Plantar fasciitis
A common cause of heel pain caused by inflammation and degeneration of the plantar fascia - the thick band of tissue that runs along the bottom of the foot from the heel to the toes.
📊 Plantar fasciitis affects approximately 10% of people during their lifetime and is the most common cause of heel pain in adults. It accounts for around 1 million patient visits per year in the UK.
What is plantar fasciitis?
The plantar fascia is a strong, fibrous band of tissue that runs along the sole of the foot from the heel bone (calcaneus) to the base of the toes. It supports the arch of the foot and acts like a shock absorber when you walk, run, or stand. When the fascia is overloaded or stressed, small tears can develop where it attaches to the heel bone, leading to pain and inflammation.
Despite its name, plantar fasciitis is now understood to be more of a degenerative condition (plantar fasciopathy) than a purely inflammatory one. Histologically, the tissue shows signs of degeneration rather than acute inflammation, which is why the term "plantar fasciopathy" is increasingly preferred. This understanding has shaped modern treatment, which focuses on loading the tissue progressively rather than simply resting it.
The condition is self-limiting in most patients, with around 80-90% of people improving within 12 months with conservative treatment. However, symptoms can be persistent and significantly affect daily activities. A small minority of patients require more advanced interventions or, very rarely, surgery.
Common causes
- Repetitive overuse - prolonged standing, walking, or running
- Sudden increase in activity level
- Tight calf muscles or Achilles tendon
- Obesity or sudden weight gain
- High-arched (cavus) or flat (planus) foot shape
- Unsupportive footwear
- Occupations involving prolonged standing on hard surfaces
Who is at risk? Risk factors include age 40-60 years, obesity (BMI greater than 30), pes planus or pes cavus foot shapes, reduced ankle dorsiflexion, and occupations requiring prolonged weight-bearing such as nursing, teaching, and factory work. Long-distance runners are also at higher risk.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- Sharp, stabbing pain in the heel - classically with the first few steps after waking or after a period of rest
- Pain that improves as you start walking, then worsens again towards the end of the day
- Tenderness on pressing the inner side of the heel bone
- Stiffness in the foot, especially in the morning
- Pain after - rather than during - prolonged activity
- Symptoms usually affecting one foot (around one-third have both)
When to seek help: See your GP or a foot specialist if heel pain has not improved with rest, stretching, and supportive footwear after 6 weeks, if pain is severe enough to limit daily activities, or if you notice any swelling, redness, or warmth, or have associated numbness or tingling.
How is it diagnosed?
Your foot and ankle specialist will take a detailed history and examine the foot. The following investigations may be arranged to confirm the diagnosis:
- Clinical examination - pain on pressing the medial calcaneal tuberosity is highly characteristic
- Windlass test - dorsiflexing the big toe stretches the fascia and reproduces pain
- Ultrasound - measures plantar fascia thickness (greater than 4mm is abnormal) and shows degenerative changes
- MRI - reserved for atypical or persistent cases to exclude other causes
- X-ray - may show a heel spur, but this is incidental and not the cause of pain
Heel spurs are present in around 50% of patients with plantar fasciitis, but they are also present in around 20% of pain-free people. The spur is the result, not the cause, of plantar fascia tension, and surgical removal is rarely indicated. Diagnosis is clinical in most cases.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Stretching and load modification
A combination of plantar fascia stretches, calf stretches, and reduction of aggravating activities. Specific exercises such as heel raises off a step (high-load strengthening) have evidence of benefit. Most patients see significant improvement within 8-12 weeks.
Supportive footwear and orthotics
Cushioned, supportive shoes with arch support, avoiding flat or unsupportive shoes. Off-the-shelf or custom orthotics provide arch support and offload the fascia. Silicone heel cups can also help.
Night splints and physiotherapy
Night splints hold the ankle in a slightly dorsiflexed position to maintain a stretch on the fascia overnight, reducing morning pain. Physiotherapy may include taping, shockwave therapy, and progressive loading programmes.
Extracorporeal shockwave therapy (ESWT)
High-energy shockwaves applied to the affected area stimulate healing and reduce pain. Evidence supports its use in chronic cases (symptoms beyond 6 months) that have not responded to first-line treatment.
Corticosteroid injection
A guided injection of steroid into the painful area can provide short-term pain relief. Use is generally limited due to risks of fat pad atrophy and plantar fascia rupture (around 2-10% risk).
