The five most overlooked causes and how Shockwave and Laser Therapy help each one
Heel pain is easily one of the most common problems I see in clinic. By the time someone reaches my door, they’ve usually googled their symptoms, spoken to friends, tried a few stretches from YouTube, and come to the conclusion that they must have plantar fasciitis. In reality, plantar fasciitis is only one of several potential causes, and it isn’t even the one I diagnose most often.
When I assess heel pain properly, the real cause is often something entirely different. And this is why the diagnosis matters so much. You can only treat heel pain effectively when you understand exactly which structure is irritated. Shockwave therapy, MLS laser, rehabilitation exercises, orthotics and footwear changes are powerful tools – but they only work when we use them for the right diagnosis.
These are the five most commonly overlooked causes of heel pain that I diagnose at RS Podiatry Clinic in Hampton-in-Arden. They are the conditions that hide behind the label “plantar fasciitis” and quietly delay recovery until someone finally gets a thorough musculoskeletal assessment.
Baxter’s Nerve Entrapment
This is one of the most frequently missed causes of persistent heel pain. Baxter’s nerve, a small branch of the lateral plantar nerve, becomes irritated or compressed. The pain often feels sharp or electric rather than simply tight, achy or stiff. Some patients describe a burning sensation that spreads into the arch or inner heel.
Why it is missed:
It mimics plantar fasciitis extremely well. But unlike the classic “first-step pain” of plantar fasciitis, nerve pain tends to get worse the longer you’re on your feet.
How I treat it:
MLS laser calms the nerve irritation itself and supports better mobility. When I combine these with nerve-glide exercises and load modification, potentially orthotics and soft tissue work, patients usually improve far quicker than expected.
Tarsal Tunnel Syndrome
This is another neural condition, but this time the tibial nerve or one of its branches is compressed near the inside of the ankle. The pain can radiate down into the heel, arch or even toes. Sometimes there’s tingling or numbness mixe
Why it is missed:
Early tarsal tunnel syndrome looks almost identical to plantar fasciitis unless the nerve is properly assessed.
How I treat it:
MLS laser has a particularly good effect on irritated nerve tissue. Strengthening the calf-soleus complex and improving foot mechanics completes the long-term solution. Sometimes srtretching and soft tissue work, also helps.
Fat Pad Atrophy
The fat pad beneath your heel is designed to protect you from impact. Over time it can thin, especially in active individuals or those who spend long hours standing. This leads to a bruised, sore feeling right in the centre of the heel
Why it is missed:
Fat pad pain does not improve with plantar fascia stretches or rolling a ball under the foot. Many people assume that the lack of morning stiffness rules out plantar fasciitis — but fat pad pain feels different and needs its own strategy.
How I treat it:
Work on footwear changes, cushioning strategies and sometimes orthotics to offload the heel properly, can make a big difference, as can taping- at least in the initial stages. Shockwave supports collagen quality and encourages healing in the surrounding tissues and could be a consideration for some, whilst MLS laser helps control local inflammation.
Calcaneal Stress Response
I see this quite often in runners, walkers, gym-goers, or anyone who has suddenly increased their training load. The deep, bone-type ache can be hard to distinguish from soft tissue pain, especially in the early stage
Why it is missed:
X-rays rarely pick up early stress responses, so many people assume it’s just plantar fasciitis and continue training through it.
How I treat it:
MLS laser can help reduce discomfort and support the healing environment. The cornerstone of treatment, however, is guided load management, addressing strength deficits, nutrition, sleep and modifying impact activities until the bone responds positively. Imaging may be required.
Insertional Achilles Tendinopathy
Pain where the Achilles attaches into the back of the heel can easily feel like heel pain. It often spreads into the sole of the foot, making it look like plantar fascia irritation.
Why it is missed:
Without examining the Achilles insertion and calf and hip mechanics, it is very easy to overlook this diagnosis.
How I treat it:
Progressive loading strategies designed specifically for the Achilles, supported by MLS laser to manage inflammation and pain allow better tolerance to exercise. Combined with footwear changes, potential orthotics or raises can make a difference but all of this needs to be carefully monitored and adjusted differently for each patient. Some will require few interventions and other further interventions.
Why accurate diagnosis matters so much
When someone has been treating the wrong condition for weeks or months, I see their frustration. They’ve stretched, iced, changed shoes, rested, tried insoles (often ones from Amazon – yes I have seen most of them before!), bought massagers, and still feel no better. Once we identify the right diagnosis, the treatment becomes targeted and the progress usually starts quickly
How RS Podiatry helps patients recover
In my clinic I use a combination of:
• Shockwave therapy for tissue regeneration
• MLS laser therapy to reduce inflammation and enhance healing
• Biomechanical assessments to identify loading issues
• Strength and conditioning programmes tailored to the lower limb
• Footwear and orthotic recommendations when needed
• Holistic, evidence-led approach that looks at lifestyle, movement, sleep, stress, diet and recovery
My aim is always to give patients clarity, confidence and a recovery plan that works for their specific diagnosis – not just a generic approach. The aim is not to overwhelm patients with information but to inform, educate and empower.
If you’ve been living with ongoing heel pain and aren’t making progress, a thorough assessment can save months of trial and error.