Plantar fasciitis: symptoms, treatment and how to ease heel pain

The NHS says you can usually ease the pain yourself. If you see a GP, they will usually suggest the same self-care measures first. NICE Clinical Knowledge Summaries lists the same approach: rest from prolonged standing, walking or running, modifying footwear, over-the-counter insoles or heel pads, maintaining a healthy weight, simple painkillers, an ice pack and regular stretching.

A pharmacist can advise on the best painkiller to take and on insoles and pads for your shoes, according to the NHS.

The main symptom, according to the NHS, is pain on the bottom of the foot, around the heel and arch. NICE Clinical Knowledge Summaries describes this as pain on the inner side of the heel, with tenderness at the heel bone, typically on weight-bearing first thing in the morning or after a period of rest.

The NHS says it is more likely to be plantar fasciitis if the pain is much worse when you first start walking after sleeping or resting, gradually improves as you move around but worsens after long periods standing, walking or running, or hurts when you stretch the bottom of your foot, for example when raising your toes off the floor or walking up stairs.

The NHS says plantar fasciitis is caused by straining the plantar fascia, the band of tissue that connects your heel bone to your toes, and that it is not always clear why this happens. It is common.

NICE Clinical Knowledge Summaries calls it a biomechanical overuse condition caused by repetitive stress to the plantar fascia where it attaches to the heel bone, and notes it is also known as plantar fasciopathy or plantar fasciosis.

The NHS lists several things that make plantar fasciitis more likely. NICE Clinical Knowledge Summaries adds structural foot deformities, limited ankle movement and axial spondyloarthritis to its list of risk factors.

• being aged 40 to 60

• recently starting to exercise on hard surfaces

• exercising with a tight calf or heel, or overstretching the sole of the foot during exercise

• doing a lot of standing, walking or running, or suddenly doing much more than usual

• wearing shoes with poor cushioning or support

• being overweight

The sources do not give a fixed recovery time. NICE Clinical Knowledge Summaries says plantar fasciitis is usually self-limiting. It advises considering referral to an orthopaedic surgeon if symptoms persist for 3 to 6 months despite management in primary care, if the diagnosis is uncertain, or if symptoms are severe and affect daily function.

The NHS says to see a GP if your foot pain has not improved after treating it yourself for 2 weeks, if it is getting worse or keeps coming back.

The NHS says that if plantar fasciitis does not get better you might need to see a physiotherapist or foot specialist (podiatrist). A physiotherapist can show you exercises to ease symptoms. A podiatrist can recommend insoles, suitable shoes or splints to wear at night.

If these do not help you may be offered steroid injections or extracorporeal shock-wave therapy, a machine that delivers high-energy sound waves to the foot. The NHS says that less commonly you may be referred to a specialist to discuss surgery.

NICE Clinical Knowledge Summaries suggests an X-ray or ultrasound scan may be considered if there are atypical features or persistent pain, to look for an alternative diagnosis.

The NHS gives simple dos and don'ts for plantar fasciitis.

• Do rest and raise your foot when you can.

• Do wear shoes with cushioned heels and good arch support.

• Do try swimming or other exercise that does not put pressure on your feet.

• Do not walk or stand for long periods.

• Do not wear high heels, tight pointy shoes, flip-flops or backless slippers.

• Try not to walk barefoot on hard surfaces.

The NHS advises seeing a GP if any of the following apply. Foot problems can be more serious in people with diabetes.

• the pain is severe or stopping you doing normal activities

• the pain is getting worse or keeps coming back

• it has not improved after treating it yourself for 2 weeks

• you have any tingling or loss of feeling in your foot

• you have diabetes and foot pain

The sources read for this guide describe plantar fasciitis mainly as a condition of adults, most often between 40 and 60. They do not give separate advice for children or for pregnancy. If a child or someone who is pregnant has persistent heel pain, ask a GP, because other causes may need to be considered.

The NHS says that in many areas you can refer yourself to community musculoskeletal (MSK) services for help such as physiotherapy without a GP referral. It also says physiotherapy is free on the NHS across the UK, but waiting times can sometimes be long, and that podiatry may not be free everywhere.

You can also pay to see a podiatrist or physiotherapist privately, and the NHS suggests using a registered podiatrist. Whichever route you choose, ask what the plan is if the heel pain does not improve.