Plantar Fasciitis

Plantar fasciitis is one of the most common causes of heel pain. It occurs when the plantar fascia — a strong band of tissue that runs along the bottom of the foot from the heel to the toes — becomes irritated or overloaded. This can lead to pain at the heel, particularly when you first stand up after rest.

Heel pain can also be caused by other conditions, so assessment is important if symptoms are persistent, worsening, or affecting mobility.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment to confirm the cause of heel pain and recommend a clear treatment plan to reduce pain, restore function and support recovery.

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Types of Heel Pain

Heel pain may be grouped by the area of discomfort and likely cause:

• Plantar fasciitis (plantar heel pain)
  Pain typically under the heel, often worst with first steps in the morning.
• Insertional Achilles tendon pain
  Pain at the back of the heel where the Achilles tendon attaches.
• Heel pad pain
  Deep, bruised sensation under the heel, sometimes after prolonged standing on hard surfaces.
• Nerve-related heel pain
  Burning or tingling pain, sometimes due to nerve irritation.
• Stress fracture (less common)
  Pain that worsens with activity and may be tender to touch in a specific spot.

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Common Causes of Plantar Fasciitis and Heel Pain

Plantar fasciitis is usually caused by repeated strain on the plantar fascia. Contributing factors can include:

• Sudden increase in walking, running or standing
• Tight calf muscles or reduced ankle flexibility
• Poor footwear (minimal support or worn-out soles)
• Long periods on hard floors
• Excess body weight increasing load through the foot
• Foot mechanics such as flat feet or high arches
• Occupational factors (jobs involving long standing or walking)

Heel pain can also be linked to Achilles tendon problems, arthritis, nerve irritation, or previous injury.

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Symptoms of Plantar Fasciitis and Heel Pain

Common symptoms include:

• Sharp or aching pain under the heel
• Pain that is worst with the first steps after waking or after sitting
• Pain that improves after a short period of walking, but may return later
• Pain after prolonged standing, walking, or exercise
• Tenderness at the underside of the heel
• Tightness in the calf or Achilles tendon

If heel pain is associated with numbness, tingling, severe swelling, or you cannot weight-bear, you should be assessed promptly.

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Diagnosis at Royal Buckinghamshire Hospital

Diagnosis usually starts with a clinical assessment. Your consultant may:

• Ask about your symptoms, activity levels, footwear and occupational demands
• Examine the heel and arch, checking for tenderness and tightness
• Assess calf flexibility, ankle movement and foot mechanics
• Check for Achilles tendon involvement or nerve symptoms

Imaging is not always needed, but may be recommended if:

• Symptoms are persistent or unusual
• A stress fracture is suspected
• There is significant swelling or a different cause is likely

Investigations can include:

• X-ray (to assess bone and rule out other causes)
• Ultrasound (to assess plantar fascia thickness or soft tissue issues)
• MRI (for complex or persistent cases)

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Treatment & Management

Most cases improve with conservative treatment, but recovery can take time. A structured plan usually provides the best results.

Self-care and early management

• Reduce or modify aggravating activity (without stopping all movement)
• Avoid walking barefoot on hard floors
• Use supportive footwear with cushioning
• Ice packs (short periods) to reduce pain after activity
• Pain relief where appropriate

Stretching and strengthening

Often the most effective long-term approach includes:

• Calf stretches
• Plantar fascia-specific stretches
• Strengthening exercises for the foot and lower leg

Your consultant or physiotherapist can provide a tailored programme.

Insoles and supports

• Arch supports or heel cushions can reduce strain
• Taping techniques may provide short-term relief
• Night splints may be recommended in selected cases

Physiotherapy

Physiotherapy can help with:

• Mobility and flexibility
• Gait and biomechanics
• Progressive strengthening and return-to-activity planning

Treatments for persistent heel pain

If symptoms do not improve with conservative care, your consultant may discuss additional options depending on your diagnosis, such as:

• Targeted injection treatment in selected cases
• Shockwave therapy in selected cases
• Further investigation to confirm the cause and rule out alternative diagnoses

Surgery is rarely needed and is usually only considered for persistent symptoms that do not respond to other treatments.

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When to seek urgent help

Seek urgent medical advice if you experience:

• Inability to weight-bear after injury
• Severe pain with swelling, redness and heat (possible infection/inflammation)
• A sudden “snap” at the back of the heel with difficulty walking (possible Achilles injury)
• Numbness, tingling, or a cold foot
• Pain that is rapidly worsening or associated with fever

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If you have heel pain that is not settling, is affecting your walking, or keeps returning, contact Royal Buckinghamshire Hospital for assessment and treatment planning. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly, any costs will always be discussed.