Symptom
Understanding foot and heel pain together
The first steps in the morning hurt. After a while it improves, but the heel starts hurting again when you stand for longer. For others, pain begins at the back of the shoe, under the forefoot or after turning an ankle. In everyday conversation, all of this may initially be described as ‘foot pain’. To find a useful treatment, it is worth looking more closely.
Open individual sections or all the details on this page.
Which changes require immediate help
A visible deformity after an accident, an open injury or an inability to put weight on your foot requires immediate medical assessment. Do not try to test a serious injury by continuing to walk. A foot that suddenly becomes cold or pale, with pain, numbness or new loss of strength, is an emergency warning sign. In an emergency, call 112.
A snap or a sensation of being kicked at the back of the lower leg, followed by loss of strength, may indicate an Achilles tendon rupture and needs prompt examination. Increasing redness, heat, swelling or fever also needs timely medical assessment. With diabetes, significant foot problems may cause little pain. A new wound or a marked change should therefore not wait for a routine online appointment.
Understanding
A closer look
We want to work with you to identify which structure is most likely to explain your symptoms and what this means for your next step. The location of pain, an X-ray finding or a diagnosis found online cannot answer that question alone. How long symptoms have been present and how they affect daily life also matter.
What the location of pain can tell us
Pain under the heel, particularly on the first steps after rest, may be related to the plantar fascia. This strong band of tissue runs along the sole of the foot. Similar pain can have other causes, however. The term ‘heel spur’ is often used in everyday language, although a bony change on an X-ray is not necessarily the main source of pain.
Pain at the back of the heel may involve the Achilles tendon or neighbouring structures. It matters whether symptoms occur directly where the tendon attaches to the heel bone or further up. Different structures may be involved in the forefoot. Burning or tingling between the toes may, for example, raise a question about a nerve. These patterns guide the assessment, but they do not allow a reliable self-diagnosis on their own.
For the ankle, it is important to know whether an accident occurred first. Turning the ankle can injure ligaments, but a bony injury is also possible. With longer-standing symptoms, range of movement, stability and tolerance of activity also matter. Grouping all these situations under the same treatment name would overlook important differences.
When the forefoot, toes or pressure points make walking difficult
Pain under the ball of the foot is often called metatarsalgia. Initially, this term describes the painful area. An irritated joint structure, a nerve, the distribution of pressure or another cause may be involved. The examination needs to distinguish between these possibilities.
Bent smaller toes, known as claw toes or hammer toes, can rub against footwear. Painful calluses and corns show where the skin is repeatedly exposed to pressure. We therefore consider the skin, toe movement, footwear and loading together. With diabetes or sensory changes, a new pressure point needs professional attention particularly early. Our detailed pages explain which ways of relieving pressure may be discussed and when medical assessment is needed.
Further information
Why the course of symptoms is part of the assessment
Tell us when the pain begins and how long it lasts after an activity. Perhaps you can walk a short distance, but a shopping trip becomes too much towards the end. Perhaps you have returned to running after a long break or spend more time standing at work than before. A change like this helps us plan activity, but it is not automatically the only cause.
What you now avoid also matters. Using stairs sideways, placing your foot differently or cancelling arrangements shows how much the symptoms affect you. Together, we want to define what improvement would look like for you. It need not be a sporting goal. Being able to reach the bus stop without frequent pauses can be just as important.
How we narrow down the cause
The examination combines your description with findings in the foot and, if needed, neighbouring areas. Depending on the question, we assess your walking pattern, movement and painful structures. Where there are relevant signs, circulation and nerve function also need to be considered. A single tender point does not answer every question.
Imaging supplements the examination when it is needed to make a decision. X-rays can help answer questions about bone; ultrasound can show suitable soft tissues. We arrange further investigations externally if needed. We review existing images and reports with you in the context of your symptoms. A normal image does not mean your difficulties are unimportant. Equally, an abnormal finding need not explain every symptom.
What to bear in mind before the next steps are planned
When severe or new pain has not yet been explained, assessment comes first. Once an acute injury or another urgent cause has been excluded, activity can be adapted appropriately. This may mean initially breaking up longer walks, reducing an activity that strongly triggers symptoms or trying different footwear. The appropriate adjustment depends on the cause.
A general exercise plan from the internet cannot replace this assessment. Forceful stretching or exercising through significant pain is not suitable for every structure. Instead, notice which activities you tolerate and how your foot responds afterwards. This feedback helps us develop a plan together, rather than repeatedly trying new measures without a clear direction.
How findings guide treatment
Once the cause has been narrowed down, we discuss the treatment goal and suitable options. For tendon or sole-of-foot symptoms, adjusting activity and targeted exercises may be important. In other situations, temporary stabilisation, suitable supports or further assessment take priority. An injection or shockwave therapy does not follow automatically from having foot pain.
The pages ‘Achilles tendon symptoms’, ‘Plantar fasciitis’ and ‘Orthoses and supports’ explain these different approaches in greater depth. We explain the potential benefit of a treatment for your symptoms, its limitations and the alternatives. If a medically appropriate option is not covered by your statutory health insurer, we also explain this and the expected costs. You decide whether to use the service. You do not have to make that decision during the appointment. If you have statutory health insurance and choose such a self-funded service, you receive a quotation beforehand. We provide the service only after you have confirmed in writing that you wish to have the treatment and accept the costs.
Frequently asked questions
Is pain under the heel always a heel spur?
No. Several structures can cause symptoms. A bony spur can also be present without pain. The examination and the course of symptoms help assess the role of a finding in your situation.
Do foot symptoms always require an MRI?
No. The examination first aims to establish which question remains unanswered. Further images are useful if they can provide information relevant to treatment. Please bring any existing images.
Can I continue sport with these symptoms?
That depends on the cause and how your foot responds to activity. If an acute injury is suspected, you should not simply continue training. After assessment, we can discuss which activities are possible and what should change temporarily.
What should I bring to the appointment?
Previous findings, access details for scans, a medication list and any existing insoles or orthoses are helpful. If footwear is part of the concern, please also bring the pair you use regularly. Tell us about previous operations and other relevant health conditions.
Your next step
