Heel Pain

"The first five steps out of bed are the worst. After that it's fine, until it isn't."

You swing your legs out of bed, put your weight through your heel, and it feels like standing on a stone bruise. By the time you reach the kettle it has eased. By lunchtime you've forgotten about it. Then you sit through a long meeting, stand up, and it's back.

Heel pain like this is one of the most common things I see in November, and almost everyone asks the same two questions: is it a heel spur? and will it ever go away? The short answers are: probably not the spur, and very probably yes. The longer answers are more useful.

What's Actually Going On

The plantar fascia, overloaded

The plantar fascia is the thick band of tissue running from your heel bone to the base of your toes, supporting the arch of the foot. When it's asked to take more than it's ready for, the attachment at the heel becomes painful. About one in ten people will get this at some point in their lives (Trojian and Tucker, American Family Physician, 2019). Stiff ankles and calves, higher body weight and long hours on your feet all raise the risk.

It's probably not "-itis"

The familiar name is plantar fasciitis, but the same review points out that the tissue isn't really inflamed, and "plantar fasciopathy" or simply "plantar heel pain" is more accurate. That matters in practice: it's a load problem more than an inflammation problem, so it responds better to managing load than to chasing inflammation.

Why November?

I'm not claiming November causes it. It's that several risk factors tend to arrive together: hard pavements and cobbles in place of summer paths, a sudden weekend on your feet at the Christmas markets or in the shops, and a switch from trainers or sandals to flat-soled or stiff winter boots. Any one of those is fine. All three in the same fortnight is how a quiet heel becomes a sore one.

Typical Symptoms

That right-hand column matters. Pain that burns, tingles or wakes you at night can be a trapped nerve, and pain in both heels with stiffness elsewhere can be inflammatory arthritis. Both look like "just a sore heel" at first and both need a proper look.

Timeline: What to Expect

How Osteopathy Helps

Looking above and below the heel

The heel is often where the problem shows, not where it starts. I check the ankle and calf, the big toe joint, the mid-foot and the hip on the same side, then use joint mobilisation and soft tissue work on the calf and sole. The first steps usually feel different straight away.

What the research says, honestly

The 2023 APTA guideline (Koc and colleagues, JOSPT) gave its top grade to manual therapy for the lower limb alongside plantar fascia and calf stretching, and advised against therapeutic ultrasound. A review of seven trials (Fraser and colleagues, 2017) linked manual therapy clearly to better function and possibly less pain, though the pain results were mixed. The guideline has also been criticised for the quality of some evidence and for saying little about load. So manual therapy helps, but stretching and load do most of the work.

Working out the load

Most of a first appointment is a frank look at what your heel is being asked to do: how long you stand, on what, in which shoes, and what changed before it started. I also make sure it really is heel pain, and not a trapped nerve, a stress fracture or pain referred from the back.

Self-Care for a Brussels November

Before your feet touch the floor

• Sit on the edge of the bed, cross one ankle over the opposite knee and pull the toes back towards your shin. Hold for 10 seconds, repeat 10 times, then swap. Plantar fascia stretching is one of the best-supported things you can do.
• Calf stretch against a wall, knee straight, then knee slightly bent, 30 seconds each. A stiff calf loads the heel.

Shoes and floors

• Avoid going barefoot on hard floors at home. Supportive slippers or indoor shoes make a bigger difference than people expect.
• For long days on your feet, choose a cushioned, supportive sole. Thin, flat or very rigid boots are the usual culprits.
• Rotate pairs rather than wearing the same boots every day.

Managing load

• At the markets or the shops, shift your weight, sit when you can and don't stack a whole weekend of standing onto a quiet week.
• Keep walking, but build it up gradually rather than jumping from very little to a lot.
• Rolling your arch over a ball or bottle is fine if it feels good. Think of it as comfort, not cure.
• Don't fixate on a heel spur. One showing on an X-ray tells you very little either way.

When to Book

• Heel pain that's lasted more than two or three weeks
• Mornings are getting worse rather than better
• It's changing how you walk, which tends to move the problem up to the knee, hip or back
• You're not sure it's heel pain at all, or any of the red flags above apply

Frequently Asked Questions