Initial Consultation Options
Choose between an initial clinical consultation face to face at the our clinic or an initial online video consultation. Check out the information below to learn more about these two options to see which is best for you.
Initial Clinic Consultation
During your initial consultation we will go through a thorough medical history together and discuss how heel pain affects your daily quality of life and restricts you in what you would like to be doing. This allows us to understand how your condition affects you as an individual which will enable us to set realistic goals on what we can achieve together. Following this we will perform a detailed clinical examination including a range of diagnostic clinical tests and a diagnostic ultrasound scan to aid the clinical diagnosis. Once we have established a diagnosis you will be informed on a range of treatment options to help you recover from heel pain.
Here at The Heel Pain Expert we provide online video consultations (also known as telemedicine) for patients that aren't able to visit the clinic. The beauty of an online video consultation is that it allows you to receive a truly expert opinion no matter where you are in the world.
During a video consultation we can provide:
a detailed and thorough medical history
diagnosis and bespoke treatment plan
referral for imaging (x-ray, ultrasound, MRI etc)
A full report of your problem and treatment plan
ongoing remote consultations to help keep you on track
liaison with a local specialist
There are a few things we cannot provide via online consultations which include a diagnostic ultrasound scan or deliver hands on treatment such as custom orthotics, injection therapy or shockwave therapy, but if these options are recommended and you are not able to come to us to receive these treatments then we will find a specialist in your local area that can and put you in touch with them.
Ready to get started? Have a question? Check out our online consultation FAQ's
We provide the most comprehensive range of evidence based treatment options in the UK. For the majority of cases we recommend ‘combination therapy’ which means combining a range of separate treatment options together to increase your chances of treatment success and full recovery by addressing all the underlying causative factors. Your recommended treatment plan is very bespoke and carefully chosen specifically for you based on your individual needs. There are many different treatment options available for treating plantar heel pain, however not all are necessarily good options or evidence-based and some come with significant risks. At The Heel Pain Expert, we only provide treatment options that are evidence-based, consistently successful and non-harmful. Below is a list of our recommended treatment options for treating plantar heel pain.
Ultrasound Guided Injection Therapy
Our injection therapy involves injecting a potent muscle relaxant into the calf muscle which is performed under ultrasound guidance to ensure accuracy. This is the fastest and most effective method to reduce calf muscle tension which is the most frequent and significant cause of plantar heel pain. By rapidly addressing the main cause, this option provides excellent and fast results. For some patients, regular stretching exercises are not powerful enough to reduce muscle tension therefore injection therapy is an excellent solution to this problem.
Exercise prescription offers multiple benefits for plantar heel pain. One of the main causes of plantar heel pain is calf and hamstring muscle tension along with weakening of the lower limb muscles. We will provide an individually prescribed exercise programme to help build strength in weak muscles and address muscular tension that could be causing your plantar heel pain. Exercise prescription is considered a crucial part of the treatment plan for most cases of plantar heel pain.
3D Printed Bespoke Orthotics
One of the most effective treatments for plantar fasciitis is the use of bespoke orthotics. We use 3D printed orthotics which is the latest advancement in orthotic manufacture technology providing superior design and accuracy for a truly custom fit. 3D printed bespoke orthotics are customised to the individual requirements of the patient. They work by reducing stress on the plantar fascia and providing the exact support required to aid your foot’s normal function. We do not recommend off the shelf orthotics, as the quality of the material is often not sufficient to alleviate stress on the plantar fascia. In addition to this as they are not made for the individual person, and provide an imprecise level of support.
Taping the foot provides additional support for the foot and reduces strain on the plantar fascia. We recommend regular taping as a short term treatment option whilst you are waiting for your bespoke orthotics. Taping is also a great option for when you want to wear shoes that your orthotics are not compatible with but need some support.
We provide splints that are specialist designed specifically for plantar fasciitis. splints supplement your stretching exercises by providing a stretch whilst you’re resting. A splint can be conveniently worn when sitting down at a work desk or relaxing on the sofa. You can also use a splint a night time whilst sleeping. They work by preventing overnight tightness of the calf muscles and the plantar fascia. Wearing a splint can speed up recovery by reducing pain and re-injury when taking your first steps in the morning.
