Plantar fasciitis: heel pain causes and treatment

What plantar fasciitis is

The plantar fascia is a thick band of connective tissue running along the sole of the foot from the heel bone to the toes. It supports the arch and works like a spring when you walk and run. Plantar fasciitis, now often called plantar heel pain or plantar fasciopathy, happens when the fascia is loaded more than it can tolerate and becomes painful and thickened where it attaches to the heel.

Despite the name, inflammation is not the main feature in most longer-standing cases. The tissue shows changes similar to tendinopathy, which is why loading and strengthening have become central to treatment.

Common causes and who gets it

It is one of the most common causes of heel pain in adults, especially between about 40 and 60. It often appears after a change in how much time you spend on your feet.

• A sudden increase in walking, running or standing, such as a new job, a holiday with lots of sightseeing or a new step goal
• Running training, especially increases in distance or speed
• Higher body weight, which increases load on the foot
• Tight or weak calves
• Unsupportive or worn-out footwear, or going barefoot on hard floors more than usual

It is also common in people who have just started walking a lot for fitness or weight loss. Our guide to walking for fat loss covers building daily steps gradually so your feet can keep up.

Typical symptoms

The classic sign is sharp pain under the heel with the first steps in the morning or after sitting for a while, which eases as you walk around, then returns as a dull ache after long periods on your feet. Pain is usually on the inner side of the underside of the heel and tender to press.

Heel pain that is worse at night, is present at rest, comes with numbness or burning in the sole, affects both heels along with other joints, or started after a fall or jump is not typical of plantar fasciitis and should be checked.

What a physio assessment looks at

Your physio will ask about your daily activity, footwear and training, then examine the heel and foot, test calf flexibility and strength, and look at how you walk. They will check for other causes of heel pain, such as a heel bone stress fracture, nerve irritation, fat pad problems or Achilles tendinopathy.

Imaging is not usually needed. Heel spurs seen on X-rays are common in people without heel pain and are not considered the cause of plantar fasciitis in most cases.

What usually helps

Most people improve with a combination of approaches rather than any single fix. The core elements are strengthening, stretching, footwear and managing load.

• Strengthening: calf raises, including high-load calf raises with the toes propped up on a rolled towel, have evidence for plantar heel pain.
• Stretching: calf stretches and plantar fascia stretches, especially before the first steps in the morning.
• Footwear: supportive, cushioned shoes and avoiding going barefoot on hard floors while it settles.
• Insoles or heel cups: can help some people in the short term.
• Load management: temporarily reducing long walks, standing time or running, and swapping some activity for cycling or swimming.

Taping can ease pain for a few days at a time. For persistent cases, shockwave therapy has reasonable evidence. Steroid injections can reduce pain in the short term but carry risks, including thinning of the heel fat pad, so they are used cautiously and arranged through a GP or specialist.

What you can start with at home

1. Plantar fascia stretch before getting up: pull the toes back and hold for 20 to 30 seconds, 3 times.
2. Calf stretches against a wall, straight and bent knee, 30 seconds each, 2 to 3 times a day.
3. Calf raises on both feet, progressing to single leg, 3 sets of 12 to 15, slow on the way down.
4. High-load heel raises with a rolled towel under the toes, every other day, building to 3 sets of 12 with a backpack for extra load.
5. Wear supportive shoes indoors and outdoors while it settles.

For runners and HYROX athletes, shoe choice and gradual volume increases matter. Our guide to HYROX shoes and kit covers footwear for mixed running and station work.

Rolling the sole of the foot over a ball or a cold water bottle can ease pain for a while. It is fine to use if it helps, but treat it as short-term relief rather than a replacement for the strengthening work.

Recovery time and when to get help

Plantar heel pain often improves within a few months with consistent management, although some cases take up to a year or longer. The on-site physio at Lycan Strength can build a plan and adjust your training, with 20% off for members; book a physio appointment online.

• Go to A&E or an urgent treatment centre if heel pain started after a fall or jump from height and you cannot put weight on it.
• Call NHS 111 or see a GP urgently if the foot is hot, red and swollen, you have a fever, or you have diabetes and notice any wound, colour change or swelling.
• See a GP if you have numbness, burning or tingling in the sole, pain at night or at rest, or pain in both heels with other joint pain or stiffness.
• See a GP or physio if heel pain gets worse with every run and hurts when squeezing the sides of the heel, as this can be a stress fracture.

Questions