

The left image shows the location of common symptoms of plantar heel pain. The right image shows the position of the toe, which could be aggravating for the plantar fascia, for which management aims to improve tolerance. 


  • What is wrong? Simple: The arch of your foot close to your heel is sore, like a headache for the foot. Structural changes that could be seen on imaging, such as “ruptures,” “tears,” “degeneration,” swelling of the fascia, heel fat pad, or inflammation within the fascia have never been consistently linked to pain or change as someone's pain improves. On ultrasound imaging, a thickened fascia might relate to the onset of symptoms, but more thickness doesn’t relate to more pain, and thickness might not change as people improve in symptoms. This is why the name does not include fasciitis anymore. Heel spurs are common in people without pain and don’t change as symptoms improve. We don’t have strong evidence for a known structural cause of heel pain or what can explain why symptoms improve over time. Be skeptical of any theories.  


  • Why me? Most of the time, this occurs either randomly or after some traumatic event to the foot. Periods of life that everyone can go through can reduce your ability to tolerate heel strain or recover from increased use, such as periods of high mental stress, worsening sleep, or increased weight gain. We know poorer general health, being overweight, social isolation, sudden weekly time spent standing, or being more sedentary can predispose someone not to tolerate increased plantar fascia use during standing, walking, running, or jumping if suddenly increased. 


  • What can I do about it? The best management for plantar heel pain involves having informed education, modifying exercise if intolerable, or adopting an exercise routine (for life) to maintain or improve general health and pain coping. Trialing heel stretching, taping, or orthotics can be helpful for some people if they wish (self-taping or off-the-shelf orthotics are just as good as anything fancier). Longer-term options (after 3-6 months of no change in intolerable symptoms) could include seeking shockwave application (we don’t offer this at Method Health at the moment) or/and corticosteroid injection, but keep expectations relatively low. These can just give a small window of opportunity for the currently unknown recovery additive to take hold. Other “quick fixes” or “shortcuts” will likely be costly and unhelpful for heel pain. Surgery is hardly ever suggested for heel pain. Movement optimism and patience are the best management strategies for heel pain. 


  • Some people might benefit from adding lower leg exercises to improve tolerance to the activities impacted by heel pain. Pain during heel pain aggravating activities is safe, especially if tolerable. Educate yourself on the condition by asking us for validated, up-to-date information (lots of unhelpful physio fluff is out there).


There are several exercise options depending on your current tolerance. Left: calf raises with toes raised; Right: Plantar fascia stretch. 


  • Busting Myths?

  • How long will it take? If you are optimistic, have clear expectations and education about what heel pain means (more heel pain does not equal more fascia damage), and follow realistic, up-to-date advice, many can feel much better before or after three months. Sometimes, it takes more than 12 months to feel better. Don’t be too concerned; just having symptoms for longer does not mean you will not improve when following good advice. Just optimistically keep doing the things that we share are helpful for your foot health, like improving your general health (sleep, body fat, physical activity, stress coping). Your symptoms might fluctuate daily, but you can live well with heel pain as you recover.  


  • What can Physio or Ex Phys at MH offer? 

    • We can offer individual advice to help you modify your active activities to tolerate keeping up with life with heel pain. Heel pain should not stop you from doing the things you love. This might involve adding some strength exercises for your lower legs to your weekly routine or supporting ways to get back to the activities you enjoy and might have reduced or avoided. 

    • We can help with taping and orthotic choice if you think these will be helpful.  

    • We can be your support crew to encourage lifestyle changes that can improve your general health, like coaching around sleep, guiding you through ways to reduce stress, or adding things to your life to better cope with stress. 

    • Suppose you have had persistent heel pain and are very confused as to why you still have it. In that case, we can help you make sense of the pain, highlight areas of management to prioritize or be more optimistic about, and give you individual guidance to assist in managing and resolving it. 


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