What is Plantar Fasciitis?
Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue — the plantar fascia — that runs across the bottom of your foot, connecting your heel bone to your toes. The condition causes sharp, stabbing pain that is usually worst with the first few steps in the morning or after sitting for a long time.
Causes and Risk Factors
Plantar fasciitis is caused by excessive strain or repetitive stress on the plantar fascia, leading to small tears and inflammation. Risk factors include:
- Being overweight — extra weight puts more stress on the plantar fascia
- Occupation — jobs that involve standing for long periods on hard floors
- Certain types of exercise — running, dancing, and other high-impact activities
- Foot mechanics — having flat feet, a high arch, or an abnormal walking pattern
- Age — the condition is most common between 40 and 60
- Wearing shoes with poor arch support or thin soles
Symptoms
The hallmark symptom is a stabbing pain near the heel, usually on the bottom of the foot. This pain is typically worst after long periods of rest (such as first thing in the morning) and may improve with activity, but often returns after prolonged standing or exercise. Some people also experience:
- Stiffness in the heel and arch
- Swelling around the heel
- Pain that is worse after (not during) exercise
Treatment
Most cases of plantar fasciitis improve with conservative treatments over several months:
- Rest — reduce or modify activities that cause pain
- Ice — apply ice to the affected area for 15–20 minutes several times daily
- Stretching exercises — calf stretches and plantar fascia stretches
- Supportive footwear — shoes with good arch support and cushioning
- Orthotics — shoe inserts to distribute pressure more evenly
- Pain relief — NSAIDs such as ibuprofen or naproxen
- Physiotherapy
- Night splints
- Corticosteroid injections — for persistent cases
Recovery
With proper treatment, most people recover fully from plantar fasciitis, although it can take several months. Surgery is rarely needed and is only considered when other treatments have failed. Maintaining a healthy weight, wearing supportive shoes, and doing regular stretching exercises can help prevent recurrence.
Why the first steps hurt most
The plantar fascia is a thick band of tissue running from the heel to the toes that supports the arch. When it is overloaded, it becomes irritated where it attaches to the heel bone. Overnight or after sitting, it tightens, so the first steps stretch it suddenly and cause that sharp, stabbing pain. It often eases as you walk, then builds up again after long periods on your feet.
Self-help: what to try first
Most people improve with simple measures, although it can take several months. Being consistent matters more than any single treatment.
- Wear supportive, cushioned shoes with a slightly raised heel, and avoid walking barefoot or in flat, thin-soled shoes, especially first thing.
- Try off-the-shelf heel cups or arch-support insoles from a pharmacy or sports shop.
- Stretch your calf and the sole of your foot several times a day, particularly before getting out of bed.
- Roll the sole of your foot over a cold bottle or a massage ball for a few minutes.
- Reduce high-impact activity, such as running or long walks on hard ground, for a while. Swap to cycling or swimming to stay active.
- If you are carrying extra weight, losing some can reduce the load on your heels.
- Simple painkillers or anti-inflammatory gel may help in the short term; ask your pharmacist.
Strengthening exercises
Once the worst pain settles, strengthening can help. Heel raises on a step, done slowly with a towel rolled under the toes, are commonly used to load the plantar fascia gradually. Calf and foot strengthening builds resilience. A physiotherapist or podiatrist can show you how to progress safely.
Seeing a podiatrist or physiotherapist
If heel pain has not improved after a few weeks of self-help, a podiatrist or physiotherapist can assess your feet, walking pattern and footwear, and suggest insoles, taping or a tailored exercise plan. Night splints, which hold the foot in a gentle stretch overnight, help some people. Many areas allow self-referral to NHS musculoskeletal services.
Injections and shockwave therapy
For stubborn heel pain lasting many months, other treatments may be considered. A steroid injection can reduce pain in the short term, but it carries risks such as thinning of the heel fat pad or, rarely, rupture of the fascia, so it is used with care. Extracorporeal shockwave therapy, where sound waves are directed at the heel, is available in some NHS and private clinics under NICE guidance for plantar fasciitis. Surgery is rarely needed.
When heel pain may be something else
Heel pain can occasionally be linked to inflammatory arthritis, especially psoriatic arthritis and axial spondyloarthritis, where the tendon attachments become inflamed. Consider this if you also have back pain and stiffness, swollen joints, psoriasis or inflammatory bowel disease. See your GP if heel pain is present in both feet with no obvious cause, if the heel is hot and swollen, if you have numbness or tingling in the foot, or if pain started after an injury and you cannot put weight on the foot.
About this page
Written by Louis Maxwell, First Contact Practitioner (HCPC PH128483), and pending clinical review. This is general information, not a diagnosis. Always follow the advice of your own GP, physiotherapist or rheumatology team. For emergencies call 999; for urgent advice use NHS 111.