Key takeaways
- Most cases improve within weeks to months with non-surgical treatment.
- Reduce aggravating activity, stretch, and wear supportive footwear as a starting point.
- Shockwave therapy, injections, and other options are considered if symptoms persist.
- Surgery is reserved for the few cases that don’t respond to conservative care.
Plantar fasciitis treatment usually starts with simple, non-surgical steps. These can include reducing aggravating activity, calf and plantar fascia stretching, and wearing supportive footwear. Most people will improve within weeks to months. Shockwave therapy and injections might be considered if symptoms persist, and surgery is reserved for the small number of cases that do not respond to conservative care.
This guide covers what plantar fasciitis is, why it happens, and the full range of treatment options, from home exercises through to surgery. For the wider range of conditions Mr Francesc Malagelada treats in London, see our foot and ankle treatments page. You can also read more about Mr Malagelada, a consultant orthopaedic surgeon who specialises exclusively in the foot and ankle.
What Is Plantar Fasciitis?
The plantar fascia is a strong band of connective tissue. It runs from the heel bone along the sole of the foot to the base of the toes. Its job is to support the arch and absorb load with every step.
Plantar fasciitis describes irritation of this tissue, usually where it attaches to the heel. Clinicians often use the term plantar fasciopathy, since the changes can reflect wear and thickening rather than classic inflammation. Both terms describe the same condition.
Pain is usually felt under the heel, sometimes spreading along the arch, and is often worse after rest when you put weight through the foot.
What Does Plantar Fasciitis Feel Like?
Plantar fasciitis has a fairly recognisable pattern. You may notice:
- Pain underneath the heel
- Pain along the arch of the foot
- Sharp pain with your first steps in the morning
- Pain after sitting or resting
- Tenderness when the heel is pressed
- Pain after long periods of standing or walking
- Stiffness in the sole
First-step pain happens because the plantar fascia tightens during rest, so the first steps after waking stretch it again suddenly. This can cause a sharp pain that usually eases after a few minutes.
What Causes Plantar Fasciitis?
There is often no single, obvious cause. Instead, a combination of factors can increase the load on the plantar fascia until it becomes irritated. These are associated risk factors rather than direct causes, and many people develop plantar fasciitis without any of them being obviously present.
| Risk factor | Potential relevance |
|---|---|
| Sudden increase in activity | Increased load on the fascia |
| Running or repetitive impact | Repeated loading of the tissue |
| Tight calf muscles | Affects ankle and foot mechanics |
| High arches | Altered load distribution |
| Higher body weight | Increased mechanical loading |
| Change of footwear | May change foot loading |
How Is Plantar Fasciitis Diagnosed?
Plantar fasciitis is usually diagnosed clinically, based on your symptoms and a foot examination. This includes checking for calf tightness and any recent changes in footwear or activity.
Doctors may also rule out other conditions that cause similar heel pain, including a calcaneal stress fracture (a stress fracture of the heel bone), tarsal tunnel syndrome (a trapped nerve at the ankle), and Baxter’s nerve entrapment (a trapped nerve near the heel).
How Is Plantar Fasciitis Treated?
Most people with plantar fasciitis improve with non-surgical treatment, though the pace of recovery varies. Treatment follows this progression, covered in turn below:
- Reducing aggravating load on the foot
- Exercise and physiotherapy
- Supportive footwear and insoles
- Additional treatments, such as shockwave therapy or injections, if needed
- Surgery, for a small number of persistent cases
Persistent heel pain that is not settling?
If your heel pain has lasted more than a few weeks despite rest and stretching, Mr Francesc Malagelada can assess your foot and confirm the right next step, from physiotherapy to shockwave therapy or, if appropriate, surgery. Appointments are available at short notice, with no General Practitioner (GP) referral required.
Non-Surgical Treatment for Plantar Fasciitis
Physiotherapy
A tailored physiotherapy programme is usually the first step. This focuses on calf flexibility, plantar fascia stretching, strengthening the calf and foot muscles, and gradually increasing load as your symptoms allow.
Stretching
Calf stretch: stand facing a wall, step one foot back, keep the heel down and lean forward gently until you feel a stretch in the calf. Hold it for 30 seconds and repeat three times, twice a day.
Plantar fascia stretch: sit down, cross the affected foot over the other knee, and pull the toes back towards the shin until you feel a stretch along the arch. Hold it for 15 to 20 seconds and repeat ten times.
If a stretch causes sharp pain rather than a mild pulling sensation, ease off and use a gentler range of movement.
Strengthening
Once stretching feels manageable, strengthening exercises can help the foot tolerate load over the longer term. These include calf raises (progressing from both feet to one foot), towel scrunches, or picking up small objects with your toes. Gradually increasing standing or walking time can also help.
Activity Modification
Reducing high-impact activity, such as running or prolonged standing, gives the plantar fascia time to settle. This does not mean stopping activity altogether. Swapping to lower-impact exercise for a few weeks, then gradually returning to your normal routine as symptoms improve, tends to work better than complete rest.
Insoles
Cushioned insoles and heel gel pads can reduce heel load and make walking more comfortable. The right option depends on your foot shape and symptoms.
Footwear
Footwear affects how load is distributed through the foot, and switching suddenly to very flat or worn shoes can sometimes trigger symptoms.
Look for: good arch and heel support, a cushioned sole, and a supportive, snug fit.
Be cautious with: prolonged barefoot walking on hard floors, very worn or unsupportive shoes, and sudden changes in shoe type.
