Place · Level 3 · Movement
Plantar Fasciitis
足底筋膜是脚弓的弓弦 · 痛来自过载退变不是炎症 · 跟骨刺不是元凶 · 真正有效的是渐进加载
Story path
Chapter 1
Plantar fascia · the foot's bowstring
Plantar fascia · the foot's bowstring
Take the sole of the foot apart first — only then will you understand how 'heel pain' actually happens.
The plantar fascia is a thick, dense sheet of connective tissue. It starts at the inner lower edge of the calcaneus (heel bone), fans forward, and splits into five bands running to the bases of the five toes. It is not a muscle — it's mostly tightly packed type-I collagen and can barely contract on its own. Its job is to bear tension passively.
Its cleverest feature is how it works with the arch. Your foot's arch isn't a rigid stone bridge but a bridge with a string: the heel bone, the plantar fascia, and the forefoot enclose a triangle, and the fascia is the bowstring stretched along its base. When you stand, walk, or land, your body weight presses the arch down and tries to flatten it; the fascia tightens and uses tension to hold the arch back up. This lets the foot both cushion on landing and stiffen on push-off to transmit force.
The first intuition this island builds: the plantar fascia is an elastic cord that is repeatedly tightened and released — not a 'piece of flesh that gets inflamed'. The next scene shows that when it goes wrong, it behaves more like a well-used rope than like a wound.
The plantar fascia is a thick, dense sheet of connective tissue. It starts at the inner lower edge of the calcaneus (heel bone), fans forward, and splits into five bands running to the bases of the five toes. It is not a muscle — it's mostly tightly packed type-I collagen and can barely contract on its own. Its job is to bear tension passively.
Its cleverest feature is how it works with the arch. Your foot's arch isn't a rigid stone bridge but a bridge with a string: the heel bone, the plantar fascia, and the forefoot enclose a triangle, and the fascia is the bowstring stretched along its base. When you stand, walk, or land, your body weight presses the arch down and tries to flatten it; the fascia tightens and uses tension to hold the arch back up. This lets the foot both cushion on landing and stiffen on push-off to transmit force.
The first intuition this island builds: the plantar fascia is an elastic cord that is repeatedly tightened and released — not a 'piece of flesh that gets inflamed'. The next scene shows that when it goes wrong, it behaves more like a well-used rope than like a wound.
Mechanism: the windlass — the arch self-stiffens with every step
The plantar fascia's single most important operating principle is the windlass mechanism; understand it, and every later 'why is the first step in the morning the worst?' falls into place.A windlass is the shipboard device that winds rope around a turning drum to pull it taut. In the foot, the drum is the toe joints (the metatarsophalangeal joints) and the rope is the plantar fascia:
When you push off and the toes bend upward (dorsiflex), the fascia winds around the metatarsal heads — its working length is forcibly shortenedAs the fascia shortens, the heel and forefoot at its two ends are drawn together, so the arch is actively raised and stiffenedSo the same foot is soft at the instant of landing (absorbing shock) and rigid at the instant of push-off (transmitting force efficiently) — not by muscular effort, but by this string's change in geometry
This mechanism means the fascia's attachment points take repeated, large pulling loads. The most concentrated of all is its small origin on the inner heel bone (the calcaneal insertion / enthesis) — the tension of the whole fan converges onto that one little patch of bone.
Hold this picture: every step you take tightens this string once, and the 'knot' where the pull anchors is always tied to that one point on the heel. That is why, when the plantar fascia goes wrong, the sore spot almost always lands on a small area at the front-inner heel, not the whole sole — and the next scene is about why that point hurts.
Chapter 2
Why the heel hurts
Why the heel hurts
The name 'plantar fasciitis' hides a misleading idea. The '-itis' implies inflammation, but under the microscope that's almost never what you see.
Take fascia tissue from someone with chronic heel pain and the pathology shows mainly collagen degeneration: disorganised collagen fibres, micro-tears and disordered repair tissue, local thickening — and very few classic inflammatory cells. So a more accurate name is plantar fasciOSIS (plantar fasciopathy), not fasciITIS. This is the same story as the tendinopathy in the knee island (tendinosis): chronic soft-tissue pain is often fundamentally a degeneration in which repair lags behind load, not a ball of inflammation that needs to be 'put out'.
