Heel Pain: The Six Common Causes and How to Tell Them Apart
Heel pain is not always plantar fasciitis. Where it hurts, when it is worst and how it feels can help distinguish the most common causes.
Heel pain is something that can affect your day-to-day life.
By now you’ve probably tried the stretches. Swapped the trainers. Bought the insoles that were meant to sort it.
Only for the pain to have stayed.
And while Googling the causes, most people land on plantar fasciitis, because it’s the name that comes up first, and it genuinely is the most common cause.
But there are other conditions that can cause similar heel pain, and only getting to the GP or getting a scan can truly differentiate them.
So here’s how to work out which one you’re dealing with, and when to book an ultrasound scan for heel pain.
Where exactly does your heel hurt?
The first step, even before a consultation, is to figure this out. Point to the sorest spot with one finger. That, plus knowing when it hurts most, is one of the first things to know.
This is usually a starting point, but when the pain starts to overlap with one another is where a self-diagnosis stops being helpful, and a foot ultrasound scan makes the most sense.
| Where it hurts | When it’s worst | Most likely cause |
|---|---|---|
| Underneath, towards the inner heel | First steps in the morning, and after sitting | Plantar fasciitis |
| Back of the heel, 2 to 6 cm up | Stiff in the morning, sore during and after running | Mid-portion Achilles tendinopathy |
| Back of the heel, right where the tendon meets bone | Uphill walking, and the back of your shoe rubbing | Insertional Achilles tendinopathy |
| A swollen, tender spot just above the heel bone | Shoes pressing on it | Retrocalcaneal bursitis |
| Underneath, but burning or tingling | Comes and goes, no clear morning pattern | Baxter’s nerve or tarsal tunnel |
| Dead centre of the heel, like a deep bruise | Standing on hard floors, barefoot on tiles | Fat pad syndrome |
| Anywhere in the heel, worsening week on week | Any weight-bearing, doesn’t settle with rest | Possible stress fracture |
What is plantar fasciitis, or policeman’s heel?
The plantar fascia is a thick band of tissue running from your heel bone to the base of your toes. It holds up your arch and stores energy every time you push off.
You’ll still hear it called policeman’s heel, a name from the days when it was blamed on walking a beat all day. Standing for long hours does aggravate it. So does running, changing your shoes, or suddenly walking a lot more than usual.
What does plantar fasciitis feel like?
Morning pain is the main indication of this condition. The fascia shortens overnight, and your first steps stretch it before it’s ready, so the pain generally shows up then.
It eases as you move, returns after you’ve been sitting, and shows up again by the end of a long day. The tender point sits on the inner side of the underneath of the heel, and you can usually find it with one thumb.
What is a heel spur?
Plenty of people get told they have a heel spur. Spurs can also turn up in people with no heel pain at all. They’re better understood as a sign that something has been pulling on the heel bone for a long time, rather than the thing generating your symptoms.
The soft tissue around the spur is usually where the answer sits, and that’s what a scan looks at.
What causes pain at the back of the heel?
If your sore spot sits behind the heel rather than underneath it, the plantar fascia probably isn’t your problem.
This is Achilles territory, and it’s covered by the ankle ultrasound scan.
Mid-portion Achilles tendinopathy
The pain sits two to six centimetres above where the tendon attaches, and the tendon often feels thickened if you pinch it.
Mornings are stiff. Running hurts during and after. The tendon warms up deceptively well in the first ten minutes of exercise, then makes you pay for it that evening.
Insertional Achilles tendinopathy
Here the pain is right at the joint between tendon and heel bone. Uphill walking makes it worse, so does the back of a stiff shoe, and calcification tends to build up in the tendon over time.
It behaves differently from the mid-portion kind and needs a different rehab approach, which is a solid reason to find out which one you’ve got.
Bursitis and Haglund’s
The retrocalcaneal bursa is a small fluid-filled cushion sitting between the tendon and the bone. When it inflames, you get a tender and sometimes visibly swollen spot just above the heel.
A Haglund deformity is a bony bump at the back of the heel that rubs against footwear and irritates both the bursa and the tendon. Some people carry theirs for decades without noticing, until a new pair of shoes starts the argument.
Sudden Achilles injury
A sudden snap at the back of the ankle, with difficulty pushing off or walking, is a different situation entirely. That needs same-day assessment.
What else gets mistaken for plantar fasciitis?
There are some other conditions that can get mistaken for plantar fasciitis due to the similarity with symptoms. Here are some common conditions:
Baxter’s nerve entrapment
A small nerve gets compressed near the inner heel. The pain sits in roughly the same place as plantar fasciitis, and the giveaway is that it burns, tingles or feels electric rather than aching. It also doesn’t follow the classic morning pattern.
Tarsal tunnel syndrome
The tibial nerve gets squeezed as it passes behind the inner ankle bone, producing burning, numbness or pins and needles spreading into the sole, often worse at night. Where nerve involvement is suspected, a peripheral nerve ultrasound is recommended.
Fat pad syndrome
The natural cushion under your heel thins or loses its bounce, usually with age or after years of impact. The pain sits dead centre rather than towards the inner edge, and hard floors are what bring it on.
Calcaneal stress fracture
Repeated loading cracks the heel bone itself, most often in runners, dancers and military recruits. The tell is pain that worsens week on week and refuses to settle with rest. Bone stress needs an MRI rather than an ultrasound, so a scan here rules the soft tissue causes in or out and gets you referred to the right place.
How do I know if my heel pain is serious?
