Plantar heel pain

What is plantar heel pain, and how common is it?

Plantar heel pain is pain under the heel that comes on gradually and may spread into the arch of your foot¹. It involves the plantar fascia (a strong band of tissue running from your heel to your toes)². You may also hear it called plantar fasciitis or, in clinical terms, plantar fasciopathy. It's often wrongly described as an inflammatory condition³.

It's very common: about 1 in 10 adults get it at some point¹. It's most often seen between about 40 and 60 years of age, but it can happen at any age².

What causes it, and who gets it?

The exact cause isn't clear, and it's likely to be a mix of things¹. A common view is that small tears build up in the plantar fascia faster than your body can repair them, so it thickens and becomes sore².

Higher body weight, tight calf muscles or limited ankle movement, and long periods of standing or walking are the factors named most often⁴. It's common in runners but also affects people who aren't active⁴. The evidence behind each of these is slight⁵, so they're clues rather than certainties.

If your work or sport involves a lot of standing, walking or running, try building up gradually rather than suddenly.

What does it feel like, and how is it diagnosed?

The main sign is pain under the heel, often at one tender spot⁶. It's usually worst with your first steps after getting out of bed or after resting, and it usually eases after a few minutes of walking⁶⁷.

A podiatrist or doctor can usually diagnose it from your story and an examination⁸. Before an appointment, it helps to note when the pain is worst, exactly where it is, and what changed beforehand, such as activity, footwear or work.

Sometimes the picture doesn't fit. Numbness or tingling in the foot can point to a nerve problem such as tarsal tunnel syndrome⁹, and a stress injury of the heel bone or a nerve problem from the lower back can also feel similar⁸. If your pain seems atypical, a clinician can look for these causes.

What helps first?

Self-care is the first step, and you can start most of it yourself. Care recommended for everyone starts with understanding the problem, easing back on what aggravates it, pain relief, ice, stretching and better footwear⁸.

• Ease back. Use pain as your guide. If your foot is sore, rest it, and avoid running or lots of walking and standing⁶.
• Stretch. For recent-onset plantar fasciitis, starting with plantar fascia stretching improved pain and function more than shockwave therapy⁸.
• Choose supportive shoes. Wide, comfortable shoes with a low heel and soft sole, with soft insoles or heel pads, can help¹⁰.
• Use ice. Wrap an ice pack in a towel and place it on your heel for up to 20 minutes every 2 to 3 hours¹⁰.
• Ask about pain relief. A pharmacist can advise on options such as paracetamol¹⁰.

Rehabilitation, advice and exercise together are considered the most effective way to manage it¹¹. Exercise alone wasn't consistently helpful in the short term, but it did help pain and function over the long term¹. Orthoses (shoe inserts) didn't work better than fake inserts or other simple care¹², so they aren't a must-have first step.

What helps if that isn't enough?

If home care isn't helping, a GP, podiatrist or physiotherapist can confirm the diagnosis and talk through options.

Corticosteroid injections and shockwave therapy (sound waves through the skin) were ranked among the treatments most likely to help, but no commonly used treatment was shown to be better than the others¹. Injections have only a modest effect, and can increase pain, thin the heel's fat pad, injure a nerve or rupture the plantar fascia¹. They're not advised as an early step¹³. Shockwave therapy can be uncomfortable, and temporary pain, altered feeling, swelling and bruising can follow¹⁴. Orthoses mostly helped when combined with shockwave therapy¹.

Before agreeing to either, ask about the expected benefit, the risks and the alternatives.

How long does it take to get better, and how can I stop it coming back?

It isn't clear yet how long recovery usually takes, so give each step a fair go rather than expecting a quick change. In long-term follow-up, women and people with pain in both heels had a worse outlook⁵.

Once the pain settles, it's sensible to keep up gentle stretching and supportive footwear, and to build activity back up gradually. Whether these stop the pain coming back isn't clear yet. If you're not improving, go back to your GP, podiatrist or physiotherapist rather than waiting it out.