Heel pain · Plantar heel pain · Footwear
Heel pain is common, but the cause still matters
Pain beneath or behind the heel can arise from different tissues and loading patterns. The timing, location, footwear and examination findings help determine whether pedorthic care belongs in the plan.
Do not wait on concerning changes
Seek prompt medical care after major trauma, if you cannot bear weight, if the foot is visibly deformed, or when there is marked swelling, redness, warmth, fever, an open wound, colour change, sudden numbness or weakness. With diabetes or reduced sensation, a wound or infection may be serious even when pain is limited.
Describe the pattern
Where and when do you notice it?
First-step or after-rest pain
Often discussed as plantar heel pain and sometimes labelled plantar fasciitis. The pattern may ease after moving, then increase again with longer standing or walking.
Shoe-counter or tendon-area irritation
Symptoms may relate to pressure from footwear, the Achilles tendon region or the nearby tissues. Location and loading response matter.
Impact, nerve or other causes
Bruising, stress injury, nerve-related symptoms and referred pain can resemble a more routine heel complaint and may require medical investigation.
Common contributors
Heel pain rarely belongs to one simple explanation
An assessment may consider a recent change in walking, running, work or standing; calf and ankle mobility; foot function; body demands; recovery; and the way footwear loads or cushions the area.
A heel spur seen on imaging is not automatically the cause of pain, and not everyone with heel pain needs an orthotic. The goal is to match the response to the presentation rather than to a label alone.
Load
Did activity volume, work exposure, surface or body demand change?
Mobility and function
What do ankle motion, gait and foot behaviour contribute?
Footwear
Does fit, cushioning, stability or wear alter the symptom?
Health context
Are there neurological, inflammatory, vascular or systemic factors?
Possible parts of a plan
Use the least complicated response that fits the findings
Load and activity change
A temporary adjustment can reduce repeated aggravation while preserving tolerable movement. The right amount depends on the problem and the person.
Footwear guidance
Fit, cushioning, heel-to-toe geometry, stability and the condition of the shoe can change how the heel is loaded.
Exercise or rehabilitation
Some presentations benefit from a progressive exercise plan provided by an appropriate clinician rather than passive support alone.
Taping or temporary support
A short trial may help clarify whether altering load is useful before a longer-term device is considered.
Custom orthotics
When assessment findings support them, orthotics may form part of a plan to change pressure or the foot–shoe interaction.
Referral
Imaging, medical assessment, medication advice or another professional scope may be more appropriate when the presentation warrants it.
At the appointment
Bring the shoes and the story
Bring the footwear used when symptoms occur, any current orthotics, your prescription if available and a short history of what changed. Be ready to describe the first painful step, the best part of the day, the worst activity and any swelling, numbness or skin change.
Clinical note
Information has limits
This page cannot diagnose the source of heel pain. It presents a decision framework for seeking appropriate assessment and understanding the pedorthic role.
- Pedorthic Association of Canada: Pedorthic certification
- College of Pedorthics of Canada: Standards of Business Practice
Persistent heel pain deserves a closer look