Typical symptoms
- A sharp or stabbing pain under the heel, especially on the inner side
- Marked pain with the first steps after getting out of bed in the morning
- Pain that returns when you stand up after sitting for a while
- Pain that eases after a few minutes of walking but builds again by the end of the day
- Pain that increases with long periods of standing or walking barefoot on hard floors
Causes and risk factors
Plantar fasciitis usually appears when the load on the foot increases faster than the tissue can currently handle. Heel spurs are also seen on the X-rays of many people with no pain, so rather than targeting the spur itself we focus on increasing the load capacity of the fascia and calf muscles.
- Working on your feet for long hours
- Increasing running or walking distance over a short time
- Excess weight or gaining weight quickly
- Tight calf muscles or limited ankle movement
- Unsupportive, thin-soled shoes or walking barefoot on hard floors
How I work with heel pain
Heel pain can also have other causes, such as a trapped nerve, problems with the heel fat pad or a stress fracture; I rule these out first.
Assessment
I assess where the pain is and when it gets worse, the flexibility of your ankle and calf, the strength of your foot and hip muscles, your walking and the shoes you wear. We also go through your work and sport load together.
Manual therapy
Techniques for the calf muscles and the soft tissues of the sole, along with ankle joint mobilisation, can help ease pain and make movement more comfortable.
Exercise therapy
We start with stretches specific to the plantar fascia and calf, then move on to a gradual programme that strengthens the calf and the small muscles of the foot. Slow, heavy heel raises are an important part of the programme.
Education and taping
We talk about adjusting your daily steps and standing time to your pain, choosing suitable footwear and returning to running gradually. During the painful phase I can apply taping for short-term support.
How many sessions will I need?
Plantar fasciitis takes patience; the pain usually eases over weeks to months, and your home exercises matter as much as the sessions. For many people 6–10 sessions followed by a regular home programme is a realistic framework. The exact plan depends on your assessment and how long you've had the problem.
What you can do at home
- Before getting out of bed in the morning, move your ankle up and down a few times and stretch the sole of your foot by pulling your toes towards you.
- At home, wear supportive slippers with a cushioned sole instead of walking barefoot on hard floors.
- Rolling a small bottle or ball under your foot for a few minutes can bring relief.
- Rather than giving up running or long walks completely, cut them back to a level that doesn't make the pain worse the next day.
When to see a doctor first
In the following situations, see a doctor before starting physiotherapy:
- Heel pain that started after a fall, jump or blow and makes it hard to put weight on the foot
- Redness, warmth, obvious swelling of the heel and fever
- Burning, numbness or tingling in the foot
- Pain that continues at rest and at night
- Pain in both heels together with swelling in other joints or morning stiffness
- With diabetes: a wound, change in colour or loss of feeling in the foot
Frequently asked questions
Does a heel spur go away on its own?
Should I use insoles for a heel spur?
Can I keep running with plantar fasciitis?
Which shoes are best for heel pain?
This page is for general information only and does not replace a medical diagnosis or examination. If your symptoms are severe or getting worse quickly, see a doctor first.