Plantar Heel Pain (Plantar Fasciitis)
Understanding causes, diagnosis, symptoms and treatments
What is Plantar Heel Pain?
- Plantar heel pain (also called plantar fasciitis) is a condition that causes pain and discomfort on the bottom of the foot, around the heel and arch.
- It often affects people who spend long hours on their feet or who walk or run regularly.
- For some, the heel pain can be very disabling, and pain is felt with every step.
- The good news is that most people recover well. With the right advice, simple treatments, and a bit of time, the pain usually settles.
What is Plantar Fascia?
Plantar fascia is a strong fibrous band that stretches from your heel to your toes.
It supports the arch of the foot and acts like a spring, which helps push your foot off the ground with each step.
How common is it?
- Plantar heel pain is the most common foot complaint, especially in middle-age.
- Around 1 in 10 people aged 50 years and over experience plantar heel pain.
- Around 8% of runners are affected.
How do I know if I have plantar heel pain?
People with plantar heel pain often notice some of the following symptoms:
- Gradual onset of pain under the heel
- Sharp pain with the first few steps in the morning or after a period of sitting
- Pain that improves when you first start to move, but returns if you stand, walk, or run for long periods
- More discomfort on hard surfaces or when walking barefoot, climbing stairs, or walking on your toes
- A limp or changing the way you walk to reduce pressure on the painful heel
Do I need a scan or x-ray to diagnose plantar heel pain?
No. Usually an MRI or x-ray does not add any helpful information to aid diagnosis.
Your GP/physiotherapist can diagnose plantar heel pain based on the activities that aggravate your symptoms, along with a physical exam of your foot.
What causes Plantar Heel Pain?
Plantar heel pain usually develops due to a combination of factors rather than one single cause.
Age
Plantar heel pain is most common in middle-age, particularly around 40 to 60 years.
Increased load on the foot
Repetitive stresses from standing, walking or running on hard surfaces can contribute, especially if there is a sudden increase in these activities.
Occupation
Jobs that involve standing or walking on hard surfaces for long periods of time.
Overweight /Obesity
A higher bodyweight is linked to heel pain because of greater load on the foot tissues and more body wide inflammation.
Reduced flexibility
Tight calf muscles, a stiffer ankle joint or limited big-toe movement can add extra stress to the heel.
Footwear
Wearing unsupportive shoes with a flat or un-cushioned heel, or shoes that are very stiff.
In this video, Consultant Orthopaedic Surgeon specialising in Foot and Ankle Surgery, Mr. Roger Haene shares his perspective on why people commonly develop plantar heel pain.
What to expect with plantar heel pain? Will it get better?
- Most people (70–80%) improve significantly within 6 months.
- The first few weeks can be quite painful, but symptoms often start to ease within 3 to 8 weeks, once you can start to reduce activities that aggravate your heel pain, and start to address some contributing factors.
- Full recovery, which involves gradually rebuilding foot and leg strength and endurance, can take up to 12 months and beyond.
- A small number of people have symptoms that are more persistent, especially if they have other long-term health conditions (e.g., diabetes, obesity) or both heels are affected.
- Understanding the condition and its expected recovery time is important. Improvements can be gradual and it’s normal to feel disheartened if progress seems slow at first.
Should I be worried about a bone spur?
A heel spur is a small bone growth that can form on the heel. It is a common finding on x-ray (1 in 3 people) but it is not linked to causing plantar heel pain.
Treatments for Plantar Heel Pain
There are two main phases to rehabilitation.
- PHASE ONE is about settling the pain and calming the foot by reducing the load and resting from aggravating activities. This can take anything from 2 to 12 weeks. As daily activities gradually become more comfortable, you’ll be ready to progress to Phase Two. To help settle the pain you can read about Pain-Relieving Strategies below and try the stretches described in Level 1 of the Exercise section.
- PHASE TWO focuses on gradually building back up strength of the foot and calf and the ability of these tissues to tolerate load. This is important for long-term recovery and preventing the pain from returning. Guidance on how to do this is provided in Level 2 of the Exercise section.
In this video listen to Chartered Physiotherapist Niamh Coffey explain the phases of rehabilitation.
Read some tips in the Table below for each recovery phase.
