If you wake up and hobble to the kettle because your heel feels like it’s been jabbed with a hot knitting needle, you’re not alone. Heel pain is one of the most common reasons people walk into our clinic here in Melbourne — often after months of gritting their teeth through every step.
The first thing most people hear is, “You’ve got plantar fasciitis.” It’s a phrase that gets thrown around a lot, and while it’s a valid diagnosis, it’s not always the right one.
Over the years, I’ve seen countless patients referred in with a “confirmed” case of plantar fasciitis — but when we actually dig a little deeper, the cause is something else entirely.
Take Jess, for example — a netball coach in her 50s who spends hours on her feet. She was diagnosed with plantar fasciitis and given standard orthotics and stretches. Six months later, she was still limping into her sessions. What she actually had? A calcaneal stress fracture, likely from overloading on unforgiving concrete courts and shoes with zero shock absorption.
It’s More Than Just “Foot Pain”
Your heel is built to bear load — your entire body weight, every time you take a step. But when something disrupts how that force is spread (like poor foot mechanics or poor footwear choices), it can lead to inflammation, stress, or even damage to the structures within your heel.
Plantar fasciitis might top the list — but it’s not the full story. That’s why accurate diagnosis is so important. Because heel pain can be sneaky — masking other injuries, imitating different conditions, and dragging on if not managed the right way.
Why Getting the Right Diagnosis Matters
I once treated a FIFO worker who was limping between job sites with what he’d been told was plantar fasciitis. Turns out he had Baxter’s nerve entrapment — a totally different beast. Once we addressed the nerve irritation using dry needling and manual therapy (instead of endless calf stretches), he was back in boots within weeks.
That’s the power of digging deeper.
Common Signs It Might Not Be Plantar Fasciitis
Here’s a quick checklist to help spot if something else could be going on:
| Sign or Symptom | Could Also Point To |
| Pain on the sides or back of the heel | Bursitis or Achilles tendinopathy |
| Tingling or burning pain | Nerve impingement (e.g. Baxter’s or tarsal tunnel syndrome) |
| Pain increases after activity (not just in the morning) | Stress fracture |
| Sudden swelling or bruising | Fat pad injury or rupture |
| History of autoimmune issues | Inflammatory arthritis |
Remember — plantar fasciitis tends to be worst with the first few steps in the morning or after sitting, and eases with movement (at least initially). If that pattern doesn’t quite fit, it’s worth a second look.
What Really Causes Plantar Fasciitis? (And How You Can Stay One Step Ahead)
Most people think plantar fasciitis just “comes out of nowhere.” But in reality, there’s usually a pattern — and spotting that pattern early can be the key to avoiding months of nagging pain.
In my clinic, I often say: “Your feet are talking — the trick is learning to listen before they start yelling.”
Whether you’re a dance mum ferrying kids to classes, a weekend hiker tackling the Dandenongs, or someone who’s returned to walking after years of sitting at a desk, the root causes of plantar fasciitis often come down to load, structure, and support.
The Top 7 Culprits Behind Plantar Fasciitis
Here’s a breakdown of what typically sets it off — with examples straight from my clinical experience.
1. Repetitive Load (Doing too much, too soon)
One of my patients, Ben, took up running again at 42 after a decade-long break. Within weeks, he was icing his heel every night. He hadn’t ramped up gradually, and his plantar fascia hadn’t built the load tolerance needed. It was a classic case of too much, too soon.
Tip: If you’re getting back into exercise, follow the “10% rule” — don’t increase distance or intensity by more than 10% a week.
2. Poor Foot Mechanics
Flat feet, high arches, or rolling in too much (overpronation) can overload the plantar fascia. I often use slow-motion video gait analysis in the clinic to show patients exactly what their feet are doing — and it’s a lightbulb moment.
Real-life scenario: Sarah, a 38-year-old hairdresser, stood all day on hard floors. Her flat feet caused extra strain, and her arch support shoes were too soft to help.
3. Excess Body Weight
Extra kilos = extra stress on your feet. It’s not about blame — it’s about physics. The heavier we are, the more force the fascia absorbs with every step.
Simple maths: Each step can place 2-3x your body weight through the foot. Multiply that by 6,000–10,000 steps a day and you can see how the stress adds up.