Extracorporeal Shockwave Therapy
Shockwave therapy has been extensively researched demonstrating its effectiveness in treating plantar fasciitis. This is an excellent treatment option for chronic or resistant cases of plantar fasciitis and we often recommend this to patients that have tried a range of previous treatments prior to coming to the heel pain clinic. Shockwave therapy is a form of regenerative medicine and helps heal painful scar tissue on the plantar fascia and increases your healing capacity. This treatment works best alongside other treatments that address the causes of your plantar heel pain.
Radiofrequency Nerve Ablation
This treatment option is highly successful in treating resistant cases of plantar heel pain. We use this treatment in cases which do not respond to the above treatment options. Radiofrequency nerve ablation is a sophisticated minimally invasive procedure performed under a local anaesthetic. This treatment is commonly used by NHS and private pain clinics for treating chronic low back pain, however there are not many providers in the UK trained and experienced in using radiofrequency nerve ablation specifically for heel pain. The treatment uses high frequency radio waves to heat the sensory nerve that is causing your heel pain to 90 degrees celsius. At this temperature the heat breaks down the nerve preventing the nerve fibres from transmitting pain. As this is a minimally invasive treatment, patients can walk immediately after the procedure and resume regular activities after 2 days.
Alternative Treatment Options
The range of treatment options described above are all provided at the clinic however, there are other treatment options that we do not provide due to them being deemed either inferior to the options above, not cost-effective relative to the benefits, lacking clinical evidence to support their use, not currently available in the UK, or involve surgery. In the minority of cases our treatment options may not be the ,most appropriate for you due to your specific diagnosis or medical history. In this scenario we will advise you on alternative options which may involve, for example, surgery and we can liaise with other specialists to help you receive the treatment that is best for you. If you would like to learn more about all treatment options for plantar fasciitis click here.
This is the most common condition we treat, simply because it is the most common cause of heel pain. Plantar fasciitis is a painful foot condition located mostly at the heel. Although originally thought of as an inflammatory process, plantar fasciitis is a disorder of degenerative changes in the plantar fascia leading to thickening of the fibre and may be more accurately termed plantar fasciopathy. Plantar means the bottom of the foot, and fascia is the fibrous tissues that connects the heel bone to the heads of the metatarsal bones found at the base of your toes. It is an overuse injury where the plantar fascia becomes strained due to levels of stress that exceed how much the plantar fascia can tolerate. The level of stress the plantar fascia can tolerate varies from person to person. Plantar fasciitis is the most common cause of heel pain affecting up to 10% of the population. Approximately 80% of heel pain is caused by plantar fasciitis. It is most often seen in middle-aged men and women (between the ages 40-60), but can be found in all age groups and is also common in the athletic population due to the repetitive nature of the some sports which can cause damage to the plantar fascia.
Achilles tendinopathy is another very common cause of heel pain which affects the back of the heel, usually around 5cm from the attachment site of the achilles tendon to the heel pain. It can be considered a similar condition to plantar fasciitis in terms of disease process, causes and the patient types it most commonly affects. It is an overuse injury where the achilles tendon becomes strained due to levels of stress that exceed how much the tendon can tolerate.
Baxter's nerve entrapment
Baxter's nerve entrapment is often misdiagnosed as the symptoms mimic plantar fasciitis and the difficulty in confirming diagnosis as it is not easy to detect with diagnostic tests. Baxter was one of the first doctors to report this condition hence the name. The specific nerve this condition relates to is known as the inferior calcaneal nerve or the first branch of the lateral plantar nerve. This small nerve supplies sensation to the plantar fascia and the bottom of the heel pain. The nerve can be become entrapped, irritated or compressed for a wide number of reasons which often presents as a burning, sharp or shooting type of pain.
Tarsal tunnel syndrome
This is another condition that is often misdiagnosed which can cause heel pain. The tarsal tunnel is a specific part of the foot and ankle anatomy where many structures pass through including blood vessels, tendons and nerves. In tarsal tunnel syndrome the tibial nerve becomes either entrapped, compressed or irritated. This can be a result of trauma or anatomical abnormalities such as a cyst compressing the nerve. The tibial nerve is relatively large and divides into smaller branches of nerves as it passes through the tarsal tunnel and into the sole of the foot. A few of the branches extend to the heel and supply sensation of motor function. When the tibial nerve becomes injured it typically presents as a sharp shooting pain and can be described as tingly, like pins and needles. Patients also report numbness or a cold sensation in the affected foot. As other branches of the tibial nerve supply sensation along the sole of the foot extending to the toes, it is common for patients to report symptoms radiating along the sole of the foot and into the toes which may be additional to heel pain.
