Understanding Heel Pain: What's Actually Happening
Here's the thing about heel pain: it's not a diagnosis—it's a symptom. Think of it like a check engine light in your car. 
That light tells you something's wrong, but it doesn't tell you whether it's a loose gas cap or a failing transmission. Heel pain works the same way.
Your heel is more complex than you might realize. The heel bone is the largest bone in your foot, and it's the foundation for an intricate system of ligaments, tendons, nerves, and a specialized fat pad that cushions every step you take. When you're dealing with heel pain, the problem could be tissue inflammation, nerve compression, bone stress, or even referred pain from somewhere else in your body.
And here's what most people don't realize: the location of your pain and when it hurts most gives me critical diagnostic clues. Pain on the bottom of your heel that's worst first thing in the morning? That's different from pain at the back of your heel that gets worse during activity. Pain that shoots or burns is different from pain that aches. These details tell me what's actually going wrong.
Why Does Heel Pain Become Chronic?
You've probably wondered why your heel pain won't just go away on its own. After all, you've cut back on activity, you've rested, you've done everything you're supposed to do. But it's still there.
The answer comes down to something called a failed healing response. When tissue gets injured, your body immediately starts trying to repair it. But certain areas of the foot—particularly the plantar fascia and Achilles tendon—have relatively poor blood supply. Without adequate blood flow, your body can't deliver the nutrients and healing factors needed to complete the repair process. It's like having a construction crew that started a job, tore out the damaged parts, but then never finished rebuilding. Now you're left with tissue that's stuck in a state of chronic inflammation.
This is why simply resting doesn't always work. Rest reduces the pain temporarily because you're not aggravating the tissue. But the moment you step out of bed or return to your normal activities, you're putting stress on tissue that never actually healed. The pain comes roaring back.
In our Houston podiatry practice, I see this pattern constantly. Patients come in after months of trying rest, ice, and over-the-counter solutions. They're frustrated because nothing's working. What they don't realize is that chronic heel pain needs intervention to restart that stalled healing process. Sometimes that's as simple as custom orthotics to change the mechanical forces. Other times we need advanced treatments like shockwave therapy to actually stimulate tissue repair at a cellular level.
What's Causing YOUR Heel Pain?
The challenge with heel pain is that there are at least a dozen different conditions that can cause it. What works for plantar fasciitis won't necessarily work for a stress fracture. What helps Achilles tendinitis might make a pinched nerve worse.
This is why accurate diagnosis matters so much. I can't tell you how many patients come in saying "I have plantar fasciitis" because they read about it online or a friend told them that's what it sounds like. And maybe they're right—plantar fasciitis accounts for about 70% of heel pain cases. But 30% of the time, it's something else entirely.
When you come in, I'm going to ask you specific questions: Where exactly does it hurt? When is it worst? What makes it better or worse? Does it shoot or burn or ache? Then I'll examine how you walk, test your range of motion, feel for areas of tenderness, and sometimes order imaging if needed. All of that helps me pinpoint the exact cause.
Because here's what I've learned after treating thousands of patients with heel pain: the right treatment for the wrong diagnosis doesn't work. You can stretch and ice plantar fasciitis all day long, but if you actually have a stress fracture, you're just wasting time and potentially making things worse.
Let's walk through the 12 most common causes of heel pain. As you read these, pay attention to which one sounds most like what you're experiencing.
Houston Podiatrist: Heel Pain Treatment That Works
After diagnosing thousands of patients with heel pain in our Houston practice, here's what I can tell you: there's no one-size-fits-all treatment. What works depends entirely on what's causing your pain. But there is a progression that makes sense—we start with the simplest, least invasive approaches first, and only escalate when those don't provide adequate relief.
The good news? About 95% of heel pain cases resolve without surgery.
The key is finding the right combination of treatments for your specific situation and sticking with them long enough to work.
Lifestyle Changes: The Foundation
Sometimes, the solution is simpler than you think. For many patients, heel pain starts improving just by changing a few daily habits.
