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Health condition · Clinically reviewed

Heel pain, plantar and posterior causes - and how a stepped plan settles most of them.

From first-step morning pain to a stubborn Achilles - a UK-guided approach with load management, physiotherapy, orthoses and, when needed, shockwave or specialist review.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BOFAS and peer-reviewed musculoskeletal sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including graded loading, shockwave therapy and image-guided injection.

Key facts

Heel pain at a glance.

The essentials, in plain English - what it is, the common patterns, and how it is treated in the UK today.

  • What it is

    Pain under or behind the heel from soft tissue, bone or nerve causes - most often plantar fasciitis or Achilles tendinopathy.

  • Common patterns

    Plantar - first-step pain under the heel. Posterior - stiffness and swelling at the Achilles insertion or above it.

  • Who gets it

    Runners, walkers, standing workers, higher BMI, sudden training load changes, and inflammatory arthritis patients.

  • Foundation therapy

    Load management, calf and fascia stretching, and graded strengthening under specialist physiotherapy.

  • Injections

    Image-guided steroid can help selected cases - used sparingly due to fascia and tendon rupture risk.

  • Shockwave

    Extracorporeal shockwave therapy has the best evidence for stubborn plantar and insertional Achilles pain.

Why this guide matters

A structured plan, not a rest-and-hope approach.

Most heel pain is a load problem in soft tissue. The three ideas below shape everything else on this page.

  • Location tells you the diagnosis

    Under the heel is usually plantar fasciitis. Behind the heel is usually Achilles tendinopathy. Getting the location right shapes the plan.

  • Loading beats resting

    Modern rehab uses graded, progressive loading - not total rest. Fascia and tendon tissue need the right dose of stress to remodel.

  • Escalate when it stalls

    If 3 to 6 months of good conservative care has not moved things, image the heel and consider shockwave, injection or specialist review.

How the diagnosis is made

From first flare to a clear plan.

The steps a UK GP, podiatrist or foot and ankle consultant will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and pain map

    Location (under, behind, medial or lateral), morning start-up pain, activity triggers, footwear and training load.

  2. 02

    Assessing

    Biomechanical and gait review

    Foot posture, calf tightness, single-leg heel raise and gait pattern - clues to load transfer and fatigue.

  3. 03

    Assessing

    Focused examination

    Palpation of the fascia, Achilles insertion and mid-portion, retrocalcaneal bursa and tarsal tunnel, plus range and strength testing.

  4. 04

    Confirming

    Weight-bearing X-ray

    Considered when trauma, stress fracture, Haglund deformity or arthritis is suspected - not routine for typical plantar fasciitis.

  5. 05

    Confirming

    Ultrasound or MRI

    Ultrasound shows fascia and Achilles thickness in real time. MRI helps with suspected stress fracture, tumour or resistant cases.

  6. 06

    Planning

    Rule out inflammatory disease

    Bilateral enthesitis, morning stiffness or systemic features warrant rheumatology review - think spondyloarthritis, gout or RA.

  7. 07

    Planning

    Specialist referral

    Persistent pain despite 3 to 6 months of good conservative care needs specialist podiatry or orthopaedic foot and ankle input.

Typical timeline: a first visit to a working plan within one or two consultations.

Symptoms

What heel pain actually feels like.

The pattern usually points to the tissue - fascia, tendon, bursa, bone or nerve. Location, timing and triggers do most of the diagnostic work.

  • First-step morning pain

    Sharp under-heel pain with the first steps of the day or after sitting - the hallmark of plantar fasciitis.

  • Posterior heel pain and stiffness

    Ache and stiffness at the Achilles insertion or 2 to 6 cm above it - insertional or non-insertional tendinopathy.

  • Palpable heel spur or bump

    A firm posterior prominence (Haglund) or medial tuberosity tenderness with a plantar spur seen on X-ray.

  • Swelling behind the heel

    Retrocalcaneal bursitis - soft, warm swelling between the Achilles and calcaneus, worse in stiff shoes.

  • Tingling or burning under the arch

    Nerve involvement (tarsal tunnel or Baxter neuropathy) - burning, tingling or numbness radiating into the sole.

  • Pain worse with weight-bearing

    Load-related pain that eases with rest but flares with walking, running or standing shifts.

  • Bilateral or systemic pattern

    Both heels sore, or heel pain with back, eye or bowel symptoms - consider inflammatory arthritis.

  • Red flag - sudden pop or weakness

    A sudden pop with an inability to push off can mean an Achilles rupture - urgent same-day review.

Treatment

How heel pain is treated in the UK.

Load management and physiotherapy first, orthoses and simple analgesia alongside - and shockwave, injection or surgery for the small number who need it.

  • Load management and footwear

    Rest from aggravating activity, cushioned supportive shoes and a temporary heel raise for Achilles pain.

  • Specialist physiotherapy

    Structured calf and fascia stretching plus heavy slow resistance calf work - the single most effective intervention.

  • Foot orthoses and heel cups

    Off-the-shelf or custom insoles offload the fascia and heel pad - see our guide at /treatments/foot-orthotics/.

  • NSAIDs and simple analgesia

    Short courses can settle a flare - not a long-term strategy on their own.