So how does it actually break down? In one line: repeated tensile overload outruns the tissue's rate of self-repair. This string is tightened thousands of times a day; when the total load stays above what it can withstand and rebuild, that small patch at the heel origin starts to accumulate micro-damage, degeneration and thickening follow, and the pain comes from here — the periosteum and tissue around the attachment (the enthesis) are innervated, so the degeneration itself and the bone surface it tugs on become the alarm source.
So the key to understanding heel pain, from the very start, is not 'where is it inflamed?' but 'has this string lately been asked to carry more than it can repair?'. The next page covers the signature symptom almost everyone recognises, and what actually pushes the load over the line.
Take fascia tissue from someone with chronic heel pain and the pathology shows mainly collagen degeneration: disorganised collagen fibres, micro-tears and disordered repair tissue, local thickening — and very few classic inflammatory cells. So a more accurate name is plantar fasciOSIS (plantar fasciopathy), not fasciITIS. This is the same story as the tendinopathy in the knee island (tendinosis): chronic soft-tissue pain is often fundamentally a degeneration in which repair lags behind load, not a ball of inflammation that needs to be 'put out'.
So how does it actually break down? In one line: repeated tensile overload outruns the tissue's rate of self-repair. This string is tightened thousands of times a day; when the total load stays above what it can withstand and rebuild, that small patch at the heel origin starts to accumulate micro-damage, degeneration and thickening follow, and the pain comes from here — the periosteum and tissue around the attachment (the enthesis) are innervated, so the degeneration itself and the bone surface it tugs on become the alarm source.
So the key to understanding heel pain, from the very start, is not 'where is it inflamed?' but 'has this string lately been asked to carry more than it can repair?'. The next page covers the signature symptom almost everyone recognises, and what actually pushes the load over the line.
Clinical: first-step pain, and what pushes load over the line
Plantar fasciopathy has an almost signature symptom: first-step pain.The first few steps off the bed in the morning, or the first few steps after standing up from prolonged sitting, bring a sharp, stabbing pain at the inner heel; after walking for a few minutes it eases somewhat; but after a long day on your feet it flares again by evening.
Why this pattern? Because while you sleep or sit the foot is relaxed, the fascia is shortened, and the micro-damage at the degenerated spot 'sets' in that static state. Suddenly loading it pulls this already-diseased, stiffened string abruptly to full length and immediately demands the windlass tension — that small degenerated origin is forcibly stretched open, so it hurts most. After a few minutes of movement the tissue 'warms up' and glides again, so the pain eases; but as cumulative load builds and repair again falls behind, it returns by evening. The pattern itself is evidence for the 'overload-degeneration' model, not for 'inflammation'.
So what pushes the total load over the line? The common risk factors nearly all point to 'tension', not 'wear':
A sudden spike in load: ramping up running volume, a new job with lots of standing and walking, starting a new sport — the same script as runner's knee and jumper's knee, the body has no time to adaptTight calf and Achilles (limited ankle dorsiflexion): a repeatedly confirmed factor. When the calf-Achilles complex is tight, the ankle can't dorsiflex enough while walking, so the body compensates through the midfoot and shunts more tension onto the plantar fasciaProlonged standing / hard floors: cooks, nurses, retail and factory work — long weight-bearing standing is a classic occupational riskHigher body weight: tension on the string rises with body weight, an important factor in non-athletic groupsUnsupportive shoes: shoes with no support, that are too loose, or worn flat leave the arch unaided, so the fascia carries more on its own
Note what is absent from this list — the thing so often blamed as the culprit: the calcaneal heel spur. Its story gets its own scene next, because it is this island's biggest misunderstanding.
Chapter 3
Myths
Myths
Heel pain is also a disaster zone of folk claims and over-treatment. This scene checks them against the evidence, one by one.
Myth 1: 'The X-ray shows a spur, the spur stabs the fascia, that's why it hurts'
The most deeply rooted claim, and the least able to withstand scrutiny. The so-called calcaneal (heel) spur is a small bony outgrowth on the lower edge of the heel bone; many people with heel pain do have one on X-ray, so the image of 'a spur stabbing the flesh' gets taken as the cause.
But the evidence doesn't support it: spurs are also common in completely pain-free feet (a sizeable fraction of asymptomatic people have one on film), and many people with heel pain have no spur at all. In other words, whether a spur is present and whether the foot hurts are only weakly related. Anatomically the spur doesn't 'stab' sideways into the fascia either — it grows in line with the load, more a reaction (a result) of long-term tension than the cause of pain. So the naive inference 'cut out the spur and the pain stops' fails at its premise. This one gets its own page.