Footwear makes a massive difference. If you're walking around barefoot at home—even just to get your morning 
coffee—stop. Those first steps on hard floors without support are when a lot of the damage happens. Keep a pair of supportive sandals next to your bed. For shoes, look for ones with good arch support and cushioning in the heel. The shoe should only bend at the ball of the foot, not in the middle. And in Houston's humidity, you need to rotate between at least two pairs of shoes—they need 48 hours to dry completely, or you're creating the perfect environment for breakdown and fungal problems that weaken your foot's structure.
Activity modifications matter too. If you're a runner, cutting your mileage by 50% for a few weeks isn't giving up—it's giving your foot a chance to heal. Switch to softer surfaces when possible.
If you stand all day for work, take 5-minute sitting breaks every hour. Use anti-fatigue mats if you can. These changes reduce the repetitive stress that keeps your heel pain from resolving.
At-Home Care: What You Can Do Today
I'm going to give you the 60-second morning routine that helps most of my patients. While you're still in bed, do 10 ankle pumps—just point your toes, then flex them back. Massage your foot and calf for 30 seconds. Then, and this is critical, put on supportive shoes before you stand up. Take those first steps gently.
Ice therapy works when you do it right. After activity, ice your heel for 15-20 minutes—not longer. I tell patients to keep a frozen water bottle under their desk and roll their foot on it while they work. You get massage and ice at the same time. Do this 2-3 times daily during the acute phase. And never use heat for plantar fasciitis—heat increases inflammation, which is the opposite of what you want.
Stretching helps, but timing matters. The biggest mistake I see? Aggressive stretching first thing in the morning when the tissue is tight and vulnerable. Do your calf stretches after you've warmed up—30 seconds, 3 reps, 3 times daily. Stretch both with your knee straight and with it bent to get both layers of the calf muscle.
Now, here's my honest assessment of over-the-counter options. Medical-grade insoles like Powerstep or Superfeet help about 30-40% of patients find some relief. They're better than nothing, but they're not addressing your specific biomechanics. Those Dr. Scholl's kiosk machines at the drugstore? Skip them—they measure pressure, not the mechanical issues causing your pain. Night splints work for about 50-60% of people who can tolerate wearing them, but compliance is a challenge because they're uncomfortable to sleep in.
For some of you, these changes will be enough. But if you've been doing all this consistently for 2-3 weeks without significant improvement, it's time to move to the next level.
Conservative In-Office Treatment: Getting Serious About Healing
This is where we start addressing the underlying biomechanical problems causing your heel pain.
Custom orthotics are my most prescribed treatment, and for good reason—they work for 60-75% of patients with 
biomechanical heel pain. These aren't the generic inserts you buy at the store. We're talking about medical devices molded specifically to your feet after a comprehensive gait analysis. Think of them like eyeglasses for your feet. While you're wearing them, they compensate for the mechanical issues causing your pain. They don't cure the underlying problem, but they prevent it from causing symptoms. Most patients notice improvement within 2-4 weeks. Yes, they're more expensive upfront—$50-150 with insurance, $400-600 without. But they last 3-5 years, which works out to about $10-17 per month.
Corticosteroid injections provide relief for about 70% of patients—but it's usually temporary, lasting 6-12 weeks. I use injections strategically, like when you have a special event coming up or when you need a bridge to other treatments. Here's my honest take: cortisone reduces inflammation, which makes you feel better, but it doesn't provide the materials your body needs to actually repair the damaged tissue. And repeated cortisone injections can actually weaken tendons over time. So while I do use them, they're not a long-term solution.
Physical therapy helps about 50-65% of patients, especially when combined with orthotics. The protocol is typically 2-3 sessions per week for 6-8 weeks, and most insurance covers it. PT works best for patients with muscle weakness or tightness contributing to their heel pain. The challenge? You're only in the therapist's office 2-3 hours per week. What you do the other 165 hours matters more. That's why actually doing your home exercises is the key to success.
