It’s commonly thought that heel pain takes 12 months to go away. That you just have to deal with it for that period of time.

I don’t think that’s the case.

Heel pain is really common and some people may have small bouts of pain, over 2-3 weeks to 1-2 months. Others will have pain for 6-12 months before the condition is no longer felt. There’s a small group of people where it takes even longer!

We refer to this period of time as the conditions ‘natural history’, i.e. that if we don’t intervene, some people will have a shorter bout of the condition, others longer.

There’s some factors we know are more likely to predict if you’ll have it for longer. These are:
– If the pain is in both heels
– You have a flatter or more pronated foot type
– You’ve already had it for 6 months (meaning if it’s stuck around for 6 months, it’s unlikely to settle down quickly after that)

Because of this idea that a bout of heel pain only lasts 6-12 months, it’s common I see people get the advice that they should just wait it out and deal with the pain.

I don’t agree.

This advice is given because in our research, it says that on average, nearly all treatments for heel pain doesn’t result in less pain at the 12 month and 24 month mark, compared to people that don’t get treatment. That the benefit is only in the short to medium term. Which you can read it as, well then don’t treat it. It can also be read in a way that says our treatments are temporary, but can provide a good amount of relief while you’re suffering.

In the clinic, I also see people that aren’t ‘average’ and without treatment, continue to worsen.

So the general advice I give to people is:
– If heel pain is limiting your ability to do your job, tasks around the house, or things that you enjoy, I think it’s worthwhile getting seen and treated.
– If heel pain is continuing to get worse, not better, I think it’s worthwhile getting seen and treated.
– If heel pain is causing you a lot of concern, I think it’s worthwhile at least getting seen and discuss what is happening and make an informed decision about what you want to do about your pain.

The most common cause of pain in the heel is to do with a thick band of tissue called the plantar fascia. When injured or irritated, it’s common to get pain when you first get up in the morning or after a rest. It’s also common that it eases when you start walking ro moving around.

If it isn’t sore when you first get up from bed or rest and gets more sore the more you stand or walk on it, it’s less likely it’s the plantar fascia that’s causing the pain. There’s a number of other potential causes such as bruising of the fat pad or heel bone.

While plantar fascia related pain can settle down over time without getting treatment, other causes are less likely. It’s worthwhile getting an assessment by a healthcare provider, such as myself, so we can figure out what is causing the pain and how we can best treat it.

No. If you have heel pain, you don’t need orthotics to get better.

For about ~50% of people, foot orthotics can be helpful, provide relief and keep them active. For the other ~50%, they may not provide much relief and for a smaller amount of people, not actually be comfortable and helpful at all!

A general explanation of how they work is to do with the plantar fascia, the most common cause of heel pain. It’s a thick band of tissue under the foot, that helps hold up the arch. When standing and moving, the plantar fascia stretches and absorbs force and then acts like a spring to pull the arch back up.

The plantar fascia is really strong and does this work most of people’s lives without any issues. It can become irritated or injured, meaning it’s sore to do these movements.

Foot orthotics can help by absorbing some of that force, so the plantar fascia doesn’t have to do as much work. It can also reduce how much the arch moves, or act like a spring itself, meaning again, the plantar fascia doesn’t do as much work.

For people who’re standing for long periods this can be really helpful as the plantar fascia can remain under stretching tension for that time. Foot orthotics can relieve this pressure.

For people who walk or jog a lot, there’s a lot of repeated shock absorbing and releasing tension, which foot orthoses can help with.

For people who run faster and longer distances, it may be helpful. But we also know that runners spend a lot more time with their feet in the air than on the ground, so foot orthotics aren’t helping as much. I also see some runners find it more difficult to adapt to foot orthotics.

My process when thinking about foot orthotics is to work with my patients to understand if foot orthotics are going to be helpful, what are their other treatment options and decide together what the best plan is for them.