Quick answer: Plantar fasciitis is the most common cause of pain under the heel. It usually causes sharp pain with your first steps in the morning or after sitting for a while. Most people get better with simple treatment such as stretching, strengthening, taping and supportive shoes, and more than 90% improve within 10 months.
What is plantar fasciitis?
The plantar fascia is a thick band of tissue that runs along the sole of your foot, from the heel bone to the toes, and supports your arch. In plantar fasciitis, the fascia becomes painful where it attaches to the heel. The name suggests inflammation, but it is caused by straining the fascia, and it is not always clear why this happens.
“Plantar heel pain” is the umbrella term for pain under the heel. Plantar fasciitis is its most common cause, but not the only one (see below).
Symptoms
- sharp pain under the heel, usually on the inner side
- pain that is worst with your first steps in the morning or after resting, and eases as you move about
- pain after long periods of standing or walking
- tenderness when you press under the heel
See a doctor if your heel pain doesn’t follow this pattern, is worse at night or keeps you awake, or if you also have tingling or loss of feeling in your foot.
Causes and risk factors
- a sudden increase in running or walking, or long hours standing at work
- being overweight
- tight calf muscles or a stiff Achilles tendon
- age, as it is most common in middle age
- shoes with little cushioning or arch support, or going barefoot on hard floors
Heel spurs (small bony growths on the heel bone) are common and usually painless. They do not cause plantar fasciitis pain.
Other causes of heel pain
Pain under the heel can also come from the heel fat pad, an irritated nerve or a stress fracture of the heel bone. Pain at the back of the heel is more likely to be the Achilles tendon. A physiotherapist or doctor can tell these apart by examining your foot.
Do I need a scan?
Usually not. Plantar fasciitis is diagnosed from your symptoms and an examination. Scans are usually only needed if the pain doesn’t improve with treatment, or if another cause is suspected.
Treatment
Treatment works best in steps, starting simple:
First steps
- Understand the problem and ease the load: cut back on running, long walks and standing where you can, and swap some activity for cycling or swimming.
- Stretch: calf stretches and stretches for the sole of the foot ease pain, especially before your first steps in the morning.
- Strengthen: heel raises build strength. In one small trial, people who did heel raises every other day, making them heavier over time, did better than people who stretched instead at 3 months, but not at 6 or 12 months.
- Tape: taping the foot can ease pain in the short term.
- Shoes: wear shoes with a cushioned heel and good arch support. Avoid flip flops, high heels and walking barefoot on hard surfaces.
- Ice and pain relief: an ice pack wrapped in a towel for up to 20 minutes can ease pain. Ask a pharmacist about painkillers.
If it isn’t improving
- Shockwave therapy: often the next step for pain that hasn’t settled with simple treatment, although results vary.
- Insoles or orthotics: insoles or heel pads may make standing and walking more comfortable. Custom orthotics are usually only considered after about 12 weeks if you are not improving.
- Steroid injections: can give short term relief, but they can weaken the plantar fascia and cause it to tear, so they are used with caution.
- Surgery: a last resort, usually only after 12 months of thorough non surgical treatment.
How long does plantar fasciitis last?
It settles slowly. More than 90% of people improve within 10 months of starting simple treatment. Sticking with your stretches and strengthening helps.
Running with plantar fasciitis
If running makes your heel pain worse, cut back on distance and speed, or swap some runs for cycling or swimming until it settles. Then build back up gradually and avoid sudden increases. Read more about common running injuries.
When to see a doctor or physiotherapist
See a doctor or physiotherapist if the pain is severe, getting worse or not better after 2 weeks, or if you have tingling or loss of feeling in your foot, or diabetes.
See a doctor the same day or go to A&E if you felt a snap or pop, or you can’t walk or stand on tiptoe.
Frequently asked questions
Is plantar fasciitis the same as heel pain?
Not exactly. Plantar fasciitis is the most common cause of pain under the heel, but heel pain can also come from the fat pad, a nerve or a stress fracture.
How long does plantar fasciitis last?
It settles slowly. More than 90% of people improve within 10 months of simple treatment.
What exercises help plantar fasciitis?
Calf stretches and stretches for the sole of the foot, plus heel raises that get heavier over time. One small trial found heel raises done every other day helped more than stretching at 3 months, but not later.
What shoes are best for plantar fasciitis?
Shoes with a cushioned heel and good arch support. Avoid flip flops, high heels and going barefoot on hard surfaces.
Do heel spurs cause plantar fasciitis?
No. Heel spurs are common and usually painless, and they don’t explain the pain of plantar fasciitis.
Sources
- JOSPT 2023 clinical practice guideline: plantar heel pain
- Morrissey et al. 2021, BJSM: best practice guide for plantar heel pain
- OrthoInfo (AAOS): Plantar fasciitis and bone spurs
- Mayo Clinic: Plantar fasciitis
- NHS: Plantar fasciitis
- NHS: Heel pain
- Rathleff et al. 2015, Scand J Med Sci Sports: high load strength training for plantar fasciitis
Need help with this? Our sports injury and running rehab team at Total Health by Hong Kong Sports Clinic can assess you and start treatment in your first session, in Central, Kai Tak or Tin Hau. Message us on WhatsApp to book.
