Plantar Heel Pain
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Plantar heel pain is pain under the heel that comes on gradually and may spread into the arch. It involves the plantar fascia, a strong band of tissue that runs from your heel bone to your toes. It is the most common soft tissue foot complaint, affecting about 1 in 10 adults at some point. The pain is typically worst with your first steps after getting out of bed or after resting. Simple steps such as stretching, supportive shoes and easing off the activities that aggravate it are the place to start, and your podiatrist can guide you from there.
What is it?
Plantar heel pain is pain under the heel that comes on slowly. It can spread along the inner side of your arch. It involves the plantar fascia, a strong band of tissue that runs from your heel bone to your toes.
It is the most common soft tissue foot complaint. You may hear it called plantar fasciitis, plantar fasciopathy or heel spur syndrome. These names all describe the same problem. Some practitioners prefer plantar fasciopathy because the condition is often wrongly thought of as mainly inflammation.
Who does it affect?
About 1 in 10 adults get plantar heel pain at some point in their lives. It is most common between 40 and 60 years of age, but it can happen at any age, even in childhood. Women are twice as likely as men to get it.
It is common in runners, with 5.2 to 17.5 per cent of active runners affected. It also affects people who aren't active. In adults aged 65 or older, about 6.9 per cent have pain and tenderness on the plantar fascia.
Signs and symptoms
The main symptom is pain on the underside of your heel. There is usually one tender spot, often towards the inner side. The pain is often described as stabbing.
It is typically worst with your first steps after getting out of bed, or when you put weight on the foot after a period of rest. It often eases after a few minutes of walking. For many people it builds up again later in the day, or after long periods of standing or walking.
What causes it?
The exact cause isn't clear, and it is likely to be a mix of things. It is generally seen as a problem of load. Small tears build up in the plantar fascia faster than your body can heal them. The fascia then thickens and becomes painful.
Several things are linked with a higher risk:
- higher body weight
- tight calf muscles or limited ankle movement
- long periods of standing, walking or running
- very flat feet or very high arches
- weak foot or leg muscles
- unsupportive shoes
The links with many of these are slight, so having one doesn't mean you will get heel pain. Stress, anxiety and low mood have only a very small link with it.
How is it diagnosed?
Your podiatrist can usually diagnose it from your story and an examination. They will want to know when the pain is worst, exactly where it is, and what changed before it started, such as your activity, shoes or work. It helps to think about these before your visit. Scans usually aren't needed when the picture is typical.
An ultrasound can help confirm the diagnosis by showing a thickened plantar fascia. An X-ray is used if the pain began with an injury, is much worse than expected, or isn't responding to treatment. An MRI may be considered if the pain drags on despite treatment or if another cause is suspected.
Your practitioner will also check for other causes of heel pain. These include a stress injury of the heel bone, a nerve problem in the lower back that sends pain and numbness down to the heel, and nerve problems in the foot such as tarsal tunnel syndrome, which can cause numbness or tingling. Pain in the heel fat pad (the cushion of tissue under the heel) is another possibility. About 4.2 per cent of adults aged 65 or older have this.
Treatment
Care usually starts with understanding what is going on, then simple steps you can do yourself.
Looking after it at home
Use pain as your guide. If your foot is sore, rest it, and avoid running and long periods of walking or standing for a while. The fascia heals slowly.
These steps can also help:
- Wrap an ice pack in a towel and hold it on your heel for up to 20 minutes, every 2 to 3 hours.
- Wear wide, comfortable shoes with a low heel and a soft sole.
- Try soft insoles or heel pads in your shoes.
- Do gentle stretches for your foot and calf.
- Paracetamol or ibuprofen gel can ease pain. Ibuprofen tablets can be used if needed.
Treatment from your podiatrist
Your podiatrist or physiotherapist can show you how to stretch the plantar fascia and your calf, and set up a graded exercise program (one that builds up gradually). For recent heel pain, stretching as the first treatment has improved pain and function more than shockwave therapy at 2 and 4 months. Exercise on its own may not give a clear benefit in the first weeks, but it helps pain and function over the longer term. People respond differently, so your program may need adjusting.