TIPS FOR PHASE ONE - Reducing load on the foot to settle pain
These may include prolonged standing, barefoot walking or running
This is the amount of standing or walking that doesn’t cause more heel pain later, or the next day
Choose lower-impact options like pool exercise or cycling instead
Try to temporarily reduce them to help settle pain
Pushing through high pain levels (particularly if sleep is disturbed) is not helpful
Even with rest it can still take up to 8 weeks for sharp pain to settle
TIPS FOR PHASE TWO – Building up strength and load tolerance
The amount of standing/walking you tolerated well in Phase 1 is your starting point
Exercises for the calves and plantar fascia will strengthen these tissues to handle increased demands
Avoid sudden increases in load or activity. Take a gradual approach to any new exercise or activity
You should be comfortable walking for 45 min + (with no increased heel pain) before you re-commence these
While the guidance above can help, it is not a substitute for seeing a physiotherapist for more bespoke advice and an individualised rehabilitation plan.
Click on the boxes to explore and learn more about the main treatment options.
Pain Relieving Strategies
Exercise
What Else Can I Do?
add-on treatments
Pain-Relieving Strategies
Ice: Can help reduce pain after standing, walking, or exercising.
Try slowly rolling your foot over a frozen water bottle for 5 to 10 minutes. An ice-pack wrapped in a damp tea-towel and pressed to the heel is another way of using ice.
Do not use ice if you have circulation problems or reduced skin sensation.
Heat: Some people find warmth relieves morning pain.
A hot shower or hot water bottle can help loosen the tissues of the foot.
Foot massage using broom handle: Place a broom handle on the ground. Focusing on the soft tissue of the arch, apply gentle pressure and roll the stick under the arch, from a seated position.
If you can tolerate more pressure, progress to standing on the broom handle and applying pressure to various points under the arch. Avoid rolling the stick over the heel bone or the bony joints in the ball of the foot. You can also try using a tennis ball or golf ball to massage the foot.
Anti-inflammatory medications: Short-term use (5 – 7 days) may help ease pain.
Check with your GP or pharmacist to make sure these are safe for you.
Heel insert: A small, cushioned pad inside the shoe under your heel can cushion and slightly raise the heel, offloading the plantar fascia for temporary relief.
Strong Feet Matter
Walking puts about 110% of your body weight through your feet, and running can increase this to up to 250%.
Strong foot muscles help support the arch and plantar fascia, allowing your feet to handle these loads more easily.
Exercise
Tips for exercising with plantar heel pain
- While you are experiencing heel pain, it’s recommended you try to remain physically active. This can be a challenge if you need to temporarily cut back on walking or running etc. For general health and fitness, try cycling, exercising in the pool or a rowing machine as alternatives to walking.
- When you are returning to walking/running for exercise, start with a small amount (10 minutes) and gradually increase as your pain improves. It can be a good idea to spend 5 minutes on the calf and plantar fascia stretches (described below in Level 1 Exercises) in preparation for walking.
- When walking or running for exercise, try take shorter steps (increase your cadence) and land with a ‘soft’ heel. Be sure to wear well cushioned walking shoes or runners.
- Try out different surfaces. Trails or grass can be more forgiving than roads or footpaths when building back up your volume of walking or running.
Listen to Chartered Physiotherapist Niamh Coffey explain how to monitor your heel pain during exercise and activity.
Exercises for plantar heel pain
Exercises that can be performed at home and have been found to be helpful are described below and accompanied by video links.
Level 1 Exercises
During the early painful phase, the plantar fascia and surrounding tissues are irritated and sensitive to load. Level 1 exercises aim to increase the flexibility of the foot and ankle with stretches, while starting to gently activate the muscles of your foot and calf (towel scrunch, heel raise).
Level 2 and Level 3 Exercises
Introducing exercises like the heel raises on a towel in this second phase starts to work the plantar fascia in a stretched position. This will stimulate the tissue to handle increased demands. Continuing to work on calf and plantar fascia flexibility remains important in this second phase.
How many exercises?
- The number of suggested exercise repetitions below is something to aim for. Everyone will have a different starting point.
- For the stretching exercises, you perform fewer repetitions, 3 to 4, but hold for longer e.g. up to 30 seconds. For the strengthening exercises e.g. heel raises, starting with just a few exercise repetitions is fine if that’s what you affected heel tolerates well, but try to build up to 10 or 15 reps.
