Plantar fasciitis and heel pain: what works, what doesn’t, and how long it takes

You get out of bed, put your foot on the floor and feel a sharp stab in your heel. After a few minutes of walking it eases, then comes back if you stand or walk for a long time. That pattern is typical of plantar fasciitis, irritation of the thick band of tissue along the bottom of the foot [13].

It is a common problem. Between 1995 and 2000, it accounted for about 1 million patient visits a year in the US [1]. It occurs most often between the ages of 40 and 60 [4].

• Age 18–440.53%
• Age 45–641.33%
• BMI under 250.29%
• Obesity1.48%

Source: Nahin, The Journal of Pain, 2018 [2]. 2013 survey; bars are scaled to 1.5%.

Why it happens

The physical therapy guideline lists four main risk factors: limited ankle flexibility, a higher body weight in non-athletes, running, and work that keeps you on your feet, especially on surfaces with poor shock absorption [4]. In one small case-control study, reduced ankle flexibility appeared to be the most important of these [3].

A common myth is that a heel spur is to blame. Most people with heel spurs do not have heel pain, and the American Academy of Orthopaedic Surgeons says spurs do not cause plantar fasciitis pain [5]. If your history and exam fit, imaging is usually not needed unless conservative care fails [4].

What the guideline recommends

The American Physical Therapy Association’s orthopedic section updated its heel pain guideline in 2023 [4]:

Treatment	Guideline position	Strength of evidence
Hands-on therapy for the joints and soft tissues of the leg and foot	Recommended	Strong
Plantar fascia and calf stretching	Recommended	Strong
Foot taping, alongside other treatment	Recommended for short-term relief	Strong
Night splints for 1 to 3 months, if first-step pain is consistent	Recommended	Strong
Resistance exercise for the foot and ankle	Recommended	Moderate
Dry needling	Recommended	Moderate
Insoles or orthotics on their own for short-term relief	Not recommended	Moderate
Insoles or orthotics combined with other treatment	May be used	Weak
Ultrasound added to stretching	Not recommended	Strong

Source: Koc et al., JOSPT, 2023 [4]. Selection of the recommendations.

A 2021 best-practice guide built from 51 trials plus expert and patient input reaches a similar conclusion: core treatment should include taping, stretching and individualized education [12].

What the trials add

The research is less tidy than a table suggests, so it helps to know the details:

• Stretching: in a trial of people with long-standing heel pain, a stretch aimed at the plantar fascia beat an Achilles stretch after 8 weeks for first-step pain [7]. But in a separate trial, two weeks of calf stretching alone gave no significant benefit [8], so a very short effort may not be enough.
• Strength training: in a small trial of 48 people, slow, heavy heel raises gave better results than stretching at 3 months, though the two groups were the same at 6 and 12 months [9]. It may simply speed things up.
• Orthotics: a review of 19 trials found that custom and prefabricated insoles performed about the same at every time point, and any benefit over a sham insole was small [10]. In other words, there is little reason to start with expensive custom orthotics.
• Steroid injections: a Cochrane review found they may slightly reduce heel pain for up to a month, but not after that [11]. Injections can also weaken the fascia and lead to a rupture [5].
• Shockwave therapy: results are mixed, and it is sometimes tried for stubborn cases before considering surgery [5] [12].

How long does it take?

Patience matters here. The American Academy of Orthopaedic Surgeons says more than 90% of patients improve within 10 months of starting simple treatment [5]. Surgery is generally saved for people who have not improved after 12 months of nonsurgical treatment [5].

Not everyone recovers quickly, though. In a Danish study of patients with severe cases treated at one clinic, 46% still had symptoms at follow-up 5 to 15 years later. The authors noted that these patients were not representative of everyone with the condition [6]. That is one more reason to deal with heel pain early instead of waiting.

What you can do at home

The NHS suggests [13]:

• Wear shoes with cushioned heels and good arch support, and use insoles or heel pads if they help
• Do gentle stretches for the sole of your foot and your heel regularly
• Use an ice pack wrapped in a towel on the sore area for up to 20 minutes every 2 to 3 hours
• Avoid long periods of walking or standing, and try exercise that takes pressure off your feet, such as swimming
• Avoid high heels, flip-flops and walking barefoot on hard surfaces
• Lose weight if you are overweight

When to get checked

See a doctor or physical therapist if the pain has not improved after 2 weeks of home care, is severe, keeps coming back, stops you doing normal activities, or if you have tingling or loss of feeling in your foot. If you have diabetes, get any heel pain checked, because foot problems can be more serious [14].

Get urgent care if you have severe heel pain after an injury, heard a snap or pop when it happened, cannot walk or stand on tiptoe, your foot or ankle has changed shape, or you have swelling and bruising in your calf and ankle. These can be signs of a fracture or a torn Achilles tendon [14].

The takeaway

• Sharp heel pain with your first morning steps is the classic sign of plantar fasciitis.
• Stretching, hands-on therapy, taping and strengthening have the best support, and insoles work best as part of a wider plan.
• Custom orthotics have not been shown to beat prefabricated ones, and steroid injections offer only short-term relief.
• Most people get better with simple treatment, but it can take months.

You can start physical therapy in Utah without a referral. If heel pain is keeping you off your feet, an evaluation can confirm the cause and get you on the right plan.