Plantar fasciitis is one of the most common causes of heel pain in adults. It’s the classic complaint of a sharp, stabbing pain under the heel as you step out of bed, which then eases and returns after a long day on your feet or a run. It’s frustrating because it hangs around, but it responds well to the right approach.
Understanding plantar fasciitis
The plantar fascia is a thick band of tissue running under the sole of the foot from the heel to the toes. It helps support the arch and absorbs load as you walk and run. Plantar fasciitis, now often described as plantar heel pain, is thought to be a load-related problem where the tissue near the heel becomes irritated and sensitive when the demands placed on it outstrip what it’s currently prepared for.
Factors that commonly contribute include:
- A sudden increase in running, walking or time on your feet
- Hard surfaces and unsupportive footwear
- Tight or weak calf muscles and limited ankle movement
- Jobs involving long periods standing or walking
- Higher body weight and a high or low arch in some people
Symptoms we commonly see
- Pain under the heel or the inner part of the heel, sharpest with the first steps after rest
- Pain that settles as you warm up and returns after long periods standing or at the end of the day
- Tenderness when pressing on the inside of the heel
- Pain with running, jumping or walking barefoot on hard floors
Our evidence-based approach
Treatment centres on education, load management and progressive strengthening, with supports such as taping and insoles used for short-term relief. Our approach includes:
- Assessment of your foot, ankle, calf and activity load, and checking for other causes of heel pain
- Load management, adjusting your running, standing and footwear so the area can settle without you stopping everything
- Progressive strengthening, including slow, heavy calf raises, which a randomised trial found gave better results than stretching alone
- Stretching and mobility work for the calf and foot where it helps
- Taping and footwear advice for short-term relief while you rebuild strength
- Hands-on treatment or dry needling where appropriate, to ease pain alongside your exercises
- A graded return to running and sport, once you can load the foot comfortably
What to expect: recovery timeline
- Early or mild cases: often improve over several weeks once load and strengthening are sorted
- Established plantar heel pain: typically needs a few months of consistent, progressive loading
- Long-standing cases: can take longer, and benefit from reviewing contributing factors such as footwear, calf strength and workload
When to seek help urgently
See a doctor promptly if heel pain follows an injury or fall and you can’t bear weight, if there is redness, warmth, swelling or fever, if you have numbness or tingling in the foot, or if you have diabetes and notice any foot wound or skin change. Constant night pain or pain across a wider area of bone should also be assessed to rule out a stress fracture.
References
- Koc TA Jr, et al. Heel pain: plantar fasciitis revision 2023. J Orthop Sports Phys Ther. 2023;53(12):CPG1-CPG39.
- Rathleff MS, et al. High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015;25(3):e292-e300.