Plantar fasciitis (heel pain)
Your health expert: Mr Jonathan Larholt, Consultant Podiatric Surgeon
Content editor review by Liz Woolf, March 2021
Next review due March 2024
Plantar fasciitis is sometimes called plantar fasciopathy. It’s the most common cause of persistent heel pain (plantar heel pain). Plantar fasciitis will usually get better by itself within six to 12 months. But in the meantime, there are several things you can do to reduce your pain and help it to heal.
What is plantar fasciitis?
There are many causes of heel pain. These include problems with the different nerves, bones and tissues in your foot. You may also have pain from conditions such as rheumatoid arthritis. If you don’t have a diagnosis for your pain, your doctor may call it plantar heel pain.
The plantar fascia is a thick band of tissue that runs along the sole of your foot (the fascia). It starts in the heel, runs along the arch and fans out to connect with the base of each toe. It stabilises your foot when you’re walking and acts as a shock absorber. If it’s damaged, it causes pain in your heel, and sometimes in the arch of your foot.
Plantar fasciitis is most common in people between the ages of 40 and 60. Around one in three people who get it have it in both feet.
Causes of plantar fasciitis
You can get plantar fasciitis if there is too much pressure on the band of tissue that runs along the sole of your foot. The following factors can increase your risk.
- Being overweight or obese.
- Having high arches in your feet or being flat-footed.
- Regular high-impact activities such as running, jumping or dancing. Around one in 10 people who run regularly develop plantar fasciitis.
- Running or standing on hard ground increases your risk.
- Spending a lot of time on your feet - for instance, a job where you’re standing or walking around all day.
- Wearing worn-out trainers that no longer absorb shock very well.
- Being pregnant - hormones associated with your pregnancy can cause your ligaments to relax. Along with the temporary weight gain, this can lead to plantar fasciitis.
Symptoms of plantar fasciitis
The main symptom of plantar fasciitis is pain in your heel or sometimes in the arch of your foot.
- The pain is often worse when you first stand up and start walking after you’ve been in bed or sitting for a long time.
- Being on your feet all day, walking, standing or running for a long time, can also bring on the pain.
- The pain may be sharp at first and gradually lessens as you start to move around.
You may be able to manage your symptoms yourself (for more information, see our section on self-help). But if it’s hard to manage your pain or your symptoms aren’t getting better after a few weeks, see a podiatrist (chiropodist), physiotherapist or your GP. If your symptoms are getting worse, it’s best to seek help sooner than that because your pain may be caused by another condition.
You can often book an appointment with an NHS podiatrist or physiotherapist without needing to go through your GP. This is known as self-referral. Ask your GP surgery whether this is available in your area.Diagnosis of plantar fasciitis
Your podiatrist (chiropodist), physiotherapist or GP will usually be able to diagnose plantar fasciitis by asking about symptoms and examining your foot. They will ask about your general health and activity, and when your symptoms usually come on.
To examine your foot, they will feel and press on different areas to see exactly where your pain is coming from. They may also ask you to walk on your toes or stand to see if this brings on any pain.
They may also check your body mass index (BMI) by weighing you and measuring your height, in case this is a factor.
You may have an X-ray or ultrasound to confirm the diagnosis and rule out other causes such as a bone problem. Rarely, your specialist may suggest an MRI scan. But you don’t always need further tests or scans to diagnose plantar fasciitis.
Self-help for plantar fasciitis
If you follow the self-help tips below, you are likely recover completely within a year. But it can take at least six to eight weeks until you start to see an improvement in your symptoms.
- Rest your foot as much as possible. Avoid standing or walking for long periods, and cut down or stop any activity that triggers your pain.
- If you’re a runner, try switching to a lower-impact exercise (such as swimming or cycling) while your foot heals. You can also see if running on a softer surface helps.
- Try doing some stretches of the plantar fascia in your foot and your calf muscles. You usually need to do these a couple of times a day.
- Apply ice (wrapped in a towel) to the area when it’s painful. You can do this for 10 to 20 minutes, up to two or three times a day.
- Make sure you’re wearing shoes with good support - laced sports shoes are a good option.
- Use insoles and heel pads in your shoes to help provide support. Your podiatrist (chiropodist) or physio may be able to recommend some. Don’t walk barefoot.
- If you’re overweight, aim to lose the excess weight by making changes to your diet and keeping active. Activities such as swimming and cycling put less pressure on your feet.
- Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen can help with the pain.
Stretches and exercises for plantar fasciitis
Stretches for plantar fasciitis can help to reduce pain and prevent further damage. You can do these stretches yourself at home. You usually need to do them at least twice a day. A podiatrist (chiropodist) or physiotherapist can give you more advice about how to do the exercises.
Achilles tendon and plantar fascia stretch
Keep a towel by your bed. Before you get up, loop a long towel around the ball of your foot and pull it. Keep your leg straight. Hold this for 30 seconds. Repeat this three times for each foot.