  • Steroid injection

    Image-guided injection helps selected plantar cases - used sparingly given fascia and tendon rupture risk. See /treatments/steroid-injection/.

  • Extracorporeal shockwave

    Focused or radial shockwave has good evidence for stubborn plantar and insertional Achilles pain. See /treatments/shockwave-therapy/.

  • Night splints and taping

    Overnight stretching splints and low-Dye taping can reduce first-step pain in plantar fasciitis.

  • Surgical options

    Fasciotomy, gastrocnemius recession or Achilles debridement reserved for the small number who fail 9 to 12 months of good conservative care.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, physiotherapist, podiatrist or foot and ankle consultant knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE CKS. Plantar fasciitis and Achilles tendinopathy summaries.

  • British Orthopaedic Foot and Ankle Society (BOFAS). Patient information and guidance.

  • NHS England. Extracorporeal shockwave therapy commissioning guidance.

  • Royal College of Podiatry. Standards for musculoskeletal foot and ankle care.

Red flags

When heel pain needs urgent attention.

Most heel pain is manageable in primary care. These are the situations that are not - and where a specialist opinion is needed quickly.

  • Sudden pop and inability to push off

    Suspect Achilles rupture - see our guide at /conditions/achilles-tendinopathy/. Needs urgent same-day orthopaedic review.

  • Focal bone pain after loading

    Point tenderness with an inability to hop, especially in runners - consider a calcaneal stress fracture and image early.

  • Night pain and rest pain

    Unremitting pain that wakes you at night warrants imaging to rule out tumour, infection or Paget disease.

  • Systemic features

    Fever, weight loss, night sweats or new inflammatory joint symptoms need rheumatology and infection screening.

  • Bilateral enthesitis in a young adult

    Think spondyloarthritis - see /conditions/ankylosing-spondylitis/ and consider HLA-B27 and MRI sacroiliac joints.

  • Acute red hot swollen heel

    Consider gout (see /conditions/gout/), septic bursitis or cellulitis - urgent assessment and bloods.

  • Progressive numbness or weakness

    Tarsal tunnel or nerve entrapment with motor signs needs neurology or orthopaedic review and nerve studies.

  • Non-healing wound over the heel

    Especially in diabetes or peripheral vascular disease - risk of osteomyelitis. Same-week specialist review.

  • Paediatric heel pain

    Growing children with posterior heel pain often have Sever disease - see /conditions/growing-pains-in-children/.

Living with it

A treatable problem, with a clear ladder.

Four things make the biggest difference day to day - manage load, give rehab time, wear supportive shoes and escalate promptly when needed.

A quiet reminder

Consistency beats intensity, every time.

Small, steady loading and mobility habits - kept up for months - do more than a heroic week that does not last.

  1. 01 Load

    Manage the dose, not just the exercise

    Cut aggravating load by a third, then rebuild slowly. Total rest usually makes tendons and fascia worse in the long run.

  2. 02 Patience

    Give rehab 12 weeks

    Fascia and tendon tissue remodels slowly. Judge progress at three months of consistent loading, not three days.

  3. 03 Shoes

    Footwear is medicine

    Supportive shoes with a modest heel and a firm heel counter reduce pain more than most gadgets - especially early on.

  4. 04 Escalate

    Ask about shockwave or imaging

    If good conservative care has not shifted things by 3 to 6 months, image the heel and consider shockwave or specialist review.

Frequently asked

Everything we get asked about heel pain.

Quick answers on plantar fasciitis, Achilles problems, scans, injections, shockwave and when to see a specialist.

  • What is the most common cause of heel pain?

    Plantar fasciitis - inflammation and micro-tearing of the plantar fascia where it attaches to the heel bone. It causes sharp first-step pain under the heel. See our detailed guide at /conditions/plantar-fasciitis/.

  • How is heel pain from Achilles problems different?

    Achilles tendinopathy causes pain at the back of the heel or 2 to 6 cm above it. It is stiff first thing in the morning, warms up with gentle activity and hurts again after loading. Read more at /conditions/achilles-tendinopathy/.

  • Do I need a scan for heel pain?

    Most heel pain is diagnosed clinically. Imaging helps when the diagnosis is unclear, when there is trauma or suspected stress fracture, or when pain does not settle. Ultrasound and MRI are the main tools - see /treatments/private-mri-scan/ and /treatments/private-ultrasound-scan/.

  • Do steroid injections work for heel pain?

    Image-guided steroid can reduce pain in selected plantar fasciitis cases, but the effect is often short-lived and repeated injections raise the risk of fascia rupture and fat pad atrophy. They are avoided in the main body of the Achilles tendon. See /treatments/steroid-injection/.

  • What is shockwave therapy and does it help?

    Extracorporeal shockwave therapy uses focused sound waves to stimulate healing in stubborn tendon and fascia problems. It has the strongest evidence base for chronic plantar fasciitis and insertional Achilles tendinopathy. See /treatments/shockwave-therapy/.

  • When should I see a specialist?

    If heel pain has not improved after 3 to 6 months of good load management, physiotherapy and footwear changes, ask for referral to a specialist podiatrist or orthopaedic foot and ankle consultant. Earlier review is sensible if there are red flags or a suspected rupture.

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