Heel Pain — Plantar Fasciitis and What Else It Could Be
That first step out of bed is the giveaway. Here is what causes it, what else mimics it, and where a scan actually changes anything.
The classic story is unmistakable: sharp pain under the heel on the first steps in the morning, easing after a few minutes of walking, returning after sitting still. That pattern is plantar fasciitis — more accurately plantar fasciopathy, since the tissue is usually degenerative rather than inflamed — and it accounts for most heel pain.
The plantar fascia is a thick band running from the heel bone to the toes, supporting the arch. Overload it and the attachment at the heel thickens and becomes painful. Common triggers: a jump in running volume, long days standing on hard floors, unsupportive shoes, or weight gain.
What else causes heel pain
| What you notice | Commonly |
|---|---|
| Sharp under-heel pain on first steps, easing with walking | Plantar fasciopathy |
| Pain at the back of the heel where the tendon attaches | Insertional Achilles tendinopathy |
| Burning, tingling or numbness spreading into the sole | Nerve irritation — not the fascia |
| Pain that worsens steadily through activity rather than easing, in a runner | Possible bone stress injury — needs assessment, X-ray or MRI |
| Heel pain with morning stiffness in other joints, or in a young adult | May be inflammatory — see your GP |
| Diffuse fat pad tenderness in the centre of the heel, worse barefoot on hard floors | Heel fat pad problem |
Heel pain that needs a doctor rather than a scan
Heel pain following a fall from height, pain that stops you weight bearing, a hot swollen heel with fever, or heel pain alongside morning stiffness in several joints should go to your GP or urgent care. Ultrasound does not show bone stress injuries — if your pain worsens through a run rather than easing, that needs a different test.
Does heel pain need a scan?
Frequently not. With the classic first-step history, the diagnosis is clinical and the treatment — calf and fascia loading, footwear changes, patience — starts without imaging. Most cases improve within months on that alone.
A scan earns its place when the story does not fit, when there is numbness or burning suggesting a nerve, when a runner’s pain worsens with activity rather than easing, or when several months of good rehab have not helped and someone needs to know what they are dealing with. Ultrasound measures fascia thickness precisely, shows the degenerative change, finds partial tears, and assesses the Achilles insertion and fat pad in the same appointment.
What it will not show is a heel spur — that is an X-ray finding, and largely a red herring anyway. Spurs are common in people with no pain at all, and their presence rarely changes treatment. It also will not show a bone stress injury, which needs MRI.
How the appointment runs
- 1
BookingNo referral, no preparation. 30 minutes. Tell us when it hurts most — the timing pattern is diagnostic.
- 2
The scanLying face down with feet over the end of the couch. The fascia is measured at its heel attachment, with the Achilles insertion and fat pad assessed too.
- 3
ComparisonThe other heel is usually scanned — fascia thickness varies between people, and your own other side is the best reference.
- 4
ResultsExplained on screen as we scan, written report usually within two hours for your GP, physiotherapist or podiatrist.
Your questions answered
Do I need a scan for plantar fasciitis?
Is a heel spur the cause of my pain?
How long does it take to get better?
Why is it worst first thing in the morning?
Should I stop running?
Can it be a nerve problem instead?
Where to go from here
When rehab has not shifted it
Fascia thickness measured at the heel with the Achilles insertion and fat pad assessed in the same 30-minute appointment — explained on screen as we scan, report usually within two hours.
Kensington, London W8 4ED
3 mins from Notting Hill Gate
This article is general information about heel pain, not individual medical advice. Heel pain after a fall, pain preventing weight bearing, or a hot swollen heel with fever needs urgent assessment — see NHS guidance on plantar fasciitis and heel pain. Ultrasound does not show heel spurs or bone stress injuries; we do not offer X-ray, MRI or injections.
Written and clinically reviewed by the HCPC-registered sonographers who perform this scan at IUS London — a CQC-registered diagnostic ultrasound clinic (Provider ID 1-2775844974). Your own findings are explained to you at the scan and set out in your report.
Author: Yianni Kiromitis, Senior Sonographer, HCPC RA38415 — over 20 years’ experience in NHS and private ultrasound
Medically reviewed: 9 August 2026