Myth 2: 'It's inflammation, so rest + ice + anti-inflammatories will fix it'
As the last scene covered, chronic heel pain is fundamentally degeneration (fasciosis), not inflammation. That undercuts the 'anti-inflammatory' route directly: such drugs mainly ease symptoms, they don't rebuild degenerated collagen; and while rest alone stops the pain in the moment (no load), it doesn't make this string stronger, and the pain often returns the moment activity resumes. The correct approach is developed in the 'what works' scene.
Myth 3: 'You must have expensive custom orthotics for it to help'
Insoles can genuinely help — their role is to give the arch some support and spread the tension at the fascia's origin. But 'the more expensive and custom, the better' doesn't hold: in several controlled comparisons, prefabricated (off-the-shelf) arch-support insoles work about as well as costly custom orthotics in the short term. An insole is a useful aid, not a paid entry ticket you must buy first.
Myth 4: 'This needs a cortisone shot, or even surgery, to truly cure it' — gets its own page, because it's where people are most easily pushed into over-treatment.
Myth 1: 'The X-ray shows a spur, the spur stabs the fascia, that's why it hurts'
The most deeply rooted claim, and the least able to withstand scrutiny. The so-called calcaneal (heel) spur is a small bony outgrowth on the lower edge of the heel bone; many people with heel pain do have one on X-ray, so the image of 'a spur stabbing the flesh' gets taken as the cause.
But the evidence doesn't support it: spurs are also common in completely pain-free feet (a sizeable fraction of asymptomatic people have one on film), and many people with heel pain have no spur at all. In other words, whether a spur is present and whether the foot hurts are only weakly related. Anatomically the spur doesn't 'stab' sideways into the fascia either — it grows in line with the load, more a reaction (a result) of long-term tension than the cause of pain. So the naive inference 'cut out the spur and the pain stops' fails at its premise. This one gets its own page.
Myth 2: 'It's inflammation, so rest + ice + anti-inflammatories will fix it'
As the last scene covered, chronic heel pain is fundamentally degeneration (fasciosis), not inflammation. That undercuts the 'anti-inflammatory' route directly: such drugs mainly ease symptoms, they don't rebuild degenerated collagen; and while rest alone stops the pain in the moment (no load), it doesn't make this string stronger, and the pain often returns the moment activity resumes. The correct approach is developed in the 'what works' scene.
Myth 3: 'You must have expensive custom orthotics for it to help'
Insoles can genuinely help — their role is to give the arch some support and spread the tension at the fascia's origin. But 'the more expensive and custom, the better' doesn't hold: in several controlled comparisons, prefabricated (off-the-shelf) arch-support insoles work about as well as costly custom orthotics in the short term. An insole is a useful aid, not a paid entry ticket you must buy first.
Myth 4: 'This needs a cortisone shot, or even surgery, to truly cure it' — gets its own page, because it's where people are most easily pushed into over-treatment.
Myth 1: the heel spur is a result, not the cause
Pull the spur out on its own, because it causes the most needless anxiety and surgery.First, two facts:
Spurs are common in symptomless feet. X-ray people who have never had heel pain and a sizeable fraction still show a calcaneal spur. If the spur were the direct cause of pain, these people should hurt but don't — which doesn't add upMany people with heel pain have no spur. Conversely, plenty of people with classic first-step pain and tenderness right at the heel origin have a clean heel bone on X-ray. If pain required a spur to occur, these people should be pain-free but aren't — which also doesn't add up
Put together, the conclusion is: whether a spur is present is only weakly related to whether the foot hurts.
Now the mechanism: a spur is not a thorn jabbing sideways into the fascia. It usually grows along the direction the sole is loaded, sitting in the heel bone rather than in the fascia. The more reasonable reading is that it's an adaptive remodelling of bone in response to long-term tension (much as bone thickens where it's repeatedly loaded) — a footprint left by the process of overload, not the source of the pain.
So the correct causal chain is: long-term tensile overload → drives both the degeneration and pain at the fascia origin, and incidentally prompts the heel bone to grow a spur. The spur and the pain are two results of one cause, with no direct causal link between them.
