What is plantar fasciitis?
Plantar fasciitis is heel pain caused by irritation where the foot's arch band attaches to the heel bone. It is usually worst with the first steps after rest and can make walking, standing at work, and exercise much harder.
Living with plantar fasciitis
Plantar fasciitis often starts as a sharp, stabbing pain in the bottom of your heel when you get out of bed or stand up after sitting. Once you “warm up,” the pain may ease, only to flare again after long periods on your feet. This can make simple things like walking the dog, standing at work, or playing sport stressful and draining.
Plantar heel pain is one of the most common foot problems seen in adults, especially between ages 40 and 60, in people who stand a lot at work, and in runners. ² ³ Lifetime incidence is thought to be close to 1 in 10 people. ²
The outlook is usually good. Most people improve with the right mix of load management, stretching, and strengthening over weeks to months, and only a small minority ever need injections or surgery. ¹ ² ³
What are the symptoms of plantar fasciitis?
Typical symptoms include:
- Sharp or stabbing pain on the inside bottom of the heel
- “First step” pain in the morning or after sitting, which often eases as you move
- Pain that returns and builds with prolonged walking, running, or standing
- Tenderness when you press on the inner heel where the arch band attaches
- Pain when you pull the toes and ankle upward, which tensions the plantar fascia (arch sole band)
- Stiffness in the sole of the foot, especially after rest
- Sometimes pain in both heels, especially if standing or weight has increased
Red flag features that are not typical of simple plantar fasciitis and need medical review include:
- Constant pain at rest or at night that does not ease with rest
- Swelling, warmth, or redness in the heel
- Very focal bone tenderness after a big increase in activity, which may suggest a stress fracture
- Numbness, tingling, burning, or electric shocks in the sole, which may point to a nerve entrapment
- Sudden “pop” in the heel with bruising or an inability to walk, which may indicate a fascia tear or rupture
If you notice these, you should see a clinician promptly for assessment. ² ³ ⁴
Did you know?
Most people get better without injections or surgery. Studies and guidelines show that plantar fascia specific stretching and progressive strengthening, combined with good footwear and load management, help most people improve over time, and only a small percentage ever need surgery. ¹ ² ³ ⁵ ⁶
What causes plantar fasciitis?
The plantar fascia is a strong band of tissue that supports the arch of your foot and helps store and release energy each time you take a step. Plantar fasciitis happens when the load placed on this tissue over time is more than it can comfortably handle. This leads to microscopic damage and gradual change, rather than a single “tear”. ¹ ³
Common contributors to plantar fasciitis include:
Overload or an increase in movement patterns
- Sudden increases in walking or running volume, hills, or speed work
- Jobs that involve long hours standing or walking on hard floors
- Limited ankle bend and flexibility, which pushes more load into the heel
- Foot postures such as very flat or very high arches in some people ¹ ²
Health and demographic factors put some more at risk
- Age between 40 and 60 years
- Overweight or obesity
- Diabetes or metabolic syndrome
- Pregnancy and recent weight gain
- Reduced strength or endurance in the calf and small foot muscles ¹ ² ³
Misunderstood Heel spurs on X ray are common in people with and without pain and are not proof that the spur itself is the cause.³ Usually there is no single cause. It is the combination of tissue load, strength, footwear, and general health that tips the tissue into an irritated state.
When should I see a doctor for plantar fasciitis?
You should book a medical or physical therapy assessment if:
- Your heel pain has lasted more than 2 to 3 weeks despite simple self care
- Pain is affecting your ability to walk, work, or exercise
- You are not sure whether the pain is from plantar fasciitis or something else
These situations may need imaging or different treatment and should not be managed as simple plantar fasciitis. ² ³ ⁴
Seek a doctor right away if you notice:
- You have severe pain and cannot put weight on the foot after an injury
- Pain at rest and for prolonged periods at night which could indicate a calcaneal stress fracture in the heel bone
- The heel is hot, red, or swollen and you feel unwell, which can indicate infection
- There is sudden sharp pain with a “pop” and bruising, which may mean a plantar fascia tear
- You have heel pain plus numbness, tingling, or burning in the sole or toes, which may be a nerve problem
How is plantar fasciitis treated?
Most people improve with structured, active care. Surgery is rarely needed, but helpful and effective treatment focuses on calming symptoms while gradually improving the strength and resilience of the plantar fascia and the whole leg. ¹ ² ³
Key parts of care include:
Education and load management
- Reduce or spread out activities that flare pain, such as sudden long walks, runs, or all day standing.
- Use a pain monitoring rule for walking and exercise, aiming for pain no higher than 3 out of 10 during and after, returning to baseline by the next day.
- Choose supportive footwear with cushioning under the heel and a small heel rise rather than very flat, thin shoes.
- Work on reducing weight and controlling blood sugar levels if relevant. ¹ ²
Stretching and exercise based rehabilitation
Plantar fascia specific stretching uses a simple stretch that pulls the ankle and big toe upward. This has been shown in randomized trials to reduce pain and improve function, and outperforms calf stretching alone in the short term. ⁵
High load strength training can help, with a program of slow heel raises with the toes propped up. Calf, small foot, and hip strengthening can also improve outcomes over 3 to 12 months. ⁶ Programs usually start gently and progress as symptoms allow, often over at least 12 weeks.
Short term ways to reduce symptoms
Taping: Low dye (taping tecnique to suport foot inner curve) or calcaneal (heel bone) taping can ease pain for several days and support the foot while exercises are started. A physical therapist can help you decide whether this option is helpful and perform the right strapping. ⁷
Foot orthoses or orthotics: These are external devices that support the bone or joints. Both off-the-shelf or custom insoles can reduce pain in the short term. Note that benefits beyond a few months are smaller and mixed, so they are best used as an addition to an exercise rehabilitation plan, not a cure on their own. ¹ ⁸
Night splints: these may help selected people with long standing, severe morning pain, but evidence is mixed. Some studies show benefit, while a trial adding a tension night splint to a strong program showed no extra gain. ¹ ⁹ ¹⁰
Injections and shock wave therapy
Corticosteroid injections: these can give short term pain relief, usually over several weeks, but the effect often fades and there is a small risk of plantar fascia rupture and fat pad thinning which can present more serious problems. These injections are usually reserved for people who have not responded to exercise and taping. Any injections should be combined with a rehabilitation plan. ¹ ³ ¹⁴
Platelet rich plasma (PRP) injections: PRPs may offer longer term pain reduction than steroid injections in some studies, especially in chronic cases, but protocols differ and costs can be high. Evidence quality is moderate at best. ¹⁵
Extracorporeal shock wave therapy (ESWT): This is an option reserved for long standing plantar fasciitis that has not responded to other care. Repeated sessions have been shown to improve pain and function compared with placebo or sham treatment. ¹ ¹³
Surgery
This option is only considered after 6 to 12 months or more of well delivered conservative care when pain is still severe and function is limited.
Procedures may include partial release of the plantar fascia and, in some cases, the release of a nearby nerve branch. Surgery carries risks such as nerve injury and arch changes and this surgery is used very sparingly. ¹ ³
Recovery time varies. Many people see clear improvement over 6 to 12 weeks with loading and stretching, while more stubborn cases can take several months. ¹ ² ³
Sword's approach
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