4. Ageing Tissues
Most cases I see happen in people aged 40–60. That’s when the collagen in our fascia loses elasticity, and recovery from micro-tears becomes slower.
Note: This doesn’t mean younger people are immune — especially if they’re active or on their feet for long hours.
5. Jobs That Keep You Standing
I’ve treated teachers, chefs, nurses, tradies — all of whom spend 8+ hours a day upright. Repetitive standing on hard, unsupportive surfaces (like concrete or timber) wears down the fascia.
6. Unsupportive Footwear
If I had a dollar for every pair of ballet flats and thongs I’ve seen contributing to plantar fasciitis…
The worst offenders:
- Flat shoes with no arch support
- Worn-out joggers
- High heels with tight calf shortening
Quick test: If you can fold your shoe in half like a taco, it’s likely doing nothing for your arches.
7. Tight Calf or Achilles Tendons
If your calves are tight, your foot can’t move properly. This shifts extra load to the fascia, especially during push-off when walking.
Checklist:
- Can you touch your toes comfortably?
- Do your heels lift early when doing a squat?
- Is your Achilles tender to touch?
If yes, some gentle calf and foot mobility work could be a game-changer.
Prevention Checklist for Plantar Fasciitis
Here’s a simple cheat sheet I share with patients:
| Action | Why It Helps |
| Stretch calves and plantar fascia daily | Improves flexibility and load distribution |
| Replace shoes every 9–12 months | Old shoes lose support and cushioning |
| Use shock-absorbing mats if standing at work | Reduces pressure through the heel |
| Cross-train (e.g., alternate walking with swimming) | Reduces repetitive strain |
| Monitor weight changes | Less load = less strain |
| Seek professional assessment early | Avoids misdiagnosis and chronic pain |
Not Plantar Fasciitis? Other Sneaky Causes of Heel Pain
If you’ve been diligently stretching, icing, and wearing your orthotics — but your heel pain just won’t budge — there’s a good chance something else is going on.
In fact, about 1 in 3 cases I assess for “plantar fasciitis” end up being another condition entirely. The foot’s a complex unit, and many tissues sit within millimetres of each other. It’s no wonder things get mixed up.
Here’s a breakdown of the usual suspects that masquerade as plantar fasciitis — and how I spot them in the clinic.
Common Misdiagnosed Conditions That Mimic Plantar Fasciitis
| Condition | Key Symptoms | Clue It’s NOT Fasciitis |
| Calcaneal Stress Fracture | Deep ache that worsens with activity | Pain doesn’t ease with warming up; may bruise |
| Fat Pad Atrophy | Sharp or bruised sensation when walking barefoot | Pain worsens on hard surfaces like tiles or concrete |
| Heel Spur (without fasciitis) | Sharp pain directly under heel | Usually visible on X-ray, but not always painful |
| Bursitis (e.g. retrocalcaneal) | Swelling and tenderness at the back of the heel | Pain increases with shoes pressing the area |
| Tarsal Tunnel Syndrome | Tingling or burning along inner ankle into heel | Neurological signs (numbness, pins and needles) |
| Baxter’s Nerve Entrapment | Pain with standing or walking; often medial heel | No relief with fascia stretches or ice |
| Referred Pain (e.g. from lower back or sciatic nerve) | Vague ache or radiating discomfort | Doesn’t change with foot movements |
How I Tell the Difference: Clinical Clues That Matter
Here’s how we approach heel pain differently at Well Heeled Podiatry:
1. Detailed Movement Testing
We test how the fascia responds to tension versus compression. A true plantar fascia issue will usually light up with pressure on the arch and first steps after rest.
2. Gait and Loading Patterns
Using slow-motion video or pressure plate analysis, I often uncover subtle imbalances — like rolling inwards (pronation) too early or lacking heel lift — which hint at nerve or tendon involvement.
3. Response to Treatment
If someone’s been doing calf stretches, icing, and orthotics for weeks with zero improvement — it’s a red flag. Plantar fasciitis usually shows some response within 2–3 weeks when treated correctly.
4. Diagnostic Injections or Imaging
We may use ultrasound, X-ray, or refer for MRI if we suspect stress fractures or deep tissue injuries. Sometimes a local anaesthetic injection pinpoints whether a nerve is involved.
