Plantar fasciitis (heel pain)

Expert reviewer, Mr Ian Reilly, Consultant Podiatric Surgeon
Next review due, December 2021

Plantar fasciitis (sometimes called plantar fasciopathy) is the most common cause of persistent heel pain (plantar heel pain). Plantar fasciitis is often self-limiting and will usually get better by itself within six to 12 months. However, there are several things you can do to reduce your pain and help it to heal, in the meantime.

Image showing plantar fasciitis (heel pain)

About plantar fasciitis

There are many causes of heel pain. These can include problems with the different nerves, bones and tissues in your foot, and conditions such as rheumatoid arthritis. If there hasn’t been a specific diagnosis for your pain yet, doctors and other health professionals may refer to it as ‘plantar heel pain’. In plantar fasciitis, the thick band of tissue that runs along the sole of your foot (called your plantar fascia) becomes damaged. This causes pain in your heel, and sometimes in the arch of your foot.

It’s most common in people between the age of 40 and 60, and you’re more likely to get it if you’re overweight or obese. Around one in three people who get it have it in both feet. It’s common in people who run too — around one in 10 people who regularly run develop plantar fasciitis.

Causes of plantar fasciitis

You tend to develop plantar fasciitis if there is too much pressure on the band of tissue that runs along the sole of your feet. The following factors can increase your risk of developing it.

  • Being overweight or obese.
  • Having high arches in your feet or being flat footed.
  • Regularly doing high-impact activities such as running, jumping or dancing. Running on hard ground increases your risk.
  • Spending a lot of time on your feet — for instance, if you’re in a job where you’re standing or walking around all day.
  • Being pregnant — hormones associated with your pregnancy can cause your ligaments to relax. This, in addition to the temporary weight gain, 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 feet.

  • The pain is often worse when you first stand up and start walking after you’ve been asleep or sitting down for a long time.
  • Being on your feet all day, or 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 might be able to manage your symptoms yourself, at home (see section on Self-help for more information). But if you’re finding it hard to manage your pain, or it’s not getting better after several months, seek advice from a physiotherapist, podiatrist or your GP.

You can often book an appointment with an NHS physiotherapist or podiatrist directly, without needing to go through your GP. This is known as self-referral. Ask at your GP surgery to see whether this is available in your area.

Diagnosis of plantar fasciitis

Your physiotherapist, podiatrist or GP will usually be able to diagnose plantar fasciitis by asking you about your symptoms and examining your foot. They will want to ask you some questions about your general health and activity, and when your symptoms usually come on.

The health professional examining you will need to feel and press on areas of your foot to check exactly where your pain is coming from. They may also ask you to perform some simple actions — like standing or walking on your toes to see whether this brings on any pain.

They may also check your body mass index (BMI) by weighing you and measuring your height too, in case this is a factor.

Sometimes, your physiotherapist, podiatrist or GP may recommend you have an X-ray or ultrasound to confirm the diagnosis and rule out other causes, such as a bone problem. You don’t always need further tests or scans to diagnose plantar fasciitis though.

Self-help for plantar fasciitis

Most people with plantar fasciitis find that they make a complete recovery within about six months if they follow the self-care tips below. 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 by avoiding standing or walking for long periods, and reducing or stopping any activity that triggers your pain.
  • If running is causing your pain, you may want to consider 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 (these are described below). You’ll 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 may need to do this for 10 to 20 minutes, for a maximum of 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 physiotherapist or podiatrist 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. Try activities such as swimming and cycling that put less pressure on your feet.
  • You can try over-the-counter non-steroidal anti-inflammatory drugs, such as ibuprofen to help with the pain.

Stretches for plantar fasciitis

Stretches for plantar fasciitis can help to reduce your pain, as well as preventing further damage to your foot. You can do these stretches yourself at home. It’s usually recommended that you do them at least twice a day. A physiotherapist or a podiatrist can give you more advice about how to do the exercises if necessary.

Achilles tendon and plantar fascia stretch

While seated and with your knee straight, loop a long towel around the ball of your foot and pull it. Hold this for 30 seconds. Repeat this three times for each foot. This is a good exercise to do before you get up out of bed in the morning.

Wall push

Stand facing a wall, with one foot in front of the other — your front knee bent and your back knee straight. Place both your hands on the wall and lean towards the wall, until you can feel the stretch in your calf, in the back of your leg. Repeat this 10 times. Now bring your back foot forwards a little, so you have a slight bend in your back knee. Again, repeat 10 times.

Stair stretch

Stand on a step/stair, facing upstairs and holding onto a stair-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 a tightening in your calf. Hold this position for 20–60 seconds, then relax. Repeat this six times.

