An Australian summer goes hand in hand with holidays, swimming and thongs – it doesn’t get much better does it? But every summer, without fail we also see a lot of patients presenting with heel pain. For some it is a niggle, for others it is highly debilitating.  Whilst heel pain is something we see all year round – summer is peak heel pain season as we become more active and start wearing less than ideal footwear such as thongs and flip flops. 

Heel pain is one of the most common presentations to health practitioners across the world and may play a role in as many as 10% all athletic injuries. 

Professionally we describe a pain at the base of the heel as Plantar Heel Pain (PHP).  Some more common terms that are used for heel heel pain include “heel spurs” or a “bruised heel” whilst more technical terms for heel pain include Plantar Fasciitis or Plantar Fasciosis.  However, there are up to 47 different causes of Plantar Heel Pain, which is why heel pain can be difficult to pin down. 

One of the main causes of PHP relates to the plantar fascia and how it reacts to loading. The plantar fascia or plantar aponeurosis is a band of tissue that runs from the heel bone into the toes. Its action is to provide support for the arch of your foot while you are doing weight-bearing activities such as walking, running and jumping. 

Researchers from Auburn University in Alabama studied the footwear biomechanics among 39 college-age men and women alternately wearing athletic shoes and thongs in 2008. 

They found that thong wearers took shorter steps and their heels hit the ground with less vertical force than when the same walkers wore athletic shoes. 

This alteration of the gait could produce problems and pain from the foot up to the hips and lower back, they concluded. 

Plantar Fasciitis is an overuse condition which causes injury within the fibres that make up the plantar fascia. This damage to the fascia usually occurs at its origin, at the inside of the heel with overuse due to many factors including: 

  • Tight calf, hamstring or gluteal muscles 
  • Poor biomechanics including a flat or high arched foot 
  • Poor intrinsic muscle strength 
  • Increase in training load 
  • Increased time in standing 
  • Hill running 
  • Aggressive terrain running 
  • Increase of barefoot walking or walking on sand 
  • Old or non-appropriate shoes for activity 
  • Wearing shoes that are not right for your foot type 

At CSSM, we see people of all ages, shapes and sizes with Plantar Heel Pain from the elite athletes to the weekend warrior and it can significantly impact quality of life. Some cases can go unresolved for over 12 months if not managed, but it is important to know that there is something that can be done about it. 

Of course, finding the solution means identifying the cause and that is where a Podiatrist can help.  

Don’t be alarmed if we grab your shoes and really test them out, they’re super important to resolving daily pain!  Orthotics may help, however, in many cases, heel pain arises in response to a change in load, so understanding your biomechanics and assisting your feet to sustain the load is important. 

Research recently conducted at La Trobe University identifies that people with plantar heel pain have reduced strength and volume of muscles in the foot compared to those without PHP1. That is why strengthening of the lower limb, in particular the small muscles of the foot can have remarkable results. 

So this summer if you start getting heel pain, take the step to talk to one of our Podiatrists about the exact cause of your pain, how you can make changes to your footwear, and how exercise may be the key to make your heel pain just a distant memory. 


  1. Osborne, J., Menz, H., Whittaker, G., Landorf, K. Muscle strength differences in people with and without plantar heel pain. 2019. Journal of Foot and Ankle Research. Doi: link. 

About the author: CSSM Podiatrist Alicia Schifferle firmly believes that healthy feet equal a healthy life. She has an understanding of the vast range of musculoskeletal injuries that occur in the foot and leg as well as the most appropriate and effective treatment approaches for each individual patient. By assessing the cause of pain and designing a treatment plan to prevent future problems, Alicia is motivated to improve every patients’ quality of life.