Heel pain

Heel pain: we assess loading, gait and foot support

Heel pain can relate to repeated load, mobility, footwear, daily activity or compensation during gait. It should not be treated as though every case were the same.

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Heel and plantar fascia highlighted during loading

Assess before unloading

Heel pain is one of the most common reasons for consultation. It may appear on first getting up, after walking for a while, after increasing activity or with certain shoes. In some patients the plantar fascia is relevant; in others the issue may involve heel overload, stiffness, training changes, footwear or a particular loading pattern.

At MEDIPIE we do not assume that all heel pain has the same cause. We assess how load is distributed, how the foot moves, what happens during gait and which day-to-day factors may be maintaining symptoms.

Information that helps identify the pattern

When pain appears and which activity provokes it.
Heel loading, pressure and tolerance to weight-bearing.
Foot mobility and its relationship with gait.
Usual, work or sports footwear.

When plantar offloading may fit the plan

When assessment supports it, an orthosis or adaptation may help reduce pressure in sensitive areas, redistribute load and improve tolerance. Footwear, activity and progression of load may also need attention.

Heel pain should not be treated by looking only at a footprint. If signs suggest another assessment is needed, we explain the appropriate route for further investigation.

Differential assessment

The pain pattern guides us, but does not confirm the cause

Plantar pain on the first steps after rest can be compatible with plantar fascia overload, but not every heel pain is plantar fasciitis. We also consider pain under the centre of the heel, at the back of the heel, after trauma or a sudden increase in activity, or symptoms such as burning, tingling or loss of sensation.

Location, timing and examination help decide whether the problem may be approached through load and function or needs another diagnostic route.

When to widen the assessment

Signs that change the plan

Major trauma, inability to bear weight, marked swelling, heat or redness, fever, persistent rest or night pain, or progressive sensory changes require caution. Pain that does not progress as expected also needs review.

In these situations we do not force offloading or make an orthosis by default; we explain what medical assessment or further testing may be necessary.

Frequently asked questions

Common questions

Does plantar fasciitis always need orthoses?

No. Heel pain can have different causes and orthoses are not needed in every case. We first assess symptoms, duration, load, mobility, footwear and examination findings; when indicated, an orthosis is usually one part of a broader plan that can be reviewed.

How can an orthosis help with heel pain?

When indicated it may redistribute load, support the arch, cushion the heel and improve walking tolerance. Design depends on the pain mechanism, footwear and individual response; it does not replace load management or other measures that may be needed.

Would you like to know how we prepare the assessment?

See what is useful to bring, how we relate heel pain to load and when further investigation may be needed.

See all questions

Appointments by phone

Tell us how long your heel has been painful

Tell us when it hurts most, your usual activity and which treatments you have already tried. This helps us prepare the assessment.

Clinical content reviewed by Juan Bautista Calero Márquez, podiatrist registered no. 115 in the Region of Murcia.

+34 628 342 080

Clinical evidence and limits

Orthoses should not be presented as stand-alone treatment for plantar fasciitis

The 2023 JOSPT/APTA clinical practice guideline recommends against using orthoses, prefabricated or custom, as an isolated short-term pain treatment for plantar fasciitis. It does support their use alongside other interventions when clinically indicated.

The same guideline notes that evidence about orthosis type, materials and design is limited. This supports a multimodal approach and avoids presenting an orthosis as a universal solution.

Clinical source: JOSPT/APTA · Heel Pain – Plantar Fasciitis: Revision 2023