medial calcaneal nerve entrapment
This is another neural cause of heel pain. The medial calcananeal nerve is a branch of the tibial nerve. This nerve usually branches off the tibial nerve within the tarsal tunnel. It extends along inside of the ankle and heel pain and terminates under the heel. This nerve supplies sensation to the skin on the heel and the plantar fat pad. Medial calcaneal nerve entrapment mimics plantar fasciitis and is often misdiagnosed as such.
Plantar fat pad injury
Plantar fat pad injuries are not as common as other causes of heel pain, additionally plantar fat pad injuries are not well documented in the medical literature. The plantar fat pad is found directly below the skin. It has a spongy property and is designed to aid in shock absorption during heel contact with the ground. The plantar fat pad can become injured such as a tear or rupture in the fat cells which can lead to pain. An example of this would be stepping on a relatively blunt object under a lot of force such as a stone which may not puncture the skin but has the potential to damage the fat pad directly below the skin. This is another condition that can mimic plantar fasciitis as both conditions are exacerbated by weightbearing.
Plantar calcaneal bursitis
A bursa is a small sac of fluid that reduces friction of moving body parts. We have bursa in many different parts of our bodies and there is a small bursa located on the bottom of the heel. This bursa can become inflamed as a result of injury. This is known as bursitis. Bursitis is often very painful and can cause patients to walk with a limp. It is difficult to confirm diagnosis from a clinical examination alone as there isn't necessarily visible swelling of the heel even though the bursa is inflamed however can be detected with diagnostic ultrasound or an MRI.
This is a common cause of posterior heel pain which means pain at the back of the heel. Between the achilles tendon and the back of the heel pain there is a bursa. A bursa is a small sac of fluid designed to reduce friction when we flex the ankle back and forth during normal activities such as walking. In this condition the bursa becomes inflamed, usually as a result of repetitive mechanical overloading or a bony abnormality such as calcaneal exostosis (benign growth of the heel bone).
Superficial calcaneal bursitis
This is another type of bursitis located between the achilles tendon and the skin. The bursa is located just under the skin hence the name superficial which means shallow. This condition is often diagnosed clinically as this type of bursitis is easy to visualise, characterised by localised redness, and swelling. This condition is most commonly cause by poor fitted footwear where the back of the shoe rubs on the back of the heel pain repetitively causing the bursa to become irritated and inflamed. Similar to retrocalcaneal bursitis, it can also be caused by a bony abnormality such as calcaneal exostosis (benign growth of the heel bone).
Flexor hallucis longus tendinopathy
The flexor hallucis longus tendon is a long tendon that runs along the back of the ankle and heel and extends along the sole of the foot to connect to the bottom of the big toe. This tendon is responsible for flexing the big toe downwards and helps with toe push off during walking. The tendon can become strained or torn anywhere along its course from the ankle to the big toe. When an injury occurs behind the ankle, it may present as pain in the back of the heel but can be difficult to pin point as it is a relatively deep structure. Flexor hallucis tendinopathy is considered an uncommon cause of posterior heel pain and is often misdiagnosed as achilles tendinopathy which is much more common.
Heel stress fracture
Stress fractures occur when the level of stress placed on a bone is greater than what the bone can tolerate. Heel stress fractures are not uncommon and are often linked to a sudden increase in activity levels over a short period of time where the bone hasn't had an opportunity to adapt to the increased stress placed on it. This condition is more common in middle aged and elderly post-menopausal women because oestrogen deficiency causes accelerated bone resorption. Calcaneal stress fractures are often very painful. Patients typically present with swelling around the heel and inability to fully weightbear on the heel.
Sever's disease (calcaneal apophysitis)
This is a very common condition typically seen in boys and girls aged between 10-12 however some may be a bit younger or older. Overall it is more common in boys and people that play sports. It is a type of bone injury in which the growth plate in the lower back of the heel, where the Achilles tendon attaches, becomes inflamed and causes pain. This condition eventually self resolves once the growth plate matures as ossifies into bone however this can take a number of years to take place. Fortunately symptoms are often very manageable with treatment and activity modification.