Heel Pain Self-Check Guide

Justin Blake, Podiatrist. CORU and HCPC registered. 30 years in clinical practice.

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Before you start

This guide walks you through the same questions and tests I run through in the first five minutes of a clinical assessment. It won't replace an in-person examination — some things require watching you move and hands-on palpation — but it will tell you a lot about what's likely going on and what's worth trying before you spend money.

Work through each section in order.

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Part 1: Where and when does it hurt?

Location

Place one finger on the exact spot that hurts most.

• Bottom of the heel, toward the front-centre: most likely plantar fascia loading
• Bottom of the heel, at the very back or centre: may be fat pad, may be bone stress
• Back of the heel (where the Achilles attaches): Achilles tendon issue, not plantar fascia
• Inside of the heel, toward the arch: may be a nerve branch or plantar fascia medial band
• Diffuse across the whole heel: may be a combination

Timing

Which of these matches your pattern?

A. Worst on first steps out of bed, eases after 5–10 minutes, returns after sitting

B. Gets progressively worse throughout the day the more you are on your feet

C. Fine at rest, comes on during or after exercise, then settles

D. Constant, doesn't ease with rest

E. Started after a specific incident

Pattern A is the classic plantar fasciitis presentation — good prognosis with self-management if caught early. Pattern B often indicates fat pad involvement or longer-standing fasciitis. Pattern C is typical of a running or overuse pattern. Pattern D needs proper assessment. Pattern E is not self-management territory — get it looked at.

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Part 2: What provokes it?

Which of these makes it worse?

• Walking barefoot on hard floors
• Flat footwear (sandals, slippers)
• Going upstairs
• Downhill walking or running
• Running
• Standing for long periods
• Sitting then getting up
• First thing in the morning

If barefoot and flat footwear provoke it: a shoe with some heel elevation will take load off the fascia short-term. If downhill and running are on your list: the soleus is a significant contributor — the bent-knee calf stretch in Part 3 is particularly important for you.

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Part 3: The calf flexibility test

Test 1 — Gastrocnemius (straight-knee)

Stand an arm's length from a wall. Step one foot back about 60cm, keep the back knee straight and heel flat on the floor. Lean your hips toward the wall. You should feel a stretch in the calf of the back leg.

No stretch with heel flat, or heel lifts to get the stretch: tight gastrocnemius.

Test 2 — Soleus (bent-knee)

Same position, but bend the back knee slightly (20–30 degrees) and push it forward toward the wall. Keep the heel flat. You should feel a deeper stretch lower in the calf.

No stretch with heel flat, or heel lifts: tight soleus. This is often the more important finding in persistent heel pain.

The calf connects directly to the plantar fascia's load chain. A tight calf increases tension through the fascia with every step. If you failed Test 2, consistent soleus stretching is the single most important thing you can do right now.

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Part 4: Single-leg balance test

Stand near a wall for safety. Balance on the symptomatic foot for 10 seconds.

• Can do it without significant wobbling: good proprioception
• Wobble a lot or need to touch the wall: foot and ankle stability work would help alongside the other things
• Painful in the heel: the tissue is significantly irritated — prioritise load management before any strengthening work

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Part 5: Red flags — stop self-managing and see someone

If any of the following apply, this guide is not the right tool. Get an in-person assessment.

• Pain started after a fall or acute incident
• Visible swelling, bruising, or warmth around the heel
• Night pain that wakes you from sleep
• Numbness or tingling in the foot
• Not improving after 6+ weeks of consistent self-management
• Diabetic or any condition affecting foot circulation or sensation
• Pain in both heels simultaneously

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Part 6: Self-management plan

Consistency over 6–8 weeks is the benchmark, not 6–8 days.

Daily stretching

Soleus stretch (bent-knee): heel flat, back knee bent at 20–30 degrees, hold 30 seconds, 3 sets per side. Do this twice a day — morning and evening. This is the most important item on this list.

Gastrocnemius stretch (straight-knee): same position, back knee straight, hold 30 seconds, 3 sets per side, twice a day.

Footwear

Wear a shoe with 8mm or more of heel drop as much as possible, including around the house. Avoid flat sandals and bare feet on hard floors while in the acute phase. This is a temporary measure to manage load, not a permanent fix.

Activity

Reduce whatever is aggravating it by 30–40%. Do not stop entirely — complete rest deconditions the tissue and the pain returns when you go back. Reduce, maintain, then build back gradually.

Ice

10–15 minutes directly over the heel after activity if there is significant post-activity pain. Useful for managing irritation. It does not accelerate healing.

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When to book a proper assessment

Self-management works for most classic plantar heel pain cases. If you are not improving after 8 weeks of consistent effort, dealing with a more complex pattern, or a runner who keeps reinjuring, a proper assessment will give you a much clearer picture and shorten the overall recovery time.

I offer a 45-minute video consultation covering your full history, movement assessment, footwear and orthotics where relevant, and a written report with a structured plan specific to your case.

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Justin Blake is a CORU and HCPC registered podiatrist with 30 years in clinical practice. This guide is for educational purposes and does not constitute a clinical diagnosis. If in doubt, seek in-person assessment.