Plantar fascia stretch

While you’re sitting down, roll your foot over a round object — like a rolling pin, drinks can or tennis ball, allowing your foot and ankle to move in all directions. Carry on for at least a few minutes. Repeat this 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 15–20 seconds and repeat three times.

Treatment of plantar fasciitis

If you see a physiotherapist, podiatrist or GP for advice on plantar fasciitis, they’ll usually recommend the self-help measures and stretching exercises listed above first. A physiotherapist or podiatrist can go through these with you to make sure you’re doing them correctly.

They will also want to check what footwear or supports you’re using in your shoes, and they may recommend some other things to try. These can include using custom-made orthoses (such as supports for your heels or arches, or insoles), taping your foot, and wearing splints at night.

If these measures don’t seem to be helping after a few months, or your symptoms are having a significant impact on your life, your physiotherapist, podiatrist or GP may suggest some other treatments.

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 itself can also be painful, and there is a small risk of complications. However, some people do find it worthwhile, especially if they need immediate pain relief. You can have up to three injections, over a period of six to 12 months.

Your physiotherapist, podiatrist or GP may be able to do the injection for you, but in some cases they may refer you to a centre to have it 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 to have it.

Specialist treatments

If after about six to 12 months of trying other treatments your symptoms still haven’t improved, your GP may refer you to a surgeon. The surgeon will assess you and advise whether the following treatments may be suitable for you.

  • Extracorporeal shockwave therapy (ESWT). This is a specialist treatment that involves using a special device to pass shockwaves through the affected area. ESWT is thought to be a safe alternative to steroid injections. The evidence about how well it works is mixed but newer research has shown a greater benefit.
  • Surgery. Surgery for plantar fasciitis involves an operation to release your plantar fascia (the band of tissue in your foot that causes the pain).

Prevention of plantar fasciitis

If you run, or are involved in other high-impact sports, there are a few measures you can take to reduce your risk of developing plantar fasciitis.

  • Make sure you wear good-quality trainers that have good cushioning or shock absorption.
  • Buy your trainers from a proper running shop, where you can get advice on the best shoes for you.
  • Replace your trainers as soon as they become worn out.
  • Avoid exercising on a hard surface.
  • Make sure you regularly stretch, both before and after exercise.

Frequently asked questions

  • Having a job or hobby where you’re on your feet for long periods of time is one of the main risk factors for developing plantar fasciitis. Examples include factory workers, hairdressers and shop workers.

    If you’re in a job where you’re on your feet all day, talk to your manager to see if there’s any way you can reduce the number of hours where you have to stand. It will also help to make sure you’re wearing 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 — gently stretching your plantar fascia. This can help your plantar fascia to heal faster. Wearing the splint is also thought to help prevent more damage when you first step out of bed in the morning.

    A night splint may be made as a cast from either plaster or fibreglass. Or you can use a pre-made plastic brace. Unfortunately, many people don’t get on with night splints, as they find them uncomfortable and hard to sleep with.

    However, if you do persist with them and use them in combination with other treatments, there’s some evidence they can help. Talk to your physiotherapist or podiatrist about whether it’s something you’d like to try.

  • The technique normally used for plantar fasciitis is called ‘low-dye taping’. It’s named after the doctor who first described it.

    With this technique, your physiotherapist or podiatrist will apply a special type of athletic tape to the underside of your foot. Usually there will be several pieces of tape going across the underside of your foot, and one piece going around your heel and the back of your foot. Sometimes your physiotherapist or podiatrist may recommend strapping the tape higher up your leg. The tape is normally left on for three to five days.

    Taping has been found to be effective in helping with short-term pain relief. It’s also useful to try them first to see whether more support with orthotics (inserts) would be helpful.

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Related information

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    • Plantar fasciitis. NICE Clinical Knowledge Summaries., last revised June 2015
    • Foot pain. Brukner & Khan's Clinical Sports Medicine (5th ed, online). McGraw-Hill Medical., published 2017
    • Plantar heel pain. Medscape., updated 1 October 2018
    • Plantar fasciitis. PatientPlus., last checked 2 February 2016
    • Muth CC. Plantar fasciitis. JAMA 2017; 318(4):400. doi:10.1001/jama.2017.5806
    • Foot and ankle pain. Versus Arthritis., accessed 21 November 2018
    • Find a physio. Chartered Society of Physiotherapy., last reviewed 13 March 2018
    • Local steroid injections. Arthritis Research UK, 2015.
    • Extracorporeal shockwave therapy for refractory plantar fasciitis. National Institute of Health and Care Excellence (NICE), August 2009.
    • Plantar fasciitis. Medscape., updated 25 December 2017

  • Reviewed by Pippa Coulter, Freelance Health Editor, December 2018
    Expert reviewer Mr Ian Reilly, Consultant Podiatric Surgeon
    Next review due December 2021