This matters practically: it means the target of treatment is not 'that spur' but 'the overload'. Manage tension well and rebuild the string's strength, and the pain can resolve even while the spur stays put; conversely, operating on the spur both misses the real lesion and takes on surgical risk. The next scene covers the target you should actually aim at.
Myth 4: are cortisone and surgery the answer
The two steps most likely to push heel pain toward over-treatment are the cortisone shot (steroid injection) and surgery. Look at the evidence on each.The cortisone shot (corticosteroid injection)
Injecting steroid into the fascia origin does give clear short-term pain relief (roughly a few weeks), which is tempting when you want fast relief. But do the full accounting:
Its advantage is mainly in the first few weeks; over the medium-to-long term (months later) the edge over not injecting often disappears — i.e. it suppresses the symptom without changing the underlying degenerationIt carries real costs: steroid weakens collagen, so repeated or high-dose injection risks rupture of the plantar fascia; and atrophy of the heel fat pad at the injection site strips the heel of its natural cushion, which can make things worse long term
So its reasonable place is a short-term bridge in a minority of cases (e.g. pain too severe to start rehab — one shot to buy a window in which to begin loading), not a first choice and certainly not a 'cure'. Its logic mirrors the steroid injection in the knee island: fine short-term, not frequently.
Surgery
Surgery (e.g. partial release of the plantar fascia) is not the road to take for the vast majority of heel pain. The reasons are direct:
This is a condition that improves on its own with time and correct rehab (see the next scene: most resolve within 6-18 months); handing a problem that will most likely self-resolve to an operation is a poor risk-benefit tradeCutting this string itself has a cost: the plantar fascia maintains the arch, and over-release can bring new problems like arch collapse and lateral-column pain
Surgery is reserved for the very few who remain stubbornly unresponsive after a long, proper trial of conservative care (loading training + insoles + time, plus shockwave if needed), and only with a specialist weighing it up.
In one line: in heel pain, the needle and the scalpel manage the short term and the extreme; what truly changes the disease course is loading and time. Reverse the order — reaching first for an injection or an operation — and you usually take on risk while missing the steadiest road.
Chapter 4
What actually works
What actually works
With the myths cleared, here's what genuinely improves heel pain. As in the knee island, the first line is entirely non-drug, and the core idea is just one: give this degenerated string controlled, progressive load so it rebuilds its strength.
First line · Load management (don't push the string to breaking first)
Not 'rest completely until it stops hurting' but dialling total load down into a tolerable window: temporarily cut running volume, shorten continuous standing, switch to a softer floor or add cushioning. The aim is to let repair catch up, not to make the foot stop moving entirely — total immobility only weakens the string, the same reason the modern POLICE principle in acute injury replaced 'Rest' with 'Optimal Loading' (Bleakley 2012).
First line · Stretching (calf + plantar fascia)
Calf / Achilles stretch: since limited ankle dorsiflexion is a clear risk factor, loosening the calf-Achilles complex directly offloads some of the tension shunted onto the fasciaPlantar-fascia-specific stretch (the windlass stretch): pull the toes up into dorsiflexion, which uses the windlass mechanism to draw the fascia to full length and hold it. This tissue-specific stretch is more on-target than a plain standing calf stretch
First line · Progressive strength training (the most important upgrade of the last decade)
Since the essence is degeneration, the best stimulus to rebuild the tissue is progressive loading — the same logic as treating knee tendinopathy with eccentric / heavy slow resistance to strengthen the tendon (Alfredson 1998 eccentric, Kongsgaard 2009 heavy slow resistance, Rio 2015 isometric analgesia). Applied to the foot, the classic move is the slow-tempo heel raise with a towel rolled under the toes: the toes are held in dorsiflexion so the windlass mechanism loads the fascia along with the calf, then you rise and lower slowly. This trains the string and the muscles around it to rebuild load capacity together.
Adjunct · Insoles and supportive shoes
Give the arch support and spread the tension at the origin. As noted, prefabricated insoles are often enough in the short term — no need to spend on custom ones from the start.
The most underrated remedy · Time
Heel pain has a natural course: combined with the above, most people improve substantially within 6-18 months. This isn't a platitude but the key to setting expectations — knowing it will get better is what stops you from panic-shopping for injections and surgery just because the first two weeks weren't dramatic.
