Heel Pain and Plantar Fasciitis: The Exercises That Help and How Long It Lasts
A stabbing pain under the heel with the first steps out of bed, easing after a few minutes and coming back after a long day on your feet — that is plantar fasciitis, the most common cause of heel pain. It can be stubborn. Here is what causes it, the exercise programme that worked best in a trial, what insoles and injections actually do, and how long it takes.
By Taha Raza
Published
The plantar fascia is a thick band of tissue running from the heel bone to the toes, supporting the arch. When it is overloaded — more weight, more standing, more walking or running than it is used to — the point where it attaches to the heel becomes painful and thickened. Despite the name, it is more a problem of an overloaded, irritated tissue than of inflammation, which is why loading it gradually works better than resting it completely.
What does plantar fasciitis feel like?
- Sharp or stabbing pain under the heel, often towards the inner side.
- Worst with the first steps in the morning or after sitting for a while; eases after a few minutes of walking.
- Aches again after long periods of standing or walking, or the day after more exercise than usual.
- Usually starts gradually, without a single injury.
What causes heel pain?
A 2003 study in the Journal of Bone and Joint Surgery compared 50 people with plantar fasciitis with 100 people without it, matched for age and sex. Three things stood out. A stiff ankle was the biggest: people who could not bend the foot upwards past neutral had 23 times the odds of those with good ankle movement, although with a very wide margin of error. A BMI over 30 gave 5.6 times the odds, and spending most of the workday on your feet gave 3.6 times. In Pakistan, add long hours standing at a shop counter, in a kitchen or in a classroom, walking barefoot on marble and tile floors at home, flat chappals with no support, and a sudden jump in walking — such as starting 10,000 steps a day overnight.
What is the best exercise for plantar fasciitis?
Strengthening. In a 2015 Danish trial, 48 people with plantar fasciitis confirmed on ultrasound all got shoe inserts, then either did daily plantar fascia stretching or a high-load strength exercise every other day: single-leg heel raises with a rolled towel under the toes. At 3 months, the strength group's foot function score was 29 points better on a 100-point scale. By 6 and 12 months, both groups had improved and were similar — so strength training seems to get people better faster, and stretching is still reasonable. A simple plan:
| Exercise | How | Dose |
|---|---|---|
| Single-leg heel raise, towel under toes | Stand on a step on the painful foot, a rolled towel under the toes, hold a rail. Rise slowly (about 3 s), hold 2 s, lower slowly (about 3 s) | Weeks 1–2: 3 × 12. Then add a backpack with books: 3 × 10, then 4 × 8 as it gets easier |
| Calf stretch, knee straight | Hands on a wall, painful leg behind, heel down, lean forward | 3 × 30 s, daily |
| Calf stretch, knee bent | Same position, bend the back knee to stretch lower down | 3 × 30 s, daily |
| Plantar fascia stretch | Sitting, cross the foot over the other knee and pull the toes back until you feel a stretch in the arch | 10 × 10 s, before getting out of bed and after long sitting |
Pain during the exercise of up to about 3–4 out of 10 is acceptable if it settles within a few hours and is no worse the next morning. If the morning pain is clearly worse, drop back a step for a week.
Do insoles, special shoes or night splints help?
Insoles help a little, briefly. In a 2006 trial of 135 people, prefabricated firm insoles and expensive custom-made ones gave small improvements in function at 3 months compared with soft sham insoles, and slightly less pain that fell short of statistical significance — but no long-term benefit at 12 months, and custom insoles were no better than off-the-shelf ones. Practical footwear matters more day to day: cushioned shoes with some arch support, and slippers with a firm sole at home rather than walking barefoot on hard floors. If you stand all day for work, a cushioned mat and a short sitting break every hour help.
Should I get a steroid injection for heel pain?
Usually not as a first step. A 2017 Cochrane review of 39 trials (2,492 adults) found a steroid injection may reduce heel pain slightly for less than a month — about 6 points on a 100-point scale — but made no difference between 1 and 6 months. Across the trials that reported side effects, there were 2 ruptures of the plantar fascia and 3 injection-site infections among 699 people injected. An injection can be reasonable to calm severe pain while you start the exercise programme, but it does not fix the problem.
How long does plantar fasciitis take to heal?
Longer than most people expect. A Danish study followed 174 patients diagnosed by ultrasound at a hospital clinic for an average of almost 10 years. The risk of still having symptoms was 80.5 percent one year after pain began, 50 percent at 5 years and 45.6 percent at 10 years. Women and people with pain in both heels took longer. These were hospital-referred patients, so likely the more stubborn cases. Two reassuring findings: neither the thickness of the fascia nor a heel spur on the scan predicted who got better, and fat-pad thickness was no different in those who had had a steroid injection.
Can I keep training with plantar fasciitis?
Yes — but swap the exercises that hammer the heel. Cut back running, jumping, skipping and long walks on hard ground for a few weeks; use cycling, swimming, rowing and upper-body and seated leg training instead. Keep up strength training for the rest of the body. If you carry extra weight, losing some reduces the load on the heel with every step. Build walking and running back gradually once morning pain is mild — see our beginner running guide for a run-walk plan.
When to see a doctor
- Heel pain after a fall, a jump or a sudden snap or pop, or you cannot put weight on the foot.
- Swelling, redness and warmth, or pain with fever.
- Numbness, tingling or burning in the foot, which can point to a nerve problem.
- You have diabetes and new foot pain, a wound or a change in colour — see a doctor promptly.
- Pain in both heels together with pain or swelling in other joints or the lower back.
- No improvement after about 3 months of consistent exercise and footwear changes.
This article is general information, not medical advice. Get persistent heel pain assessed by a doctor or physiotherapist, and seek prompt care for foot problems if you have diabetes.
Frequently Asked Questions
What is the fastest way to heal plantar fasciitis?
Start a progressive strengthening exercise early. In a 2015 trial, single-leg heel raises with a towel under the toes every other day improved pain and function more than stretching at 3 months. Add supportive footwear and cut back on running and long walks for a few weeks.
Should I walk barefoot with plantar fasciitis?
Avoid walking barefoot on hard floors such as marble or tile while the heel is painful. Wear cushioned shoes or slippers with a firm sole at home, especially for the first steps in the morning.
Can I still walk or run with plantar fasciitis?
Short, comfortable walks are fine, but cut back long walks and running for a few weeks and use cycling or swimming instead. Return gradually once morning pain is mild, using a run-walk plan.
Is a heel spur the cause of my pain?
Not necessarily. In a long-term Danish study of 174 patients, having a heel spur at diagnosis did not affect who recovered, and the treatment is the same either way.
Do insoles help plantar fasciitis?
A little, for a short time. In a 2006 trial, firm prefabricated and custom insoles gave small improvements at 3 months but no long-term benefit over sham insoles, and custom insoles were no better than off-the-shelf ones.
How long does plantar fasciitis last?
It can last months or years. In a Danish study of hospital patients, 80.5 percent still had symptoms a year after onset and about half at five years, so it pays to start the right exercises early rather than waiting.
Sources
- Rathleff MS et al. High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12-month follow-up. Scandinavian Journal of Medicine & Science in Sports, 2015
- Riddle DL et al. Risk factors for plantar fasciitis: a matched case-control study. Journal of Bone and Joint Surgery (American), 2003
- Landorf KB et al. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Archives of Internal Medicine, 2006
- David JA et al. Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database of Systematic Reviews, 2017
- Hansen L et al. Long-term prognosis of plantar fasciitis: a 5- to 15-year follow-up study of 174 patients with ultrasound examination. Orthopaedic Journal of Sports Medicine, 2018
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