condition
Heel Pain: Understanding the Most Common Causes
Heel pain is a frequent reason people seek podiatry care.
While pain is often felt in a similar area, the underlying cause can differ significantly, which is why some treatments work well for one person and fail completely for another.
Three of the most commonly confused causes of heel pain are plantar fasciitis, Baxter’s neuritis, and posterior tibial tendon dysfunction (PTTD). Each affects a different structure and presents with distinct clinical features.
Getting the diagnosis right is essential if treatment is going to be effective.
The Three Most Common Causes of Heel Pain
- Plantar Fasciitis
Plantar fasciitis is caused by overload or degeneration of the plantar fascia, a thick band of connective tissue supporting the arch of the foot. It is the most common cause of plantar heel pain.
Typical features include pain under the heel that is worst with the first steps in the morning or after rest.
- Baxter’s Neuritis
Baxter’s neuritis occurs when Baxter’s nerve (the inferior calcaneal nerve) becomes compressed near the heel. It is a nerve entrapment condition and is often misdiagnosed as plantar fasciitis.
Pain is typically burning or tingling and often worsens with activity rather than easing.
- Posterior Tibial Tendon Dysfunction (PTTD)
Posterior tibial tendon dysfunction develops when the posterior tibial tendon, which supports the arch on the inside of the foot, becomes overloaded or degenerative. Over time, this can lead to progressive flattening of the foot.
Pain is usually felt along the inside of the ankle and heel rather than directly under the heel.
Symptoms: How They Differ
Plantar Fasciitis Symptoms
- Sharp or aching pain under the heel
- Pain with first steps in the morning
- Pain after periods of rest
- Localised heel tenderness
- Pain that may ease with movement initially
Baxter’s Neuritis Symptoms
- Burning or sharp heel pain
- Tingling, pins and needles, or numbness
- Pain radiating into the arch
- Pain that worsens with activity
- Persistent pain throughout the day or at night
Posterior Tibial Tendon Dysfunction Symptoms
- Pain or aching along the inside of the ankle and heel
- Swelling behind the inner ankle bone
- Progressive flattening of the foot arch
- Fatigue or weakness in the foot
- Difficulty standing on tiptoes on the affected side
Causes and Contributing Factors
Plantar Fasciitis
- Tight calf muscles or Achilles tendon
- Sudden increases in walking or running
- Over-pronation or poor foot biomechanics
- Unsupportive or worn footwear
- Prolonged standing on hard surfaces
Baxter’s Neuritis
- Long-standing plantar fasciitis
- Nerve compression near the heel
- Flat feet or high arches
- Muscle tightness near the heel
- Previous foot injury or surgery
Posterior Tibial Tendon Dysfunction
- Repeated overload of the posterior tibial tendon
- Flat feet or poor arch control
- Prolonged walking or standing
- Increased body weight
- Previous ankle injury
How Heel Pain Is Diagnosed
Accurate diagnosis begins with a thorough clinical assessment. Your podiatrist will assess pain location, foot posture, movement, strength, and symptom behaviour.
Imaging such as ultrasound or MRI may be used to confirm tissue involvement, assess severity, or rule out other causes. Correct diagnosis ensures the right structure is treated, improving recovery time and outcomes.
Treatment Options
Plantar Fasciitis Treatment
- Calf and plantar fascia stretching
- Load management and activity modification
- Manual therapy
- Orthotic insoles and footwear advice
- Extracorporeal Shockwave Therapy
Baxter’s Neuritis Treatment
- Reducing nerve compression and irritation
- Manual therapy to offload the nerve
- Footwear and biomechanical modification
- Neural mobilisation techniques
- Strapping and exercise rehabilitation
- Image-guided injections when required
Posterior Tibial Tendon Dysfunction Treatment
- Foot and ankle manipulation
- Supportive footwear and orthotic support
- Strapping or bracing to support the arch
- Progressive strengthening rehabilitation
- Load management and activity modification
Early treatment significantly reduces the risk of injections or surgery for all three conditions.
Which One Sounds Like You?
