In short
Plantar fasciitis is pain under the heel, typically worst with the first steps in the morning or after sitting. It comes from overload of the thick band of tissue under the foot, and is more common with excess weight and long hours standing. Stretching the sole of the foot, calf-raise strengthening, taping and supportive shoes are the core treatments. It is slow to settle and often takes months.
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What is plantar fasciitis?
The plantar fascia is a strong, thick band of tissue that runs along the bottom of your foot, from the heel bone to the toes. It helps form the arch of the foot. Plantar fasciitis is when that tissue becomes sore, usually where it attaches at the heel.1
It is the most common cause of pain under the heel. In a British survey of adults aged 50 and over, about one in ten had this kind of heel pain.2
Plantar fasciitis symptoms
The main symptom is pain under the heel, which can be dull or sharp. You may also have aching or burning along the sole. The pain is usually worse:1
- With your first steps in the morning
- When you stand up after sitting for a while
- After long periods on your feet, or after a lot of activity
It often eases once you have been moving for a few minutes, then builds again through the day.
Pain that keeps coming back?
Talk it through with an Australian doctor online. No referral needed.
What causes plantar fasciitis?
Repeated load on the heel that outpaces the tissue’s ability to adapt. Common factors include:1
- Running, dancing, aerobics and jumping sports, especially after a sudden increase in training
- Spending a lot of time on your feet
- Being overweight, or pregnant
- Being middle-aged or older
- Flat feet or high arches
- Tight or weak calf muscles
- Shoes with poor support, or a change in footwear
Body weight is the factor with the strongest evidence. In a meta-analysis of 51 studies, a higher body mass index was the only clinical factor consistently linked with plantar fasciitis, and the link was strongest in people who weren’t athletes.3
What about heel spurs?
A heel spur is a small spike of bone on the underside of the heel. Spurs often show up on X-rays of people with plantar fasciitis, but many people have them with no pain at all.1 In a long-term follow-up study, having a spur made no difference to how people recovered.4 The spur is not what needs treating.
How long does plantar fasciitis last?
Longer than most people expect. It often lasts weeks or months.1 In a Danish study that followed 174 people for an average of nearly 10 years, about 80 per cent still had symptoms a year after they began, and around half did at five years.4
Those were patients seen at a specialist clinic, so they probably had tougher cases than average. But it helps to know that slow progress is normal and not a sign that something has been missed.
How to treat plantar fasciitis
Stretch the sole of your foot
Sit with the sore foot across your other knee. Pull your toes back towards your shin until you feel a stretch along the arch. Hold for 10 seconds, repeat 10 times, and do it three times a day, including before your first steps in the morning.
In a trial of people with long-standing plantar fasciitis who were taught this stretch, 94 per cent reported less pain two years later and 92 per cent were satisfied with the result.5 A best-practice guide based on a systematic review found good evidence for plantar fascia stretching and for taping to reduce first-step pain in the short term.6
Strengthen with heel raises
Stand on a step on the sore foot, with a rolled towel under your toes, and slowly rise onto the ball of your foot and lower again. In a Danish trial, people who did this every second day had better foot function at three months than people who did the stretch. By 12 months the two groups were the same.7 So strengthening may speed things up, and either approach gets you there.
Shoes, inserts and taping
- Wear shoes with good support and cushioning1
- Heel pads or arch supports can help.1 A meta-analysis of 19 trials found inserts reduced pain in the medium term, and that custom-made ones worked no better than prefabricated ones8
- Supportive taping before activity reduces load on the fascia1,6
Ease the load
Cut back on running and long periods of standing while it settles. An ice pack for 10 to 20 minutes, up to four times a day, can ease pain.1 If you are carrying extra weight, losing some reduces the load with every step.
If it isn’t improving
The next steps a doctor or podiatrist may suggest are shockwave therapy, and occasionally an injection into the heel. Surgery is rare and kept for the most severe cases.1 A network meta-analysis of 31 trials found no treatment was clearly better than the others, though shockwave therapy and injections were among those most likely to help.9
When to see a doctor
- Heel pain that has lasted more than eight weeks1
- Pain that is affecting your walking or your work
- Heel pain after a fall or a sudden “pop”
- Numbness or tingling in the foot
- A heel that is red, hot and swollen, or pain at night and at rest
Pain behind the heel may be a different problem, such as damage to the Achilles tendon.10
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- healthdirect. Plantar fasciitis.
- Thomas MJ, Whittle R, Menz HB, et al. Plantar heel pain in middle-aged and older adults: population prevalence, associations with health status and lifestyle factors, and frequency of healthcare use. BMC Musculoskelet Disord. 2019;20(1):337.
- van Leeuwen KD, Rogers J, Winzenberg T, et al. Higher body mass index is associated with plantar fasciopathy/'plantar fasciitis': systematic review and meta-analysis of various clinical and imaging risk factors. Br J Sports Med. 2016;50(16):972-81.
- Hansen L, Krogh TP, Ellingsen T, et al. Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination. Orthop J Sports Med. 2018;6(3):2325967118757983.
- Digiovanni BF, Nawoczenski DA, Malay DP, et al. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 2006;88(8):1775-81.
- Morrissey D, Cotchett M, Said J'Bari A, et al. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. Br J Sports Med. 2021;55(19):1106-1118.
- 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.
- Whittaker GA, Munteanu SE, Menz HB, et al. Foot orthoses for plantar heel pain: a systematic review and meta-analysis. Br J Sports Med. 2018;52(5):322-328.
- Babatunde OO, Legha A, Littlewood C, et al. Comparative effectiveness of treatment options for plantar heel pain: a systematic review with network meta-analysis. Br J Sports Med. 2019;53(3):182-194.
- healthdirect. Heel pain.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.