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Plantar Fasciitis (Heel Pain): What's Going On and What Helps

5 hours ago
4 min read

The first steps out of bed are the worst part of your day. Your heel feels like you stepped on a pebble, and after a few minutes of walking it loosens up, only to complain again after a long shift on your feet. If that sounds familiar, plantar fasciitis is a common reason.


What is plantar fasciitis?

The plantar fascia is the band of tissue that connects your heel bone to your toes. Plantar fasciitis is a condition where that tissue gets strained and the bottom of the heel and arch become painful [2]. It is the most commonly recognized cause of plantar heel pain. It makes up about 15% of foot problems in the general population and is most common between ages 40 and 60 [1].


The name suggests inflammation, but the guideline notes that the tissue changes are better thought of as a spectrum that includes both inflammatory and degenerative features [1]. It tends to start gradually, often after a change in how much you stand, walk, or run [1]. The NHS lists other things that can make it more likely: starting to exercise on hard surfaces, a tight calf, shoes with poor cushioning or support, and carrying extra weight [2].


Man stretching his calf with his hands against a brick wall

What does it feel like?

The classic pattern is pain on the bottom of the foot, around the heel and arch. It is usually much worse with the first steps after sleeping or sitting, eases as you get moving, and flares again if you stand, walk, or run for a long time. Stretching the bottom of the foot, such as raising your toes off the floor or climbing stairs, can also hurt [2].


Red flags that need urgent care

Plantar fasciitis is not an emergency, but heel pain has other possible causes, and a few things should be checked promptly. The NHS suggests seeing a doctor if you have [2]:


  • Tingling or loss of feeling in your foot

  • Diabetes along with foot pain

  • Severe pain, or pain that is stopping you from doing normal activities

  • Pain that is getting worse or keeps coming back

  • No improvement after about 2 weeks of treating it yourself


Other possible causes of heel pain include a thinned heel fat pad, nerve irritation, and a stress fracture of the heel bone, and the guideline recommends re-checking the diagnosis if your symptoms are not improving with treatment [1]. That is one reason an exam is worth it.


What can you do at home?

  • Choose supportive shoes. The NHS suggests cushioned heels and good arch support, insoles or heel pads, and avoiding flip-flops, backless slippers, tight pointy shoes, and walking barefoot on hard floors [2].

  • Stretch the bottom of the foot and the calf. The physical therapy guideline supports plantar fascia and calf stretching for short and long-term pain and function [1], and the NHS suggests gentle stretches too [2].

  • Consider heel raises. In a trial of 48 people, daily plantar fascia stretching was compared with high-load heel raises (toes on a rolled towel) done every second day. At 3 months the strength group had better foot function scores. By 6 and 12 months the two groups were no different, and everyone in the trial also wore shoe inserts [3]. Strengthening is worth doing, but it may not be a magic shortcut.

  • Use ice for up to 20 minutes every 2 to 3 hours if it calms things down, and choose low-impact exercise such as swimming while it settles [2].


Gray running shoes beside a rolled exercise mat on a wood floor

How does physical therapy help?

The research on plantar heel pain is one of the stronger areas in orthopedic physical therapy. The 2023 guideline recommends [1]:


  • Manual therapy for the joints and soft tissue of the foot and lower leg

  • Stretching of the plantar fascia, calf, and soleus

  • Taping, alongside other treatments, for short-term pain relief

  • Resistance training for the foot and ankle muscles

  • Night splints for 1 to 3 months if the first step in the morning is the worst

  • Dry needling to trigger points in the calf and foot


It also says foot orthotics should not be used as the only treatment for short-term pain relief, but may help alongside other care [1].


If these measures do not help, the NHS notes that a doctor may offer other options such as steroid injections or shockwave therapy [2]. Many people have symptoms for more than a year before seeking care [1], so earlier help is not overreacting.


Physical therapist examining a woman's foot as she lies on a treatment table

When should you get seen?

See us if heel pain has not improved after about 2 weeks of home care, if it keeps coming back, if it is getting worse, or if it is limiting your work, workouts, or time on your feet [2]. Foot pain with diabetes, or with tingling or numbness, is worth checking sooner [2].


How can Hybrid Physical Therapy help?

We spend the first visit working out what is driving your heel pain, not just where it hurts. You work one-on-one with a Doctor of Physical Therapy every session, and we build the plan around what you want to get back to.


This post is general education and does not replace an exam. If your heel has been complaining for more than a couple of weeks, come in and let us take a look.


Let Hybrid Physical Therapy be the ones to optimize your performance.



References: 

  1. Koc TA, Bise CG, Neville C, et al. Heel Pain - Plantar Fasciitis: Revision 2023. J Orthop Sports Phys Ther. 2023;53(12):CPG1-CPG39. doi:10.2519/jospt.2023.0303. PubMed (PMID 38037331)

  2. NHS. Plantar fasciitis. Page last reviewed 14 February 2025. Source page

  3. Rathleff MS, Mølgaard CM, Fredberg U, 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):e292-300. doi:10.1111/sms.12313. PubMed (PMID 25145882)

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