Most heel pain tends to settle after a few days. But if you experience any of these symptoms, it’s better to book that consultation or call a clinic:
- Pain that keeps worsening week after week and doesn’t ease with rest
- A sudden snap or pop at the back of the ankle, or a heel you can’t walk on
- Numbness, tingling or loss of feeling anywhere in the foot
- Swelling, redness, heat, or feeling unwell alongside it, which can point to infection
- Any foot pain if you have diabetes, where the NHS advises seeing a clinician
How is heel pain diagnosed on an ultrasound?
During a heel ultrasound, a probe goes over the heel and puts a live picture of the fascia, tendons, bursae and nerves on the screen beside you. The scan takes about 25 to 35 minutes.
For plantar fasciitis, the fascia is measured where it attaches to the heel bone. A healthy one is thin and evenly striped. A painful one is usually thickened, darker, and has lost that stripe pattern, and tears show as a clear break in the fibres.
For the Achilles, the scan shows thickening, degeneration, calcification, bursitis and partial tears, and the tendon can be watched gliding while your ankle moves.
What are the treatment options for heel pain?
Treatment for heel pain depends on what’s causing it and how severe your symptoms are. At London Private Ultrasound, we follow evidence-based pathways that get to the root of the problem. Here’s what we recommend:
Movement and loading beat rest
For most heel pain—whether it’s plantar fasciitis or Achilles tendinopathy—structured exercise and loading programmes have the strongest evidence.
The key is consistency. These programmes need to be done regularly for several months, which is where many people struggle. That’s why our personalised rehabilitation programme is built around the specific findings from your scan. We tailor the exercises to your exact condition, so you’re on the fastest and best road to recovery.
Footwear and cushioning
Simple changes to your footwear can make a big difference while your heel settles down:
- Wear supportive shoes with a cushioned heel
- Try insoles or heel pads for extra support
- Avoid walking barefoot on hard floors
- Stay away from high heels and flip-flops
The NHS recommends the same approach, along with rest, ice, and activity modification while the tissue heals.
Injections
An ultrasound-guided steroid injection can calm down a stubborn bursa or a very painful plantar fascia enough to get you moving again. Think of it as a bridge into rehabilitation, not a permanent cure.
It’s also important to know that injecting the plantar fascia carries a small risk of rupture, which is exactly why precise placement under live ultrasound imaging matters. Our injection is £299 all-inclusive and is done by clinicians who specialise in MSK imaging.
Shockwave therapy
Shockwave therapy is one of the options the NHS lists for plantar fasciitis that hasn’t responded to self-care and conservative treatments. We also offer it in-house, but we’ll be upfront if your scan findings suggest it’s worth exploring elsewhere.
Most heel pain improves with the right combination of loading exercises, footwear changes, and time. Injections can help you get started with rehab if pain is holding you back. And if your scan shows something that needs a different approach, we’ll point you in the right direction.
Book a Shockwave Therapy SessionBook a foot and heel ultrasound in London
Most people who book a heel scan with us have been living with this for months, not days.
They’ve done the stretches, they’ve been told to give it time, but they’re at the point where a treatment pathway or the right diagnosis makes the most sense for them.
That’s what we’re set up for, at London Private Ultrasound:
What you can book with us
Foot ultrasound
A focused scan of the plantar fascia, nerves, plantar plate and tendons, with dynamic assessment, on-the-spot explanation and a written report within 24 hours.
Book a foot ultrasoundFoot and ankle ultrasound
For heel pain you can’t localise, or pain that moves between the sole and the back of the heel. Covers the plantar fascia and the Achilles in one appointment.
Book a foot and ankle ultrasoundJoint Pain Clinic
If your scan finds something that needs more than a report, you don’t have to start again somewhere else. Guided injections, rehabilitation and MSK specialist review all happen in the same building.
Explore the Joint Pain ClinicFrequently asked questions
Do heel spurs ever go away on their own?
The bony spur itself doesn’t dissolve. The better news is that it usually isn’t what’s hurting you, so your pain can settle completely while the spur stays exactly where it is on any future X-ray.
How much does it cost to see a podiatrist in London?
Across the UK, a private podiatry initial consultation and assessment typically runs £35 to £65, and London tends to sit at the higher end. A podiatrist assesses your gait, footwear and biomechanics. A scan answers a different question, which is which structure is damaged, so the two work well together rather than replacing one another.
How long does plantar fasciitis last?
Months rather than weeks for most people, and a fair number take a year or more. The NHS advises seeing a GP if it hasn’t improved after two weeks of self-care, mainly so other causes get considered early rather than late.
Should I book the foot scan or the ankle scan?
Pain underneath the heel means the foot scan. Pain behind the heel, where the Achilles attaches, means the ankle scan. If you genuinely can’t tell, the combined foot and ankle scan covers both for £299 per side, or call us and we’ll work it out with you.
Do I need a GP referral for a private foot ultrasound?
No. You can book directly. If you want your results sent on to your GP, physiotherapist or podiatrist, just tell us on the day.
Is a foot ultrasound safe?
Yes, it’s completely safe. Ultrasound uses sound waves, not radiation. Nothing is injected, and there’s nothing you need to avoid afterwards.
When will I get my results?
Your sonographer talks you through what they found on the screen before you leave. Your full written report is emailed within 24 hours.
Find the cause of persistent heel pain
Book a private foot ultrasound from £199 at our Harley Street or St Albans clinic, with no GP referral required.
Book a foot ultrasound