Night Splints
Night splints hold the foot in a position that gently stretches the plantar fascia overnight. The aim is to reduce the sharp first-step pain many people notice in the morning. Not everyone gets on with them, and they usually work best as part of a wider plan rather than on their own.
Other Treatments for Persistent Plantar Fasciitis
Shockwave Therapy
Extracorporeal shockwave therapy, usually known as shockwave therapy or ESWT, delivers focused sound waves through the skin to the affected part of the plantar fascia. It’s generally considered for persistent, chronic heel pain that has not responded to several months of physiotherapy and other conservative measures.
Treatment usually involves a few sessions, spaced a week or two apart, delivered in clinic without anaesthetic. NICE has reviewed the evidence on shockwave therapy for plantar fasciitis, and your specialist will discuss whether it suits your case.
Steroid Injections
A steroid injection can ease inflammation around the plantar fascia and provide short-term relief. Repeated injections carry a small risk of weakening or tearing the fascia, so doctors don’t use them as a routine first-line treatment.
PRP Injections
Platelet-rich plasma, or PRP, involves taking a small sample of your blood, concentrating the platelets, and injecting the resulting plasma back into the affected area to support the body’s healing response.
PRP is sometimes considered for persistent plantar fasciitis that hasn’t responded to earlier treatment. The evidence is still developing, and results vary between patients, so it isn’t offered as a routine or guaranteed alternative.
When Is Surgery Needed?
Surgery is generally considered only after a reasonable period of non-surgical treatment (usually six to twelve months) hasn’t led to enough improvement. This timeframe isn’t fixed. It depends on how your symptoms respond.
Before recommending surgery, your specialist will:
- Confirm the diagnosis and rule out other causes of heel pain
- Reassess your response to treatment so far
- Discuss the expected benefits and risks with you
As with any operation, surgery carries risks, including infection, nerve irritation, and the possibility that pain does not fully resolve. Your specialist will discuss the risks with you before any decision is made. See our guide on foot and ankle surgery for more on how we assess whether an operation is the right step.
Types of Plantar Fasciitis Surgery
Plantar Fascia Release
This procedure partially releases the plantar fascia to reduce tension on the tissue, often through a small incision or using keyhole techniques. Recovery usually involves a period of protected walking.
Gastrocnemius Release
Tight calf muscles can restrict ankle movement and increase load on the plantar fascia. A gastrocnemius release lengthens part of the calf muscle to improve ankle flexibility and reduce ongoing strain on the fascia. This reflects an area of particular research interest for Mr Malagelada, whose work has focused on calf and tendon conditions.
How Long Does Plantar Fasciitis Take to Heal?
Recovery is usually gradual. Many people see some improvement within a few weeks, but full recovery can take several months. This will depend on how long and how severe your symptoms have been.
Persistent symptoms do not automatically mean surgery is needed. Many people with longer-standing plantar fasciitis still improve with physiotherapy, footwear changes and treatments such as shockwave therapy before surgery is considered.
When Should You See a Specialist?
It is worth arranging an assessment if:
- Pain persists despite rest, stretching and supportive footwear
- Symptoms are getting worse rather than better
- Pain limits your daily activity
- You are unsure what is causing your heel pain
- You notice numbness or tingling
- You are concerned about another cause for your pain
Mr Malagelada offers private appointments across London, at short notice and without a GP referral, to assess persistent heel pain.
Plantar Fasciitis Treatment on the NHS
Your GP is usually the first point of contact and may refer you on to physiotherapy or podiatry. Waiting times for a first appointment vary by area.
If NHS conservative treatment hasn’t helped after a reasonable period, you may consider further options such as shockwave therapy, injections, or a specialist opinion, either through the NHS pathway or privately. Private appointments with Mr Malagelada do not require a GP referral. This can give you faster access to specialist investigations such as ultrasound or MRI.
Speak to a foot and ankle specialist about your heel pain
If your plantar fasciitis isn’t improving, Mr Francesc Malagelada offers a full range of treatments, from physiotherapy and shockwave therapy to surgery when needed. As a consultant surgeon who treats only foot and ankle conditions, he can give you a clear, personalised recovery plan.
FAQs
What is the best treatment for plantar fasciitis?
For most people, treatment starts with calf and plantar fascia stretching, supportive footwear, and reducing aggravating activity. Shockwave therapy is usually the next step if symptoms persist.
What is the fastest way to get rid of plantar fasciitis?
There is no overnight fix, but reducing aggravating activity and stretching consistently from the start tends to help symptoms ease sooner.
Can plantar fasciitis go away without treatment?
Mild cases can settle with rest and activity changes, which is in line with NHS advice on plantar fasciitis. Targeted treatment usually speeds up recovery.
What exercises are best for plantar fasciitis?
Start with calf and plantar fascia stretches, then add calf raises and foot strengthening as symptoms allow.
Should I rest if I have plantar fasciitis?
Reducing aggravating activity helps, but complete rest is usually unnecessary. Gentle, low-impact movement alongside stretching tends to help more.
Can I run with plantar fasciitis?
You often need to reduce or pause running while symptoms are acute, then return gradually once the pain settles.
Are insoles good for plantar fasciitis?
Insoles and heel gel pads can reduce load through the heel. The right type depends on your foot shape and symptoms.
When is surgery recommended?
Surgery is usually recommended only after several months of non-surgical treatment haven’t led to enough improvement and after a full assessment of the foot and calf.