Heel pain is a syndrome of probable multiple aetiology. Factors thought to be responsible for the often debilitating pain localised to the centre and medial aspect of the heel include obesity, abnormal biomechanics, nerve entrapment, calcaneal spurs and systemic disease. Management should depend on the aetiology of the pain but since in many cases no specific cause can be found treatment is often arbitrary. Standard conservative treatment includes stretching exercises, orthoses (either custom made or OTC) and steroid injection into the heel. This study investigated 76 patients with unilateral heel pain. A variety of tests were carried out including radiography, foot biomechanics and blood analysis. No single indicator for the aetiology of heel pain was found. Significantly more pain was reported by patients with radiating pain (p < 0.015) and the prevalence of obesity (78.9%) was increased in the heel pain population, although this was not statistically significant (F = 0.94 Multiple Regression Test). No biomechanically significant variation was seen within the 'study' group. The management of heel pain was assessed within a randomised trial comparing anti-pronatory pads with local steroid injection. Symptomatic relief was measured using a visual analogue scale and the outcome between three treatment groups discussed. Significant improvement was recorded for all treatment modalities, with the steroid injection group showing greater statistically significant improvement for 12 weeks compared with the orthosis group (p = 0.001).

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