Advanced Therapy: The "Third Option"
Here's what's exciting about treating heel pain in 2025: we now have treatments that almost make surgery obsolete. Most doctors think in terms of medicate or operate—if medication doesn't work, the next step is surgery. But there's a third option that most doctors never mention.
Shockwave therapy has an 82% success rate for chronic plantar fasciitis and Achilles problems. We use low-to-
medium energy acoustic waves targeted at the damaged tissue. Think of it like aerating a lawn—by creating small channels in compacted soil, you allow water, air, and nutrients to penetrate more deeply. Shockwave does the same thing in your tissue, creating pathways for healing factors to reach the damaged area. The protocol is three weekly sessions, about 10-15 minutes each. About 40% of patients notice immediate improvement, but most see the biggest changes at weeks 4-6 as the tissue remodels. The treatment costs about $750 for the series of three, and insurance never covers it. But compared to the cost and downtime of surgery, most patients find it's worth it.
I personally used shockwave therapy for my own heel pain. It works.
PRP (platelet-rich plasma) therapy is like liquid gold for healing. We draw a small amount of your blood, spin it in a centrifuge to concentrate the platelets, then inject those concentrated healing factors directly into the damaged tissue. PRP works for about 70-80% of patients with chronic tendon problems. The timeline is longer—you'll see improvement over 4-8 weeks, with full benefit at 3-6 months. It costs about $850 and insurance never covers it. I'm honest with patients: it's expensive, results aren't immediate, and you're playing the long game. But for stubborn cases that haven't responded to other treatments, it can be the difference between healing and staying stuck in chronic pain.
For severe, long-standing heel pain, we sometimes combine shockwave and PRP. It's like planting seeds in a garden—PRP provides the seeds (growth factors), while shockwave prepares the soil and creates optimal growth conditions. The success rate for this combination is 85-95%, the highest of any non-surgical approach. Yes, it's expensive—$1,400-2,700 depending on the specifics. But for patients who've been dealing with debilitating heel pain for months or years, who've tried everything else, and who want to avoid surgery, it's the most powerful tool I have.
Surgery: When Everything Else Has Failed
Let me be clear about something: only about 5% of heel pain patients need surgery. I mention this because a lot of people avoid coming in because they're afraid I'm going to tell them they need an operation. The vast majority of patients I see never end up in the operating room.
But for that 5% who do need surgery, here's what you should know. Surgery becomes necessary when you've genuinely tried conservative treatment for 6+ months without adequate relief, the pain is significantly affecting your quality of life, and imaging confirms there's a structural problem we can fix.
Look, I know that foot surgery sounds scary. But modern minimally invasive techniques have changed everything. My preferred approach for plantar fasciitis is the Tenex procedure—it's ultrasound-guided, preserves healthy tissue, and has a much faster recovery than traditional surgery. You'll walk in a boot for about a week, transition to supportive shoes by week 2-4, and most patients are back to normal activities by 6 weeks. Full recovery including high-impact sports takes about 3 months. The success rate is 85-90%.
Traditional plantar fascia release surgery has similar success rates, but recovery takes longer—typically 6-12 months for full recovery. I only release the minimum amount of fascia necessary, because releasing too much can cause arch collapse and chronic instability. The surgery itself is outpatient. You'll have a dressing on your foot and you'll be wearing a surgical boot, but you can bear weight without crutches within the first week.
What you really want to know: Will I need crutches? (Only for the first few days to a week.) How much will it hurt? (4-6 out of 10 for the first 3-5 days, manageable with medication.) When can I drive? (Right foot: 2-4 weeks; left foot: 1 week.) When can I exercise? (Walking 4-6 weeks, running 12-16 weeks.) Will I need physical therapy? (Yes—surgery fixes the structure, but PT rebuilds strength and flexibility.)
The bottom line? Most people never need surgery. For those who do, it's not nearly as scary as they imagine. And for the vast majority of patients, we have so many effective non-surgical options that surgery is truly a last resort.
