Heel Pain

A simple pain assessment tool using a visual analogue scale to track heel pain severity with optional comments for additional context.

Instructions:

Please answer all questions about your heel pain.

Initial Diagnosis

What is the main cause of the heel pain?

Plantar Fasciitis

Achilles Tendinitis

Insertional Achilles

Which foot is affected?

Left

Right

Both

Level 1 Treatments

Weight loss towards healthy BMI

Type: tried-treatment

Rest

Type: tried-treatment

Calf stretches physio

Type: tried-treatment

Slant board exercises

Type: tried-treatment

Heel lift / insoles

Type: tried-treatment

Supportive shoes

Type: tried-treatment

Level 2 Treatments

Have you tried Shockwave?

Yes

Have you tried Injections?

Yes

Level 3 Treatments

Have you had Calf stretch surgery?

Yes

Have you had Heel Surgery?

Yes

Activity Level

On average, how many hours per week do you engage in physical activity?

Less than 1 hour

1–3 hours

4–6 hours

7–10 hours

More than 10 hours

Who has already tried to help?

Which medical professionals have you seen?

Chiropractor

Hospital Consultant Royal Surrey

Hospital Consultant Other

Osteopath

Physio (NHS)

Physio (Private)

Podiatrist (NHS)

Podiatrist (Private)

Specialist Physio / Musculoskeletal Service

Other (specify)

Who referred you to the Heel Pain Clinic?

Chiropractor

Hospital Consultant Royal Surrey

Hospital Consultant Other

Osteopath

Physio (NHS)

Physio (Private)

Podiatrist (NHS)

Podiatrist (Private)

Specialist Physio / Musculoskeletal Service

Other (specify)

Patient Watch Form - 4/2/2026