Heel Pain
Heel pain is one of the most common conditions we treat at Manly Cove Podiatry, and it covers a broader range of causes than most people realise. The location of your pain, when it hurts and what makes it worse all point toward different diagnoses, and each of those diagnoses has a different treatment approach.
Getting the diagnosis right from the start is what separates a quick recovery from months of treating the wrong thing.
What Is Causing Your Heel Pain?
Several different conditions produce heel pain, and they can feel remarkably similar. Here is what we commonly see and how each one presents.
Plantar Fasciitis
The most common cause of heel pain. Sharp pain under the heel that is worst with that first step in the morning is the hallmark. You may also hear it called heel spur syndrome. Read our full guide to plantar fasciitis.
Achilles Insertional Tendinopathy
Pain and swelling at the back of the heel where the Achilles tendon attaches to the bone. Common in runners across the Northern Beaches who have increased their training load. Aggressive Achilles stretching can worsen this condition, which is why correct diagnosis matters.
Fat Pad Atrophy
The heel’s natural cushioning thins with age, producing a deep bruised ache directly under the heel that is worst on hard surfaces. It is frequently mistaken for plantar fasciitis, but the treatment is entirely different. Getting the right diagnosis here is essential.
Sever’s Disease (Heel Pain in Children)
The most common cause of heel pain in children aged 8 to 14, typically during growth spurts. It is entirely manageable and resolves completely once growth is complete. Read more about children’s heel pain.
Heel Stress Fractures
Less common but important to rule out. Heel pain when running that worsens progressively through activity rather than easing with warm-up is a red flag. If your pain is not responding to treatment, this needs to be considered.
Heel Pain Assessment at Our Manly Clinic
Because several conditions produce similar heel pain, getting the diagnosis right is the most important step. We start with a detailed history: how long you have had it, what makes it better or worse, when in the day it is worst and whether it came on gradually or suddenly.
We then carry out a physical examination of the heel and surrounding structures, combined with a biomechanical assessment to understand how load is moving through your foot during walking and activity. This tells us far more than imaging alone. We can see whether your foot mechanics are contributing to the problem and exactly where the excess stress is being placed.
For patients with diabetes or circulation concerns, your wider health picture shapes both diagnosis and treatment decisions from the outset.
If you are based in Manly, Seaforth, Fairlight, Freshwater or anywhere across the Northern Beaches, our clinic is conveniently located on the East Esplanade in Manly.
Heel Pain Treatment
Heel pain treatment depends entirely on what is actually driving your symptoms. There is no universal protocol. A plantar fasciitis case in a 45-year-old runner and fat pad atrophy in a 70-year-old are treated completely differently.
Depending on the diagnosis and contributing factors, your treatment plan may include:
Custom orthotics — altering how load is distributed across the foot to remove stress from the affected structure
Prefabricated orthotics — a practical and often effective starting point; we will always tell you honestly if one will do the job
Stretching and strengthening — targeted exercises specific to the structure involved, which differ significantly between conditions
Soft tissue therapy — hands-on treatment to release tension, reduce inflammation and restore mobility
Footwear advice — the shoes you wear daily have a significant impact on heel pain regardless of the cause
Shockwave therapy — for chronic or treatment-resistant plantar fasciitis and Achilles tendinopathy, with strong clinical outcomes
Why It Is Worth Sorting This Out Sooner Rather Than Later
Heel pain changes the way you walk. When you compensate for pain at the heel, you shift load onto other parts of the foot, the knee and the hip. What starts as a heel problem can quietly develop into something much broader over time.
The longer most heel conditions sit unaddressed, the more entrenched they become. Plantar fasciitis that might resolve in six weeks when caught early can take six months or more once it becomes chronic. Achilles insertional tendinopathy managed early with load modification rarely needs anything more involved.
Left too long, the tendon degrades in ways that are harder to reverse.
There are also several conditions that can mimic heel pain, including nerve entrapments, referred pain from the lower back and tarsal tunnel syndrome. All of these require a completely different treatment approach.
Our podiatrists in Manly see heel pain presentations across the full spectrum daily. An AHPRA-registered podiatrist can tell you definitively what you are dealing with and make sure you are treating the right thing from day one.
When Should You See a Podiatrist?
Many people put up with heel pain for months before seeking help. What could resolve in a few weeks becomes a chronic problem requiring more involved treatment. It is worth booking an appointment if any of the following apply.
Pain has been present for more than two weeks
It is affecting the way you walk
It is not responding to rest
It came on suddenly after an injury
You have diabetes or reduced circulation
There is visible swelling or bruising
The pain is severe enough to affect your daily activity
Frequently Asked Questions
How do I know what is causing my heel pain?
Location, timing and aggravating factors all give strong clues. Pain under the heel worst in the morning suggests plantar fasciitis. Pain at the back of the heel suggests Achilles involvement, while a deep bruised ache on hard surfaces often indicates fat pad atrophy.
These conditions can overlap and present atypically. A proper clinical assessment is the only reliable way to confirm what is going on.
Can I keep exercising with heel pain?
Often yes, with some modification. Swimming and cycling are generally well tolerated during recovery from most heel conditions. What you can safely continue depends on the diagnosis, and we will give you honest, specific advice based on what you actually have.
Do I need orthotics?
Not always, and not always custom ones. Orthotics are one tool among several and their value depends on what is driving your heel pain. We assess your gait and foot mechanics first and give you an honest recommendation, including whether a well-chosen prefabricated device will do the job just as well.
Why is my heel pain worse in the morning?
Morning stiffness and pain that eases once you get moving is the classic presentation of plantar fasciitis. The plantar fascia contracts during rest and the first steps stretch it suddenly. If your heel pain is worst after prolonged activity rather than at rest, or if it does not ease with movement, a different cause is more likely.
My child is complaining of heel pain: should I be concerned?
Heel pain in a child between about 8 and 14 who is active in sport is most likely Sever’s disease, an irritation of the growth plate that is entirely manageable and resolves completely with time and appropriate treatment. It should not be pushed through, but it is not a serious or permanent condition. A podiatrist can confirm the diagnosis and put a management plan in place to keep your child active through recovery.
How long will heel pain take to resolve?
It depends on what is causing it and how long it has been present. At your appointment, we will give you guidance on an expected recovery timeframe for your specific condition so you know what to realistically expect from the outset.
Conditions
Contact Your Local Podiatrist in Manly
If so, it is recommended that you make an appointment to see our
caring Northern Beaches podiatrists. Use our easy online appointment or give us a call on (02) 8966 9552 and speak to our friendly team.
Take care of your feet and they will take care of you.