The order is clear: build the foundation of loading, stretching, insoles, and patience first; the needle and the scalpel are reserved for the stubborn few. The next page makes 'how to train' and 'what's left when it's stubborn' concrete.
First line · Load management (don't push the string to breaking first)
Not 'rest completely until it stops hurting' but dialling total load down into a tolerable window: temporarily cut running volume, shorten continuous standing, switch to a softer floor or add cushioning. The aim is to let repair catch up, not to make the foot stop moving entirely — total immobility only weakens the string, the same reason the modern POLICE principle in acute injury replaced 'Rest' with 'Optimal Loading' (Bleakley 2012).
First line · Stretching (calf + plantar fascia)
Calf / Achilles stretch: since limited ankle dorsiflexion is a clear risk factor, loosening the calf-Achilles complex directly offloads some of the tension shunted onto the fasciaPlantar-fascia-specific stretch (the windlass stretch): pull the toes up into dorsiflexion, which uses the windlass mechanism to draw the fascia to full length and hold it. This tissue-specific stretch is more on-target than a plain standing calf stretch
First line · Progressive strength training (the most important upgrade of the last decade)
Since the essence is degeneration, the best stimulus to rebuild the tissue is progressive loading — the same logic as treating knee tendinopathy with eccentric / heavy slow resistance to strengthen the tendon (Alfredson 1998 eccentric, Kongsgaard 2009 heavy slow resistance, Rio 2015 isometric analgesia). Applied to the foot, the classic move is the slow-tempo heel raise with a towel rolled under the toes: the toes are held in dorsiflexion so the windlass mechanism loads the fascia along with the calf, then you rise and lower slowly. This trains the string and the muscles around it to rebuild load capacity together.
Adjunct · Insoles and supportive shoes
Give the arch support and spread the tension at the origin. As noted, prefabricated insoles are often enough in the short term — no need to spend on custom ones from the start.
The most underrated remedy · Time
Heel pain has a natural course: combined with the above, most people improve substantially within 6-18 months. This isn't a platitude but the key to setting expectations — knowing it will get better is what stops you from panic-shopping for injections and surgery just because the first two weeks weren't dramatic.
The order is clear: build the foundation of loading, stretching, insoles, and patience first; the needle and the scalpel are reserved for the stubborn few. The next page makes 'how to train' and 'what's left when it's stubborn' concrete.
Clinical: how to train + what's left when stubborn (shockwave to injection)
Make 'you should load it' concrete and executable.How to train (slow-tempo heel raise with a towel under the toes)
The move: standing heel raises with a rolled towel under the toes so they're held in dorsiflexion. On the way up, the windlass mechanism loads the plantar fascia together with the calf. On one or both feet, rise slowly, pause at the top, lower slowlyTempo: deliberately slow (a typical cadence is something like 3 seconds up, 2-second hold, 3 seconds down), to keep the tissue under tension longerProgression: start two-footed and easy; once adapted, move toward single-leg and add load with a backpack, a little at a timeFrequency: start every other day, a few sets each time; leave a recovery gapPain rule: the same ruler as tendinopathy — pain within an acceptable range during the exercise (a common rule is ≤ 3-5 on a 0-10 scale, and not worse within 24 hours) is fine to continue; more painful each session, worse the next day, is the cue to reduce volumePatience: stable improvement usually takes weeks to months. The heel is a long game — don't judge it by two weeks
Paired with a daily calf stretch and the plantar-fascia-specific stretch, plus a supportive shoe / prefab insole, this combination is the mainline for the large majority of heel pain.
What's left when it's stubborn (still not better after a proper trial of conservative care)
Extracorporeal shockwave therapy (ESWT): for chronic, recalcitrant heel pain, shockwave is a second-line option with some evidence support; meta-analysis finds it superior to placebo — suited to those who stay stuck after months of adequate loading + stretchingSteroid injection (the cortisone shot): as covered in the myths scene, only a short-term bridge, with its edge concentrated in the first few weeks, and a risk of fascia rupture and fat-pad atrophy — not given frequentlySurgery: reserved for the very few who remain stubborn after every conservative measure (including shockwave) is exhausted, weighed up by a specialist
Read the two pages together and the treatment logic of heel pain mirrors the knee island exactly: what truly changes the disease course is progressive loading + stretching + weight loss (if overweight) + time; shockwave, injection, and surgery line up behind, managing the stubborn and the extreme. Reaching first for a needle or scalpel usually spends money while missing the steadiest window.