- You could repeat these more than once a day. When you’ve increased the repetitions, perform the exercises once a day or every other day.
What if these exercises make my pain worse?
A temporary increase in discomfort can be normal. This should be short-lived. Try cutting back on the number of repetitions or drop back to easier exercises. If this does not help and symptoms continue to be made worse by the exercises - then stop. Contact your GP or physiotherapist for further advice.
what else can i do?
Footwear
- If you spend long periods on your feet, choose cushioned, supportive shoes (e.g., trainers) to reduce heel strain.
- Gel heel cups available from pharmacies can provide extra cushioning.
- Avoid wearing hard, flat or unsupportive shoes. Walking barefoot on hard surfaces like wood or tiled floors should also be avoided initially.
- Over-the-counter arch supports or custom-made insoles may help some people. They are thought to help load distribution through the foot and reduce pressure on the plantar fascia. Insoles should be tried in combination with other strategies such as exercise and stretching rather than as a stand-alone treatment. If insoles provide relief, try to wear them in your shoes all the time.
- In the early stages your physiotherapist may recommend taping your foot to help offload the plantar fascia. This can be helpful in combination with an exercise programme.
weight management
- People with a higher body weight can experience more prolonged heel pain and have a slower recovery.
- Reducing your weight can generally help with joint pain, and that includes heel pain.
- Having heel pain can make it more difficult to be active which in turn can make weight management even more challenging.
- If weight is something that you want to address, it’s worthwhile making an appointment with your GP to access some advice and support around this.
- Even if you cannot change your weight right now, improving the overall quality of your diet, and becoming fitter and stronger can help lower inflammation levels in the body and this can also help heel pain.
- To understand more about how our understanding of obesity and weight management has advanced click here.
Add-on treatments
It is generally recommended you try the exercise and other options described above first, for at least 3 months, before exploring these other treatment options.
In this video listen to Consultant Orthopaedic Surgeon specialising in Foot and Ankle Surgery Mr. Roger Haene explain the importance of taking an active approach to recovery.
night splints
- These splints can be worn at night and apply a constant stretch to the plantar fascia while you sleep.
- The research evidence surrounding night splints is quite limited. If you get relief from stretching the plantar fascia and your morning heel pain is severe you could try a night as an add-on treatment. However, they require some getting used to, and many patients find them cumbersome or cannot tolerate wearing them overnight.
Shock-wave Therapy
- Extra Corporeal Shockwave Therapy (ECST) is a procedure where low-energy sound wave pulses are passed through the skin to the heel and plantar fascia. In theory, this energy works by increasing blood flow to the injured area, influencing inflammation and nerve fibres involved in pain.
- This procedure is well researched in plantar heel pain. It usually takes several sessions to notice an improvement, and it does not work for everyone.
- ECST is usually recommended for persistent plantar heel symptoms that are not resolving. It should only be considered when all the core treatments have been tried for an extended period (e.g stretching, exercise, footwear modifications etc.)
Injections and Surgery
- Corticosteroid injections can provide short-term relief (4-6 weeks) for plantar heel pain. Usually performed by orthopaedic doctors, these injections can be painful to receive. These injections increase the risk of tissue breakdown and rupturing of the plantar fascia, which is irreversible. It is strongly recommended you try other treatments first before considering this option as a last resort.
- Plasma Rich Protein (PRP) injections are an alternative injection. Like corticosteroid injections, they have a short window of effect (4-6 weeks) and can be painful. There is no proof from research studies to support the use of platelet rich plasma injections for this condition
- Surgery for plantar heel pain is rarely required. Procedures such as plantar fascia release are very occasionally carried out by a specialist foot and ankle orthopaedic surgeon and involve cutting the plantar fascia. This can help in carefully selected cases, for people with very persistent pain, but carries risks. For example, releasing the plantar fascia can shift the problem to elsewhere in the foot.
In this video Consultant Orthopaedic Surgeon specialising in Foot and Ankle Surgery Mr. Roger Haene explains the risks associated with the use of corticosteroid injections for plantar heel pain.
The information in this website page was informed by the following sources/references:
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