Heel Pain Comparison Table
| Feature | Plantar Fasciitis | Baxter’s Neuritis | Posterior Tibial Tendon Dysfunction |
|---|---|---|---|
| Primary structure affected | Plantar fascia | Baxter’s nerve | Posterior tibial tendon |
| Type of condition | Connective tissue overload | Nerve entrapment | Tendon degeneration |
| Main pain location | Under the heel | Inner heel, arch | Inside of ankle and heel |
| Pain quality | Sharp, aching | Burning, tingling | Aching, fatigue-type pain |
| Morning pain | Very common | Less prominent | Variable |
| Pain with activity | May ease initially | Often worsens | Worsens with walking/standing |
| Neurological symptoms | Absent | Common | Absent |
| Arch changes | Usually normal | Usually normal | Progressive flattening |
| Typical treatment focus | Fascia rehabilitation | Nerve decompression | Arch support and tendon rehab |
When to Seek Professional Help
If heel pain:
- Persists for more than 2–6 weeks
- Worsens despite rest or footwear changes
- Includes burning, tingling, or spreading pain
- Is associated with flattening of the foot
…it is important to seek professional assessment. Early diagnosis leads to faster recovery and better long‑term outcomes.
Medical Disclaimer
This content is for informational purposes only and does not replace professional medical advice. Always consult a qualified podiatrist or healthcare professional for diagnosis and treatment of foot and heel conditions.
Plantar Heel Pain: Causes, Symptoms, and Treatment Options
Plantar heel pain is one of the most common causes of foot discomfort and affects people of all ages. It is typically felt as pain under the heel, especially with the first steps in the morning or after long periods of rest. While plantar fasciitis is the most well-known cause, plantar heel pain can result from several underlying conditions. There are more than 30 different causes of plantar heel pain and it is important to get the right diagnosis if treatment is going to be effective.
Early diagnosis and proper treatment can significantly reduce pain and prevent long-term complications.
What Is Plantar Heel Pain?
Plantar heel pain refers to pain felt on the bottom (plantar surface) of the heel. It is often caused by irritation or damage to the soft tissues of the foot.
The pain is usually mechanical in nature, meaning it worsens with weight-bearing activities such as walking, standing, or running.
Symptoms of Plantar Heel Pain
Symptoms can vary in severity and may develop gradually or suddenly. Common symptoms include:
- Sharp or stabbing pain under the heel
- Heel pain with the first steps in the morning
- Pain after sitting or resting for long periods
- Pain that worsens after prolonged standing or walking
- Tenderness on the underside of the heel
- Stiffness in the foot or ankle
In many cases, the pain improves with gentle movement but worsens again later in the day.
Common Causes of Plantar Heel Pain
Plantar heel pain can have multiple causes, including:
- Plantar fasciitis
- Baxter’s neuritis (a trapped nerve)
- Tight calf muscles or Achilles tendon
- Posterior Tibial Tendon Dysfunction (a muscle problem)
- Fat pad atrophy
- Sudden increases in activity or exercise intensity
- Prolonged standing on hard surfaces
Actually, there are over 30 different causes, but the ones above are the most common. One thing we should say though is that heel spurs may be present but are NEVER the source of pain.
Yes, you read that correctly – it has been repeatedly proven that (as scary as they look on X-ray) heel spurs do not cause any pain at all.
How Plantar Heel Pain Is Diagnosed
A specific diagnosis of the condition that is responsible for your heel pain typically involves a physical examination and discussion of symptoms and activity history.
Your podiatrist may assess foot posture, gait, and areas of tenderness. Imaging such as X-rays or ultrasound may be used to rule out stress fractures or other causes of heel pain.
Accurate diagnosis is important to guide effective treatment. Once the diagnosis is clear, so is the best treatment option.
Plantar Heel Pain Treatment Options
Most cases of plantar heel pain respond well to conservative treatment. Common options include:
- Manipulation of the related joints of the foot and ankle
- Activity modification
- Stretching and strengthening exercises for the calf and the intrinsic muscles of the foot
- Orthotic insoles or footwear modification
- Extracorporeal shockwave therapy to stimulate tissue regeneration and improve healing times
For persistent pain, additional treatments such as corticosteroid injections, an Aircast walking boot, or other medical interventions may be recommended. Surgery is rarely required.
When to See a Podiatrist for Heel Pain
If heel pain lasts more than two weeks, worsens over time, or interferes with daily activities, professional evaluation is recommended. Early treatment can help prevent chronic pain and reduce recovery time significantly. It can also speed up a return to sport or work.
Plantar Heel Pain FAQs
Is plantar heel pain the same as plantar fasciitis?
Plantar fasciitis is one of the most common causes of plantar heel pain, but not all heel pain is plantar fasciitis.
Can plantar heel pain go away on its own?
Mild cases may improve with rest and proper footwear, but untreated pain often becomes chronic.
What shoes help plantar heel pain?
Good quality running shoes are generally the best option to help with plantar heel pain. Makes such as Saucony, Aasics and Brooks work really well. Avoid minimalist shoes and Barefoot running shoes, as these lack the cushioning and control your heel craves when it is struggling.