When to Reconsider the Diagnosis
You might not have plantar fasciitis if:
- Pain feels like pins and needles or burning
- Symptoms get worse with activity (not better)
- There’s no morning pain, just constant dull ache
- Swelling or bruising appears
- Rest and standard treatment haven’t helped after 4–6 weeks
Diagnosing & Treating Heel Pain: From Guesswork to Game Plan
By the time most people land in my treatment chair, they’ve already been through a bit of a saga — Dr Google, a pair of chemist-bought inserts, maybe even a cortisone jab that “kind of worked for a bit.” Sound familiar?
Heel pain is common, yes. But it’s not simple. That’s why a clear, structured diagnosis is the first (and most important) step.
How We Properly Diagnose Heel Pain
At Well Heeled Podiatry, our assessment process is hands-on, movement-based, and designed to uncover the root cause — not just manage symptoms.
Here’s how we typically work through it:
1. Comprehensive History
We ask targeted questions like:
- When did the pain start?
- What shoes do you wear day to day?
- Does it feel better after walking or worse?
- Any past injuries or changes in weight/training?
It’s amazing what you can uncover just by listening.
2. Physical Exam
This includes:
- Palpating the heel and arch to map pain patterns
- Checking calf and Achilles flexibility
- Assessing foot shape and mobility
- Watching your walking (gait) and how you distribute pressure
I’ve had patients come in limping on one side and not realise their “good foot” was doing double the work — until they saw it on screen.
3. Imaging (If Needed)
- X-ray: Useful for spotting heel spurs or fractures
- Ultrasound: Shows fascia tears, thickening, or bursal inflammation
- MRI: Reserved for complex or chronic cases
Heel Pan Treatment Options (That Actually Work)
Once we know what’s going on, treatment is all about reducing pain, restoring movement, and preventing relapse.
Here’s a look at what’s in our toolkit:
Home-Based Treatments
| Method | Why It Helps |
| Rest + Ice | Calms acute inflammation |
| Towel scrunches / marble pickups | Activates intrinsic foot muscles |
| Rolling foot over a frozen bottle | Combines massage and cooling |
| Calf and plantar fascia stretches | Reduces strain and restores tissue glide |
| Switching to supportive shoes | Reduces load immediately |
In-Clinic Treatments
Foot Mobilisation Therapy
We use gentle joint manipulation to improve alignment and reduce stiffness. Great for people who haven’t responded to orthotics.
Shockwave Therapy
This one’s a favourite of mine — especially for chronic plantar fasciitis or heel spurs. We’ve seen big improvements after just 3–5 sessions. It boosts circulation and tissue healing, and it’s backed by solid clinical evidence.
Dry Needling
Helps release tight trigger points in the calf or arch, which often play a role in ongoing pain.
Custom Orthotics
These can help redistribute pressure, especially for people with structural foot issues or who stand all day. But they’re not a magic bullet — they work best as part of a bigger plan.
Strapping / Taping
We sometimes tape the foot to offload pressure during the early phase of healing. Great for tradies or anyone who can’t take time off their feet.
Injections & Surgery (Rare, but Sometimes Necessary)
If conservative care fails after 6 months, other options might include:
- Cortisone injection: Temporarily reduces inflammation
- Platelet-rich plasma (PRP): Uses your own blood cells to promote healing
- Surgery: Reserved for cases with confirmed fascia rupture or severe nerve entrapment
Most patients never need surgery — and I’ll always push for tissue-friendly options first.
Realistic Recovery Timeline
Here’s what a typical recovery looks like if we catch it early:
| Timeframe | What to Expect |
| 0–2 weeks | Pain starts to ease with offloading + support |
| 2–4 weeks | Mobility improves, stretches feel easier |
| 4–6 weeks | Can usually return to low-impact walking or exercise |
| 6–10 weeks | Strength + rehab progress, pain nearly gone |
| 3–4 months | Back to full activity for most patients |
The longer pain has been around, the more patience we’ll need. Chronic cases can take 3–6 months, but I’ve seen even 18-month problems turn around with the right plan.
Don’t Let Heel Pain Drag On
Pain under the heel is more than just an inconvenience. It saps energy, affects work, exercise, and how you feel at the end of the day. And most importantly — it’s treatable.
Whether it’s plantar fasciitis or something else entirely, you deserve proper answers and real relief. If something hasn’t been working, it’s time to ask why — and get fresh eyes on the problem.
