Heel Pain & Plantar Fasciitis

What about heel spurs?

Many people are shown an X-ray with a heel spur and told this is the cause of their pain. Heel spurs are common in people with no heel pain whatsoever, and plenty of people with severe plantar fasciitis have no spur at all. The spur is generally a response to long-term traction rather than the source of symptoms.

This matters because treatment aimed at the spur — including surgery to remove it — addresses the wrong target. Treatment aimed at the fascia’s load tolerance addresses the right one.

Assessment

Assessment confirms the diagnosis and identifies the contributing factors: calf flexibility and strength, foot posture and how much the arch moves under load, walking pattern, footwear, and any recent change in activity or standing time. The location of tenderness helps distinguish plantar fasciitis from the alternatives.

Other causes of heel pain are screened for, including fat pad irritation, Achilles problems at the back of the heel, nerve entrapment, and stress-related bone pain — which needs a different approach and is important not to load aggressively.

Treatment

Calf strength and flexibility are central. The calf and the plantar fascia work together during walking, and a stiff, weak calf transfers more load to the fascia with every step. Calf stretching and progressive calf raise loading form the backbone of the programme.

Loading the plantar fascia directly — often through heel raises performed with the toes extended over a rolled towel — targets the tissue itself and is well supported by evidence. Progression is gradual and measured by symptom response.

Alongside this, treatment includes manual therapy to the foot and calf, temporary activity modification, taping for short-term relief, and specific footwear advice. Where an insole would genuinely help, we will say so; where it would not, we will say that too.

Practical measures that help

• Avoid walking barefoot on hard floors while symptoms are settling — supportive footwear indoors makes a real difference.
• Do a few gentle calf and foot stretches before your first steps in the morning, while still sitting on the bed.
• Choose shoes with a firm heel counter and some cushioning; completely flat, unsupportive shoes tend to aggravate it.
• Increase walking distance gradually rather than in sudden jumps.
• Roll the sole of the foot over a cold bottle after a long day on your feet.
• Where standing all day is unavoidable, use a cushioned mat and shift position regularly.