Heel spur / plantar heel pain
Plantar heel pain is pain beneath the heel and is often associated with loading of the plantar fascia. A heel spur seen on imaging does not necessarily cause the pain and can also occur in people without symptoms.
Mild pain under or around the heel, often most noticeable with the first steps after rest or in the morning. Symptoms often ease as the foot becomes active.
Plantar heel pain often develops gradually from repeated loading of the foot. Rapid changes in running, jumping, or other weight-bearing activity may contribute. Limited ankle mobility and reduced foot and calf strength may also be relevant factors.
Common loading factors
- •Increased running or jumping volume
- •Sudden change in training surface
- •Long periods of standing or walking
- •Reduced foot and calf strength
- •Limited ankle dorsiflexion
Prevention mainly involves gradual load progression and developing strength and load tolerance in the foot and calf.
- •Increase running and jumping gradually
- •Vary loading across the training week
- •Train the foot and calf muscles regularly
- •Avoid large sudden increases in training volume
- •Address recurrent heel pain early
Temporarily modify running and jumping according to symptoms. Alternative training that does not provoke pain can often be maintained. Avoid prolonged complete unloading unless medically indicated.
Load management
Reduce provoking loads and modify running and jumping.
Goals
Reduce pain while maintaining physical capacity.
Progression criteria
Daily activities and light training are tolerated without significant worsening.
Foot and calf strength
Progressive foot and calf strengthening is combined with gradual increases in running load.
Goals
Increase foot and calf load tolerance.
Progression criteria
Increased training load is tolerated without significant pain increase.
- Daily activities are possible without significant pain
- Foot and calf strength are adequate
- Running is tolerated
- Jumping and changes of direction are tolerated
- Full football training can be completed without significant worsening
The information in the Injury Center is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare professional for diagnosis and treatment.
Heel spur / plantar heel pain
Plantar heel pain is pain beneath the heel and is often associated with loading of the plantar fascia. A heel spur seen on imaging does not necessarily cause the pain and can also occur in people without symptoms.
Mild — Kan förbättras inom några veckor men kan också kvarstå längre. Belastningsstyrning och progressiv rehabilitering är viktiga.
Symptoms
Mild pain under or around the heel, often most noticeable with the first steps after rest or in the morning. Symptoms often ease as the foot becomes active.
Acute Treatment
Temporarily modify running and jumping according to symptoms. Alternative training that does not provoke pain can often be maintained. Avoid prolonged complete unloading unless medically indicated.
Rehabilitation
Reduce provoking loads and modify running and jumping.
Goals
Reduce pain while maintaining physical capacity.
Progression criteria
Daily activities and light training are tolerated without significant worsening.
Progressive foot and calf strengthening is combined with gradual increases in running load.
Goals
Increase foot and calf load tolerance.
Progression criteria
Increased training load is tolerated without significant pain increase.
Return to Play
- ☐ Daily activities are possible without significant pain
- ☐ Foot and calf strength are adequate
- ☐ Running is tolerated
- ☐ Jumping and changes of direction are tolerated
- ☐ Full football training can be completed without significant worsening
Moderate — Ofta flera veckor till några månader. Långvariga besvär förekommer och kräver ofta strukturerad rehabilitering.
Symptoms
Significant heel pain affecting running, jumping, or longer walks. Morning pain or pain after rest is common with plantar heel pain.
Acute Treatment
Reduce loads that provoke pain and begin structured rehabilitation. Persistent symptoms should be assessed by a physiotherapist or physician to confirm the diagnosis and exclude other causes of heel pain.
Rehabilitation
Load is modified and foot and calf function are assessed.
Goals
Reduce pain and restore daily function.
Progression criteria
Walking and daily loading are tolerated.
Foot and calf strength are developed alongside appropriate mobility work.
Goals
Increase tissue load tolerance.
Progression criteria
Strength training and increasing running load are tolerated.
Running, jumping, changes of direction, and football-specific activities are gradually reintroduced.
Goals
Tolerate competition demands.
Progression criteria
Full training is tolerated without significant post-training reaction.
Return to Play
- ☐ Pain is controlled
- ☐ Walking and daily loading are tolerated
- ☐ Foot and calf strength are restored or adequate
- ☐ Running and jumping are tolerated
- ☐ Full football training is tolerated
Severe — Varierar kraftigt beroende på bakomliggande orsak. Andra diagnoser än plantar hälsmärta kan kräva månader.
Symptoms
Severe heel pain, significant difficulty walking, pain at rest or at night, marked swelling, or traumatic onset may indicate another or more extensive condition than typical plantar heel pain.
Acute Treatment
Seek medical assessment to exclude conditions such as stress fracture, acute soft-tissue injury, or other causes. Modify loading until the diagnosis is clear.
Rehabilitation
The cause of severe or atypical heel pain is assessed.
Goals
Exclude another injury or medical condition.
Progression criteria
Diagnosis and treatment plan are established.
Loading and rehabilitation are adapted to the identified cause.
Goals
Restore full foot function and load tolerance.
Progression criteria
Full football-specific loading is tolerated and medical assessment allows return.
Return to Play
- ☐ More serious causes have been assessed
- ☐ Pain is controlled
- ☐ Normal walking and running
- ☐ Jumping and changes of direction are tolerated
- ☐ Full football training is tolerated
- ☐ Medical clearance when a structural injury has been identified
When to Seek Medical Care
Persistent or worsening heel pain should be assessed, particularly when symptoms do not fit the typical pattern of plantar heel pain.
- Pain that does not improve despite load modification
- Pain at rest or at night
- Significant difficulty walking
- Marked swelling
- Pain after significant trauma
- Numbness or tingling
- Suspected stress fracture
References
- Heel Pain – Plantar Fasciitis: Revision 2023 — American Physical Therapy Association / JOSPT (https://doi.org/10.2519/jospt.2023.0303)