Plantar heel pain: causes, symptoms and treatment

If you experience a sharp heel pain with your first steps in the morning that eases as you move, only to worsen again by the end of the day, you’re not alone. This is a classic presentation of plantar heel pain, previously known as plantar fasciitis.

Plantar heel pain affects up to 10% of people during their lifetime, with over 50% of people still struggling with it 10 years later. Despite being common, it’s often misunderstood.

Who gets plantar heel pain?

Plantar heel pain can affect anyone, but these are some things that put you more at risk:

• Jobs with a lot of standing
• Flat feet
• High arches
• Increased weight

Runners are also at high risk:

• 8% of all running injuries are due to plantar heel pain
• Risk increases with distance run!

What is plantar heel pain?

The plantar fascia is a thick band of connective tissue that runs under the foot from the heel to the toes. It supports the foot arch and absorbs forces during walking and running. When the weight or repetition becomes too much for the plantar fascia, it gets irritated and we feel that as heel pain.

The old name “plantar fasciitis” indicates inflammation. However this condition is more accurately described as a degenerative and overload-related problem, so many professionals now prefer the terms plantar fasciopathy or plantar heel pain (PHP).

Common symptoms

• Painful first steps in the morning
• Painful walking after resting
• Improves with movement
• Worse later in the day
• Pain with prolonged standing, walking, or running
• Tenderness on the heel

Heel spurs are often seen on imaging, but they are not the cause of pain and are frequently found in people without symptoms.

How is it diagnosed?

Plantar heel pain is usually diagnosed based on:

• Your symptoms
• Clinical examination
• Pain location and load sensitivity

Ultrasound imaging may show thickening of the plantar fascia, but imaging is not routinely required, as it rarely changes management.

Anti-inflammatory medication (NSAIDs)

Current evidence suggests NSAIDs are one of the least effective treatment options for plantar heel pain:

• Inflammation is not the main cause of plantar heel pain
• Does not address load tolerance, biomechanics, or tissue capacity
• Does not improve long-term outcomes

While NSAIDs may offer temporary symptom relief for some people, they should not be relied upon as a primary treatment. Active, movement-based care is consistently shown to produce better results.

The evidence for stretching

Strong evidence supports the use of plantar fascia-specific stretching and calf (gastrocnemius and soleus) stretching to reduce pain and improve function.

• Plantar fascia stretching targets the tissue directly
• Calf stretching helps reduce strain on the plantar fascia by improving ankle movement
• Combining both approaches has been shown to provide the best outcomes

Stretching is effective in both the short and long term, with benefits lasting from weeks to months.

Building strength

Modern rehabilitation focuses on gradually increasing the foot’s ability to tolerate load, rather than complete rest.

This may include:

• Intrinsic foot muscle strengthening
• Progressive calf loading
• Modified loading programs (such as the Rathleff-inspired approach)
• Advice on activity modification rather than stopping activity entirely

Osteopathic treatment

At Health Within Osteopathy we use various techniques to support the foot and plantar fascia. Our focus is never just on the foot and we also look at the ankle, knee, hip and spine as we know this degenerative overload of the fascia often occurs alongside changes in other parts of the body. Studies also support specific osteopathic techniques for plantar heel pain. A randomised controlled trial found that muscle energy techniques combined with conventional care led to:

• Greater pain reduction
• Improved ankle dorsiflexion
• Better overall foot function

At our clinic, osteopathic treatment may include:

• Manual therapy that incorporates cranial osteopathy and balancing tension in the foot, ankle, and calf to support circulation and healing
• Joint mobilisation of the subtalar joint and ankle. We commonly use traction to improve mobility of the ankle.
• Muscle energy techniques to the calf muscle
• Whole body assessment (foot, ankle, knee, hip, pelvis as well as the back)

This approach helps reduce strain on the plantar fascia and supports more effective long lasting rehabilitation.

We take an evidence-based, whole-person approach using gentle osteopathic techniques to focus on restoring the lost mobility in the foot and ankle. This reduces the strain from over tight muscles, compressed joints, and overloaded fascia, making sure the whole body is functioning well to support the foot.

We also create rehabilitation exercise programs to help with load on the plantar fascia, incorporating taping and orthotics when needed. At Health Within Osteopathy we know how important feet are for movement and health and our holistic approach can bring faster changes to the compromised heel that tend to ensure it does not return.

Taping

As part of our holistic care for plantar heel pain we also offer foot taping, which can provide:

• Short-term pain relief
• Improved function
• Temporary mechanical support

Taping is most effective when used alongside exercise and manual therapy, rather than on its own. Studies suggest teardrop taping might be the most effective approach.

Foot orthotics

We offer Prokinetics foot orthotics. Prokinetics can be useful as part of a combined treatment plan, particularly when they reduce strain and improve comfort. Orthotics work best when combined with stretching, strengthening, and education.

Key information

• Plantar heel pain is common and treatable
• Stretching and strengthening are essential
• Manual therapy improves outcomes
• Recovery is about progressive loading and movement
• The sooner you seek treatment the better the outcome

References

1. Martin RL et al. Heel Pain—Plantar Fasciitis Revision 2023 Clinical Practice Guidelines. JOSPT. 2023.
2. Rathleff MS et al. High-load strength training improves outcome in plantar fasciitis. Scand J Med Sci Sports.
3. Tanwar A et al. Effectiveness of Muscle Energy Technique in Plantar Fasciitis.
4. Guimarães LH et al. Stretching interventions for plantar fasciitis: Systematic review and meta-analysis.
5. UK Healthcare Professional Survey on Plantar Heel Pain Management. PMCID: PMC12515048