Chapter 5
Red flags
Red flags
Everything this island says about 'load it, don't panic, give it time' rests on one premise: your heel pain is the common, benign overload — plantar fasciopathy. But several situations are genuine red flags — they don't need a rehab plan, they need prompt medical care, and a few are emergencies. Please read the following carefully.
Needs immediate emergency evaluation (possible infection)
A heel that is red, swollen, and hot, together with fever, chills, and pain too severe to put weight on — especially if the skin is broken, or if you have diabetes (high risk of foot infection) — this may be an infection of the soft tissue or bone, an emergency in which bacteria spread fast. Do not apply heat, do not push through it, do not wait until tomorrow — go to the emergency department immediately.
Needs prompt medical care (not self-rehab)
Inability to bear weight after acute trauma: if the heel pain began right after a clear injury — a jump from height, a missed step, a car accident — and you cannot bear weight on the foot, be alert for a calcaneal fracture; it needs imaging, not training-through as if it were fasciitisSudden severe pain + a 'pop' you heard or felt: a sudden severe pain in the sole during exertion or a misstep, as if kicked, followed by weakness — this may be an acute rupture of the plantar fascia and needs medical assessmentNumbness, tingling, burning, or electric-shock sensations in the heel or sole: this looks more like a nerve problem (for example tarsal tunnel syndrome, where the tibial nerve is compressed at the inner ankle) than fasciopathy. Typical fasciopathy is a localised tender spot and should not bring marked numbness or shocks — if these appear, get the nerve checked
Also warrants medical evaluation (not emergency, but don't delay)
Pain in both heels at once + systemic or multi-joint symptoms: if both heels hurt together, with swelling or pain in other joints, morning stiffness, eye or skin symptoms, or a relevant family history — get checked for seronegative spondyloarthropathy (such as ankylosing spondylitis or reactive arthritis), which often begins with enthesitis (the heel being a favourite site) and is managed completely differently from ordinary overloadHeel pain that won't settle, hurts at night + unexplained weight loss: pain at rest and at night, with unexplained weight loss, needs further work-up
This site provides general education and advice — it does not replace a physician's diagnosis and treatment. For any heel pain that is persistent, worsening, or carries the red flags above, see an orthopaedic, foot-and-ankle, or rheumatology doctor in person for assessment.
Needs immediate emergency evaluation (possible infection)
A heel that is red, swollen, and hot, together with fever, chills, and pain too severe to put weight on — especially if the skin is broken, or if you have diabetes (high risk of foot infection) — this may be an infection of the soft tissue or bone, an emergency in which bacteria spread fast. Do not apply heat, do not push through it, do not wait until tomorrow — go to the emergency department immediately.
Needs prompt medical care (not self-rehab)
Inability to bear weight after acute trauma: if the heel pain began right after a clear injury — a jump from height, a missed step, a car accident — and you cannot bear weight on the foot, be alert for a calcaneal fracture; it needs imaging, not training-through as if it were fasciitisSudden severe pain + a 'pop' you heard or felt: a sudden severe pain in the sole during exertion or a misstep, as if kicked, followed by weakness — this may be an acute rupture of the plantar fascia and needs medical assessmentNumbness, tingling, burning, or electric-shock sensations in the heel or sole: this looks more like a nerve problem (for example tarsal tunnel syndrome, where the tibial nerve is compressed at the inner ankle) than fasciopathy. Typical fasciopathy is a localised tender spot and should not bring marked numbness or shocks — if these appear, get the nerve checked
Also warrants medical evaluation (not emergency, but don't delay)
Pain in both heels at once + systemic or multi-joint symptoms: if both heels hurt together, with swelling or pain in other joints, morning stiffness, eye or skin symptoms, or a relevant family history — get checked for seronegative spondyloarthropathy (such as ankylosing spondylitis or reactive arthritis), which often begins with enthesitis (the heel being a favourite site) and is managed completely differently from ordinary overloadHeel pain that won't settle, hurts at night + unexplained weight loss: pain at rest and at night, with unexplained weight loss, needs further work-up
This site provides general education and advice — it does not replace a physician's diagnosis and treatment. For any heel pain that is persistent, worsening, or carries the red flags above, see an orthopaedic, foot-and-ankle, or rheumatology doctor in person for assessment.