In short: most heel pain is plantar fasciitis — an overload injury of the thick band of tissue under your arch. It classically hurts most with your first steps in the morning. With an accurate diagnosis and the right combination of load management, footwear, strengthening and orthotic support, the large majority of cases settle within 6 to 12 weeks without injections or surgery.
What causes heel pain
Heel pain is rarely caused by one single thing. It is almost always a mismatch between how much load your foot is being asked to absorb and how much it can currently tolerate. That mismatch might come from a sudden jump in walking or running, a new job on hard floors, a change of shoes, weight gain, or simply a foot that has always pronated more than average.
The conditions we diagnose most often are:
- Plantar fasciitis (plantar heel pain). Pain under the heel and along the arch, sharpest with the first steps in the morning or after sitting. This is by far the most common cause.
- Heel spurs. A bony growth on the heel bone, often found alongside plantar fasciitis. Importantly, the spur itself is usually not the source of the pain — plenty of people have spurs and no symptoms at all.
- Achilles tendinopathy. Pain at the back of the heel rather than underneath, often stiff first thing and warming up with activity.
- Fat pad irritation. A deep, bruised feeling in the centre of the heel, more common with age as the natural cushioning thins.
- Severs disease (calcaneal apophysitis). Heel pain in active children roughly 8 to 14 years old, caused by irritation of the growth plate. See our children’s podiatry page.
- Nerve entrapment or referred pain from the lower back, which can mimic all of the above.
How we work out what is wrong
Treating heel pain without a firm diagnosis is how people end up buying three sets of insoles that do not work. Your first appointment is built around getting that diagnosis right.
We will ask about the pattern of your pain — when it is worst, what makes it better, what changed in the weeks before it started — then examine the foot directly, test the surrounding tendons and joints, and look at your footwear for wear patterns that give the game away.
Where it is useful, we carry out a biomechanical assessment, which can include walking or running on a treadmill with video analysis so we can see exactly how your foot loads through the gait cycle rather than guessing from a static examination.
How we treat it
Effective heel pain treatment is layered. We rarely rely on a single intervention, because the evidence is clear that combining approaches works better than any one of them alone.
- Settle the pain. Strapping, padding and short-term load changes to get you comfortable enough to function while the tissue calms down.
- Fix the load. Practical adjustments to how much you are walking, standing or training, so the tissue is challenged but not overwhelmed.
- Footwear. Often the fastest win available. Bryce’s background managing a technical footwear store means specific, brand-level advice rather than “wear supportive shoes”.
- Strengthening. A progressive calf and foot loading programme. This is the part most people skip, and the part with the strongest evidence for preventing recurrence.
- Orthotic therapy. Where your foot mechanics are a genuine driver, prefabricated or custom orthotics redistribute load away from the painful tissue.
- Onward referral. If your pain is not behaving the way it should, we will say so and arrange imaging or refer you on for another opinion rather than persisting with a plan that is not working.
How long recovery takes
Most people feel meaningfully better within two to six weeks of starting treatment, and the majority of plantar fasciitis resolves within 6 to 12 weeks. Longstanding cases — pain you have had for a year or more — take longer, often three to six months, because the tissue has had time to change structurally.
Two things reliably slow recovery down: stopping the strengthening work as soon as the pain eases, and returning to full activity in one jump rather than in stages. We will give you a specific plan for both.
When to get help
Book an assessment if your heel pain has lasted more than two weeks, is worse first thing in the morning, is changing how you walk, or is stopping you doing something you want to do. Early treatment is simpler and faster than treating a problem that has been compensated around for months.
Seek care promptly if you have diabetes and any new foot pain, if the heel is red, hot and swollen, or if the pain followed a distinct injury and you cannot bear weight.
Common questions
Should I rest completely?
Usually not. Complete rest often makes plantar fasciitis feel better briefly and worse on return, because the tissue loses tolerance. The goal is to reduce load enough to settle symptoms while keeping the foot working — which is exactly what your plan will be built around.
Do I need a scan or X-ray?
Most heel pain is diagnosed clinically and does not need imaging. We will arrange it when the presentation is unusual, when a stress fracture is a possibility, or when pain has not responded as expected to appropriate treatment.
Will I definitely need orthotics?
No. Orthotics help when your foot mechanics are contributing to the overload, and plenty of heel pain settles with footwear changes, load management and strengthening alone. If we do not think you need them, we will tell you. Read our honest take in do I really need custom orthotics?
Is a heel spur the cause of my pain?
Almost certainly not on its own. Heel spurs are common in people with no pain at all, and removing them is rarely necessary. The spur is usually a sign of long-term traction on the heel bone rather than the source of symptoms.
Can I keep running?
Often yes, at a reduced volume. We would rather modify your training than stop it entirely, and we will set out what that looks like week by week. See sports podiatry for how we manage running injuries.
This page is general information, not personal medical advice. Reviewed by Gideon Poratt, Principal Podiatrist (B.App.Sc (Pod), M.A.Pod.A), a member of the Australian Podiatry Association. Please book an assessment for advice specific to your feet.