Heel pain is a common problem that affects people of all ages, often causing discomfort with every step. Because the heel absorbs the body’s full weight during walking, running and standing, it is particularly vulnerable to strain and injury.

The pain may start with a mild ache that becomes sharper over time or it can appear suddenly after strenuous activity. Many patients notice the pain is worse in the morning when they first get out of bed or after long periods of standing. While it may seem minor at first, untreated heel pain can worsen and interfere with walking, exercise and even daily tasks like climbing stairs or standing at work.

Most cases are caused by inflammation or overuse of the structures that support the heel, including ligaments, tendons and surrounding soft tissues. But with early diagnosis and the right treatment, heel pain can be managed effectively and future recurrences can be prevented.

What are the types of Heel Pain?

The pain can develop from several different underlying conditions. Each affects specific structures in the heel and surrounding areas, which is why accurate diagnosis is key to proper management.

This includes, but is not limited to:

• Achilles tendinopathy – the Achilles tendon, which connects the calf muscle to the heel bone, can become inflamed or degenerate due to repetitive strain. This leads to pain, stiffness and swelling at the back of the heel, especially after physical activity.

• Heel bursitis – inflammation of small fluid-filled sacs (bursae) located at the back of the heel, often due to prolonged pressure or friction from ill-fitting shoes. Pain is typically felt deep inside or behind the heel.

• Heel spurs – over time, chronic strain on the plantar fascia can lead to the formation of a small bony growth (spur) on the underside of the heel bone. While not always painful on their own, heel spurs are often linked to long-standing plantar.

• Plantar fasciitis – the most common cause of heel pain. This occurs when the plantar fascia, a thick band of tissue that supports the arch, becomes inflamed from excessive stress or tight calf muscles. Patients often describe a stabbing pain under the heel when taking their first steps in the morning.

• Stress fractures – tiny cracks in the heel bone may occur from repetitive impact or overtraining, particularly in runners or those who suddenly increase their exercise intensity.

What causes Heel Pain?

Heel pain develops when the structures that support the heel become irritated, inflamed or overloaded. While acute injuries can trigger sudden pain, most cases develop gradually over time due to repeated stress or poor biomechanics.

Some of the common causes include:

• Excess body weight – carrying extra weight places greater strain on the heels and arches, accelerating wear and tear.

• Flat feet or high arches – abnormal foot alignment changes how weight is distributed, overloading certain structures and increasing stress on the heel.

• Improper walking posture – gait abnormalities or uneven leg length can also contribute to chronic heel pain.

• Inadequate footwear – shoes without proper cushioning or arch support fail to absorb impact, placing excessive pressure on the heel. High heels or worn-out soles also disrupt normal foot mechanics.

• Overuse and repetitive strain – running, jumping or prolonged standing can strain the plantar fascia or Achilles tendon, causing microscopic tears and inflammation.

• Sudden increase in physical activity – rapidly ramping up training volume or intensity without adequate conditioning can lead to overuse injuries.

• Tight calf muscles – reduced flexibility in the calf limits ankle movement, pulling on the heel and plantar fascia with each step.

What are the symptoms of Heel Pain?

The pain can feel different for each person as it is dependent on its cause and severity. It may come and go or become a constant presence that limits mobility.

But typically, symptoms include:

• Difficulty standing – either flat-footed or walking barefoot
• Dull ache or soreness – this typically worsens with prolonged standing or walking
• Pain – the sensation improves with rest, but returns after activity
• Sharp or stabbing pain – usually under the heel, especially during the first few steps after waking up
• Stiffness or tightness – in the foot or calf, especially after inactivity
• Tenderness or swelling – often around the heel or the arch

Who is at risk of Heel Pain?

Despite the fact that heel pain is a common occurrence, there are certain factors that make some people more susceptible.

This includes:

• Age – middle-aged adults are more prone to heel pain and the plantar fascia and tendons naturally lose flexibility and resilience over time.

• Foot structure – flat feet, high arches or uneven leg length increase the likelihood of overuse injuries.

• Obese – extra body weight adds stress to the heels, especially during walking and standing.

• Occupational hazard – professions such as teaching, retail staff, healthcare workers and factory employees are particularly prone due to long hours of standing.

• Lifestyle – athletes or individuals with an active lifestyle often experience repetitive heel impact due to high-impact sports or activities such as running or dancing.

• Improper or unsupportive footwear – wearing shoes with poor arch support, thin soles or high heels can strain the heel.

How is Heel Pain diagnosed in Singapore?

A proper diagnosis ensures that treatment targets the true source of pain rather than just relieving the symptoms.

• History assessment – Your doctor will ask when the pain started, how it feels and what activities worsen the pain, as it provides vital clues.

• Physical examination – the foot and ankle are examined for tenderness, swelling, flexibility and gait abnormalities. The location of pain often indicates the specific structure affected.

• Imaging studies – an ultrasound is often performed to visualise soft tissue inflammation, tears or thickening. On the other hand, magnetic resonance imaging (MRI) scans provide a detailed view of soft tissues and can confirm conditions like chronic plantar fasciitis or Achilles tendinopathy, while an X-ray helps detect bone spurs, stress fractures or other bone abnormalities.

How is Heel Pain treated in Singapore?

Most cases improve with non-surgical care that is focused on relieving inflammation, improving flexibility and addressing mechanical imbalances, through methods like:

Conservative Treatments

• Medication – non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help relieve pain and inflammation.

• Ice therapy – applying ice packs for 15–20 minutes after activity can reduce swelling and discomfort.

• Orthotic devices – custom-made insoles or heel cups help correct abnormal gait and distribute weight more evenly.

• Footwear adjustments – supportive shoes with adequate cushioning and arch support reduce pressure on the heel.

• Rest and activity modification – avoiding high-impact activities such as running or jumping gives the inflamed tissues time to recover.

Non-surgical Interventions

• Corticosteroid injections – deliver concentrated anti-inflammatory medication directly to the affected area, offering quick relief from pain and swelling.

• Platelet-Rich Plasma (PRP) injection – uses the patient’s own blood platelets to stimulate natural healing in cases resistant to conventional therapy.

Surgical Interventions

• Plantar fascia release – cutting a small portion of the plantar fascia to relieve tension.

• Heel spur removal – shaving off the bony growth if it contributes to persistent pain.

• Tendon repair – reattaching or strengthening the Achilles tendon if significantly damaged.

Rehabilitation and Physiotherapy

• Manual therapy and massage – helps loosen tight tissues, improve blood flow and reduce stiffness.

• Shockwave therapy – a non-invasive treatment that stimulates healing and tissue repair for chronic heel pain conditions.

• Stretching and strengthening – specific exercises target the calf muscles, Achilles tendon and plantar fascia to improve flexibility and resilience.

• Taping or bracing – provides temporary support during activity and relieves tension on the heel structures.

Book an Appointment

Persistent heel pain should never be ignored. What starts as a mild morning ache can progress into chronic discomfort that affects walking, posture and overall mobility. Delayed treatment may lead to long-term inflammation, compensatory strain on the knees or hips and even degeneration of the tendons or plantar fascia.

Dr James Tan offers a comprehensive approach to diagnosing and treating heel pain, from detailed gait analysis and imaging to personalised treatment plans that address the root cause. Whether your discomfort is due to plantar fasciitis, a heel spur or Achilles tendinopathy, early evaluation can make recovery faster, smoother and more complete.

If heel pain is interfering with your daily routine or workouts, book an appointment today to discuss your symptoms, understand your options and begin your path to lasting relief.