That first step out of bed in the morning can be agony. Many people describe a sharp, stabbing pain beneath the heel that eases as they start walking, only to return later in the day. For some, it’s a minor irritation. For others, it becomes a daily struggle that affects walking the dog, exercising, standing at work or even getting around the supermarket.
One of the most common causes of heel pain is plantar fasciitis, but it’s important to remember that not all heel pain is plantar fasciitis. In fact, assuming that’s the cause without a proper assessment can delay the right treatment.
At Feet & Motion Podiatry Clinic in Horsham, we regularly help people with persistent heel pain by identifying the underlying cause, treating the symptoms and helping them get back to doing what they love.
What is plantar fasciitis?
The plantar fascia is a thick band of connective tissue that runs along the sole of your foot, connecting your heel bone to your toes. It plays an important role in supporting the arch of your foot and absorbing the forces created during walking and running.
Although most people know the condition as plantar fasciitis, we now understand that long-standing cases are often better described as plantar fasciopathy. Rather than being driven by ongoing inflammation, persistent heel pain is usually associated with changes within the tissue itself caused by repeated overload. This helps explain why the condition can be slow to settle and why simply resting for a few days rarely solves the problem.
What are the symptoms?
Plantar fasciopathy typically causes:
- Sharp or stabbing pain underneath the heel.
- Pain with the first few steps in the morning.
- Pain after sitting or resting for a while.
- Discomfort after long periods of standing or walking.
- Pain that eases as you get moving but returns later in the day.
- Tenderness when pressing beneath the heel or along the arch of the foot.
Symptoms may develop gradually or sometimes follow an increase in activity or an injury.
But heel pain isn’t always plantar fasciitis
Although plantar fasciitis is one of the most common causes of heel pain, it certainly isn’t the only one.
Other conditions that can produce very similar symptoms include:
- Heel fat pad syndrome.
- Nerve irritation or entrapment.
- Stress fractures.
- Achilles tendon disorders.
- Arthritis.
- Referred pain from elsewhere in the leg or lower back.
Because each of these conditions requires a different approach to treatment, getting the correct diagnosis is essential. Treating the wrong condition can delay recovery and prolong unnecessary pain.
Why does plantar fasciitis develop?
At Feet & Motion, we rarely start by asking, “What hurts?”
Instead, we ask, “Why does it hurt?”
Heel pain is rarely caused by one single factor. More commonly, it develops when the load placed on the plantar fascia exceeds its ability to recover.
That overload can result from a combination of factors, including:
- A sudden increase in walking, running or exercise.
- Standing for long periods at work.
- Changes in footwear.
- Tight calf muscles.
- Reduced strength.
- Changes in foot mechanics.
- Carrying extra body weight.
- Spending more time barefoot on hard floors.
Often, several of these factors combine over weeks or months before symptoms appear. Understanding which factors are contributing to your pain is the key to successful treatment.
Why can it take so long to heal?
One of the most frustrating things about plantar fasciopathy is that it rarely simply “goes away.”
Many people hope that resting for a few days will solve the problem. Others continue pushing through the pain, assuming it will eventually settle by itself.
Unfortunately, because the plantar fascia is loaded every time we stand or walk, complete rest isn’t realistic. If the underlying causes aren’t addressed, symptoms often persist or gradually worsen.
Many people spend months stretching their calves, buying different shoes and trying exercises they’ve found online without ever receiving a proper diagnosis. Unfortunately, treating the wrong condition can delay recovery just as much as receiving no treatment at all.
This is why early assessment can make such a difference. Rather than simply waiting for the pain to improve, identifying and addressing the factors that are overloading the tissue gives it the best opportunity to recover.
Is there a link with menopause and ageing?
Emerging evidence suggests there may be.
As we get older, our connective tissues naturally become less elastic and often take longer to recover from repeated stress. Tendons, ligaments and fascia become less resilient, making them more susceptible to overload.
For women, the menopause may also contribute. Declining oestrogen levels can affect collagen, the protein that gives connective tissues their strength and flexibility. Some women notice new aches and pains during the menopausal transition, including heel pain and tendon problems, even without changing their activity levels.
This doesn’t mean heel pain is inevitable, but it does mean that recovery may take longer and often benefits from a structured treatment plan rather than simply waiting for symptoms to settle.
How can a podiatrist help?
At Feet & Motion, we don’t just focus on where it hurts—we look at why it hurts.
A comprehensive assessment allows us to identify the factors contributing to your heel pain before creating a personalised treatment plan that’s tailored to your needs.
For persistent heel pain, one of the treatments we commonly use is Extracorporeal Shockwave Therapy (ESWT). Shockwave therapy stimulates the body’s natural healing response and has an excellent evidence base for many long-standing cases of plantar fasciopathy. However, it isn’t suitable for everyone, which is why a proper assessment always comes first.
Depending on your diagnosis, treatment may also include:
- A personalised home exercise programme to improve strength and flexibility.
- Footwear advice.
- Orthotics (custom-made insoles), where clinically appropriate, to reduce excessive strain on the plantar fascia.
- Activity and load-management advice to keep you moving while allowing healing to take place.
Rather than relying on a single treatment, we combine the most appropriate interventions to improve recovery and reduce the likelihood of symptoms returning.
Don’t put up with heel pain
Whether your goal is getting back to running, walking the dog, enjoying a round of golf or simply walking comfortably around the supermarket, persistent heel pain doesn’t have to become your “new normal.”
The sooner the underlying cause is identified, the sooner the right treatment can begin.
At Feet & Motion, our goal isn’t simply to reduce your pain. It’s to understand why it’s there in the first place, treat it effectively and help you keep doing what you love.
Olive Giles
Natalie Kitchener