Hands-on treatment (manual therapy) has also improved pain and function more than comparison treatments.
Orthoses (shoe inserts made to support your foot) have not been found to work better than fake inserts or other simple treatments. On their own they weren't effective, but they mostly worked when combined with shockwave therapy. Ask your podiatrist whether they are worth trying for you.
Other options
If simple care hasn't been enough, your podiatrist or GP may suggest other treatments. It is worth asking about the expected benefit, the risks and the alternatives before you agree to any of them.
Shockwave therapy uses pulses of sound waves on the heel. It is among the treatments most likely to help, although no commonly used treatment has been shown to be better than another. During treatment it commonly causes pressure, discomfort and pain in the area. Afterwards you may have short-term pain, changed feeling, swelling or bruising, and sometimes a severe headache. No long-term problems are expected, but higher doses can be harder to put up with.
A corticosteroid injection (a steroid injected near the sore spot) has only a modest effect overall. Possible harms include more pain after the injection, thinning of the heel's fat pad, nerve injury, rupture of the plantar fascia and infection. Some guidance advises against using it as a first or second step, because the long-term benefit is limited.
Recovery
Plantar heel pain can take a while to settle. How long it takes isn't clear yet, and it differs from person to person.
Women and people with pain in both heels tend to have a harder time recovering. Keep going with your stretches and exercises, supportive footwear and activity changes, and be patient with the process.
Preventing it
It isn't yet clear which steps stop plantar heel pain coming back or starting in the first place. Some sensible habits are still worth keeping up, because they ease the load on your heel.
Continue your stretches once the pain settles, and keep wearing supportive, cushioned, low-heeled shoes rather than going barefoot on hard floors. If your work or sport involves a lot of standing, walking or running, build up gradually rather than suddenly. If your calves feel tight, ask your podiatrist or physiotherapist about improving their flexibility.
When to see a podiatrist
Book an appointment if
Your heel pain hasn't improved after 2 weeks of home care, hasn't improved within 6 to 8 weeks, has lasted more than three months, is getting worse or keeps coming back, or is severe. Book an appointment with your podiatrist.
Seek prompt assessment if
Go to the nearest emergency department if your foot or ankle looks out of shape or sits at an odd angle after an injury.
See your GP or another doctor today, without delay, if:
- you have severe pain after an injury
- you heard or felt a snap, grinding or popping at the time of an injury
- you can't move your ankle or foot
- you feel sudden pain in your calf or heel while exercising
- you think you may have broken your heel bone
These can be signs of a broken bone or a ruptured (torn) Achilles tendon, so don't try to treat it yourself. If your GP can't see you today, go to an urgent care clinic or an after-hours GP.
If you have a skin sore, discolouration or signs of infection on your foot and you also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, this could be sepsis: call your local emergency number.
See your GP soon if:
- pain wakes you or keeps you awake at night
- you have a fever, night sweats or weight loss along with the heel pain
- you have a skin rash, discolouration, a sore or signs of infection on your foot
- you notice numbness, tingling, weakness, frequent tripping or a change in the shape of your foot
- pain and numbness travel from your lower back to your heel
- the pain is much worse than you would expect, or isn't responding to treatment
If you have diabetes, see your podiatrist or GP soon about any heel pain, because foot problems can be more serious.
Frequently asked questions
Is a heel spur causing my pain?
Probably not. People with heel pain are almost 5 times more likely to have a heel spur (a small bony growth) on an X-ray, but a spur is unlikely to be the cause of the pain. Many people have a spur without any symptoms, and having one doesn't make your outlook worse.
Does losing weight help heel pain?
Extra weight adds strain to the plantar fascia, and higher body weight is a commonly reported risk factor. Health advice is to lose weight if you are overweight as part of looking after your heel. Ask your GP or another health professional about gradual, sustainable weight management.
Can stress or low mood cause heel pain?
Not in any way that matters much. Depression, anxiety and stress have only a very small link with heel pain, and job dissatisfaction a similar small one. Heel pain is mainly a problem of load on the plantar fascia. Look after your stress and mood for their own sake.