Wall push
Stand facing a wall, with one foot in front of the other. Your feet should be shoulder width apart and facing the wall, with your front knee bent and your back knee straight.
Place both your hands on the wall, shoulder width apart. Lean towards the wall by bending your front knee. You’ll feel the stretch through your calf in the back leg. Hold for 30 to 45 seconds, then relax. Repeat three to four times, two to three times a day.
The further the back leg is from the wall, the greater the stretch. So, you should start closer to the wall to begin and over time move the back leg further way from the wall.
Stair stretch
Stand on a stair, facing upstairs and holding onto the rail for support. Position your feet so that your heels hang over the end of the step, and your legs are slightly apart. Lower your heels, until you feel tightening in your calves. Hold this position for 20 to 60 seconds, then relax. Repeat six times.
Plantar fascia stretch
While you’re sitting down, roll your foot over a round object - such as a rolling pin, drinks can or tennis ball. Allow your foot and ankle to move in all directions. Carry on for a few minutes or until you feel discomfort. Repeat at least twice a day.
Another way to stretch your plantar fascia is to sit down, crossing one foot over your knee. Then, grab your toes and pull them back towards your body. Hold this for 15 to 20 seconds and repeat three times.
Treatment of plantar fasciitis
With self-help and treatment, plantar fasciitis usually goes away completely. If it does come back, you need to start treatment and self-help measures again as soon as possible.
If you see a podiatrist (chiropodist), physiotherapist or GP, they’ll usually recommend self-help measures and stretching exercises first. A podiatrist or physiotherapist can go through these with you to make sure you’re doing them correctly.
They’ll also check your footwear and what supports you may be using in your shoes. They may recommend some other things to try. These can include using custom-made orthoses such as insoles or heel or arch supports. They may suggest taping your foot or wearing a splint at night. There is more information in our FAQs: How can a night splint help? and What does taping involve?
Your podiatrist, physiotherapist or GP may suggest some other treatments. This is most likely if the measures above haven’t helped after a few months. Or if your symptoms are having a significant impact on your life.
Steroid injection
A steroid injection may help to give you some short-term pain relief. But it doesn’t always last for long - the pain can return within a month. The injection is often quite painful, and there is a small risk of complications. But some people do find it worthwhile, especially if they need immediate pain relief. If it helps, you can have the injection repeated once, with at least six weeks between injections. Your specialist should do the injection, which may be done under ultrasound. This helps to guide it into the right place.
It’s important to weigh up the pros and cons with your doctor before you decide whether or not to have a steroid injection.
Specialist treatments
Your GP may refer you to a surgeon if your symptoms haven’t improved after six to 12 months. The surgeon can tell you if the following treatments may be suitable.
- Extracorporeal shockwave therapy (ESWT) involves passing shockwaves through the affected area. ESWT is thought to be a safe alternative to steroid injections and you may find it helpful.
- Surgery – an operation to release your plantar fascia can help to relieve pain. But if you’ve had the condition for longer than two years, this may be less likely to help.
Prevention of plantar fasciitis
There are a few measures you can take to reduce your risk of developing plantar fasciitis.
- Wear good-quality, well-fitting trainers with good cushioning or shock absorption.
- Buy your trainers from a running shop, where you can get advice on the best shoes for you.
- Replace your trainers as soon as they are worn out.
- Avoid exercising on a hard surface.
- Make sure you stretch before and after exercise.
- Losing weight if you need to may help because being overweight is a risk factor.
A job or hobby where you’re on your feet for long periods of time is one of the main risk factors for plantar fasciitis. So, if you’re a factory worker, hairdresser, postman or shop worker, for example, you are at risk.
If you’re in a job where you’re on your feet all day, ask your manager if there’s any way to cut down on standing. It will also help to wear appropriate footwear that supports your heel as well as the arch of your foot.
Most people naturally sleep with their feet pointing down. This causes shortening of your plantar fascia - the band of tissue on the underside of your foot. A night splint can help to keep your foot pointing upwards and your toes extended while you sleep. This gently stretches your plantar fascia and can help it to heal faster. Some people find that wearing a splint means they have less pain and stiffness in the morning.
You can buy a pre-made plastic splint to use at night. Unfortunately, many people find night splints uncomfortable and hard to sleep with. But if you persist with them alongside other treatments, there’s some evidence they can help. Talk to your podiatrist or physiotherapist if it’s something you’d like to try.
The technique normally used for plantar fasciitis is called ‘low-dye taping’. Your podiatrist or physiotherapist applies a type of athletic tape to the sole of your foot. Usually several pieces of tape go across the underside of your foot. Another piece goes around your heel and the back of your foot. The tape is normally left on for three to five days.
Taping may help to relieve pain in the short-term. It can be particularly helpful if you have stiffness and pain in the mornings. It’s also useful to try taping to see if more support with orthotics (inserts) would be helpful.
Physiotherapy
Steroid joint injections
If you have a painful joint from an injury or arthritis, for example, your doctor may offer you a joint injection of a corticosteroid (steroid) medicine.
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