Not sure which treatment approach is right for your heel pain?
You don't have to figure this out alone. When you come in, I'll examine your heel, test your range of motion, evaluate how you walk, and determine exactly what's causing your pain. From there, we'll create a treatment plan tailored to YOUR specific situation and goals.
Call us at 713-785-7881 or request an appointment online.
What to Expect When You Come In
I know that first appointment can feel intimidating, especially if you've been dealing with heel pain for a while. So let me walk you through exactly what happens.
When you come in, I'll start by listening to your story. I need to know when the pain started, where exactly it hurts, what makes it better or worse, and what you've already tried. Then I'll watch you walk—your gait tells me a lot about the mechanical forces acting on your heel. I'll examine your foot, checking for areas of tenderness, testing your flexibility, and seeing how your ankle and heel move. If you're experiencing shooting or burning pain, I'll do some specific tests to check for nerve involvement.
Most of the time, I can diagnose heel pain through examination alone. But if I suspect a stress fracture, bone spur that's actually causing symptoms, or if the diagnosis isn't clear, I might order X-rays. We have digital X-ray in the office, so you'll get results right away. For soft tissue problems like plantar fascia tears, I sometimes use diagnostic ultrasound, which lets me see the tissue in real-time right there in the exam room.
Here's what happens next. If it seems like your heel pain is from biomechanical issues—things like overpronation or high arches—we'll talk about custom orthotics and I'll often recommend physical therapy or specific stretching protocols. I'll demonstrate the stretches right there so you know exactly how to do them. If you're dealing with acute inflammation, we might discuss a cortisone injection for immediate relief while the mechanical fixes take effect.
But if we realize the source of the problem is chronic tissue damage that's not responding to conservative care, we'll cycle through more advanced options. I'll explain how shockwave therapy works, what the timeline looks like, and whether combining it with PRP makes sense for your situation. We'll talk about costs, we'll talk about realistic timelines, and we'll create a plan that fits YOUR goals and YOUR life.
The whole appointment usually takes 30-45 minutes. You won't feel rushed. And you'll leave with a clear diagnosis, a specific treatment plan, and realistic expectations about how long it'll take to get better. If we're starting with conservative treatment, I typically want to see you back in 4-6 weeks to check progress. If we're doing shockwave therapy, you'll come back weekly for three weeks. If I prescribe orthotics, you'll return in 2-3 weeks once they're ready so I can make sure they fit properly and make any needed adjustments.
Either way, I need to see you to figure out exactly what's causing your heel pain. Because once we know what we're dealing with, we can fix it.
Heel Pain: Your Next Step
If you've read this far, you're tired of heel pain controlling your life. I get it. You've canceled plans because you knew all that walking would leave you limping. You've avoided activities you used to love. You've probably told yourself "it'll get better eventually" more times than you can count. And maybe you've put off coming in because you were afraid of what I'd tell you, or worried about the cost, or convinced that nothing would really help anyway.
Here's what I want you to know: heel pain is treatable. About 95% of cases resolve without surgery.
The key is getting the right diagnosis and starting the right treatment plan. You don't have to live with this—and you definitely don't have to figure it out alone.
I won't judge you if it's been months since this started. Most of my patients tried everything else first before coming in. That's completely normal. What matters now is taking that next step. Give us a call at 713-785-7881 or request an appointment online. When you come in, we'll examine your heel, identify the specific cause, and create a treatment plan tailored to YOUR goals. Most patients wish they'd come in sooner—don't let heel pain steal another month of your life.
Serving Houston, Tanglewood, Galleria, Memorial, River Oaks, West University, Bellaire, and surrounding areas.
Houston Foot & Ankle Specialist Dr. Andrew Schneider offers comprehensive heel pain diagnosis and treatment including custom orthotics, shockwave therapy, PRP, and minimally invasive surgery. Contact Tanglewood Foot Specialists at 713-785-7881.