Plantar fascia release
Surgical release of part of the plantar fascia, performed in fewer than 5% of patients who fail all conservative measures over 12 months or more. Outcomes are reasonable but not guaranteed, and overall foot mechanics may be altered.
Recovery
Recovery from plantar fasciitis is gradual. Most patients see meaningful improvement within 3-6 months and complete resolution within 12 months with consistent conservative treatment. Recovery is faster in those who commit to a regular stretching and loading programme. Recurrence can occur, particularly with rapid increases in activity or returning to unsupportive footwear.
- First-line stretching: 6-12 weeks
- Significant improvement: 3-6 months
- Full resolution in most: 6-12 months
- Return to running: 3-9 months
What results can I expect?
Excellent in most patients. Around 80-90% of people are pain-free at 12 months with conservative management alone. Risk factors for slower recovery include high BMI, persistent symptoms beyond 6 months at presentation, and bilateral symptoms.
In numbers
When can I…?
Typical activity timelines for this condition. These are approximate and vary considerably between patients. Always follow the specific guidance given by your surgeon and physiotherapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Walk normally | Most days | Pain is typically worst with the first steps in the morning and after rest, easing as you walk around. Continue to walk; complete rest does not help.[2] |
| Drive | No restriction | Driving is rarely affected. Plantar fasciitis is not a reason to stop driving. |
| Stretch the calf | Daily, from day 1 | Twice-daily calf and plantar fascia stretches are the single most evidence-backed treatment.[2] |
| Return to running | When pain is settling | Reduce volume and intensity rather than stopping completely. Gradual return as morning pain improves.[2] |
| Try heel cushions | Anytime | Gel heel cushions, supportive trainers, and avoiding flat sandals all help while symptoms settle.[3] |
| Expect improvement | 3-6 months | Most patients improve substantially within 3-6 months, and over 80% resolve fully within a year.[2] |
Is this normal?
Common concerns from patients with this condition or recovering from treatment, and whether they are expected or worth mentioning to your team.
Preparing for surgery?
Read our step-by-step guide: what to expect before, during, and after your procedure.
Related conditions
Your questions, answered
Plain-English answers to the things people most often ask, grounded in published guidance. Tap a question to open it.
About thisWhy does my heel hurt most for the first few steps in the morning?
Plantar fasciitis causes pain under the heel that is classically worst for the first steps after rest, then eases as you walk and warms up. The plantar fascia tightens while you are off your feet, so loading it again on rising is what hurts.
It is very common and usually self-limiting. Most people settle over several months to about a year with simple measures, even though it can be slow and frustrating.
Your choiceWhat actually helps, and how long before it improves?
First-line care is relative rest from aggravating activity, supportive well-cushioned footwear or insoles, regular calf and plantar fascia stretching, weight management if relevant, and a short course of anti-inflammatory medication if suitable for you.
Improvement is gradual and measured in months rather than days. Sticking with the stretches and footwear changes is the part that makes the biggest difference.
InjectionsShould I have a steroid injection?
A corticosteroid injection can give short-term pain relief when symptoms are stubborn, but the benefit often fades and it is not a cure. There are small risks of thinning of the heel fat pad and, rarely, rupture of the fascia, so it is used selectively.
For persistent cases, extracorporeal shockwave therapy is a recognised option approved by NICE before any thought of surgery.
Getting backCan I keep running or exercising?
You do not have to stop moving, but easing off high-impact loading for a while usually helps. Swapping to lower-impact options such as cycling or swimming keeps your fitness up while the heel settles.
Keep up the calf stretching and build impact back gradually once the first-step pain is improving.
Pain & sleepWould a night splint help?
A night splint holds the foot so the fascia stays gently stretched overnight. Some people find this noticeably reduces that sharp first-step pain in the morning.
It is not essential and not everyone gets on with one, but it is a low-risk thing to try.
UrgentWhen should heel pain be checked more urgently?
See someone if the pain followed a fall or sudden injury and you cannot put weight through the heel, if there is numbness or pins and needles spreading into the foot, or if you have night pain with feeling unwell or a temperature.
Seek urgent help for a hot, swollen, painful calf or breathlessness, which can signal a clot.
References & further reading
- 1.NICE CKS: Plantar fasciitis (clinical knowledge summary)
- 2.British Orthopaedic Foot & Ankle Society: Plantar fasciitis patient information
- 3.NHS: Heel pain (plantar fasciitis)
References are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.