Patient information from BMJ

Heel pain (plantar fasciitis)

Last published:Jun 05, 2024

Heel pain can be uncomfortable and make it hard to walk. It usually gets better on its own with time, but trying certain exercises and treatments might help relieve the pain.

You can use our information to talk to your doctor and decide which treatments are best for you. 

What is heel pain?

This information is about a type of heel pain that gives you soreness or tenderness on the bottom of your heel and the sole of your foot. The medical term for this is plantar fasciitis.

The plantar fascia is a band of tissue that stretches from your heel to the ball of your foot. A pad of fat in your heel, over the plantar fascia, helps absorb the shock when you walk.

What causes heel pain?

Most heel pain of this type happens in people over 40 years old. This might be because the plantar fascia doesn’t stretch so well as people get older.

The fat pad on the heel may also get thinner as you age and not absorb so much of the shock as you walk. You might also get a spur of bone growing where the plantar fascia joins your heel bone. This can make your heel painful.

Heel pain might be more common in people who are overweight, do lots of running or stand on hard surfaces for a long time. Sometimes there is no obvious reason why someone has heel pain.

What are the symptoms of heel pain?

Heel pain can feel sharp, like a knife sticking in the bottom of your foot.

The pain is usually worst first thing in the morning when you take the first few steps after getting up, and when you first stand up after resting. After standing for a while the pain may become more like a dull ache. The pain might get worse when you walk barefoot.

This type of heel pain causes soreness and tenderness only on the bottom of your foot. You don't usually feel a pain on the back of your heel. The pain often spreads from the centre of your heel and continues along the sole of your foot. The inside of the arch of your foot may ache.

Pain levels can vary from person to person. It may just be an irritation that you notice when you first stand up, or the pain can be bad enough to stop you walking.

What treatments work?

The pain in your heel should go away by itself with time, but it might take several months. But if it is very bad or is taking a long time to get better you can talk with your doctor about treatment. There are simple treatments that should be tried first to help improve the pain.

If these don’t help or your foot is very painful, you might need more advanced treatment.

Your doctor will recommend the best treatment based on how long you’ve had heel pain, and how bad the pain is. They might refer you to a physiotherapist or podiatrist (foot doctor) who is specially trained to treat heel pain.

Things to try first

Rest

It might sound obvious, but the first thing to try is to rest your foot as much as possible. Many people find that this helps reduce their pain.

If you want to stay active while resting your foot you could try activities that don't involve putting too much weight on your foot, such as cycling and swimming.

Stretching

Stretching the plantar fascia might reduce heel pain. There are various ways to stretch this part of the foot. Your doctor can show you how to do this, or they might refer you to a physiotherapist or podiatrist who can show you how to do it.

Ice packs

Placing an ice pack on your heel can help reduce pain in the short term. Ice should always be wrapped in a thin cloth and not used for more than 20 minutes at a time. Ice should never be put directly onto the skin for any length of time.

Supports for your feet

There are several types of support devices that can help reduce heel pain. You might hear these called orthotics. These range from simple insoles and heel pads that you can buy from a pharmacy, to custom-made shoes. You may have to try several methods and see which works for you.

Another method of supporting the foot involves taping the foot to give support to the arch. The idea is to strap up the foot, a little like bandaging, to give support and reduce how much the foot moves and flattens when walking. Your doctor or podiatrist will be able to tape your foot properly and show you how to do it yourself.

Night splints

Night splints hold the foot steady in one place while you sleep. If you use this treatment you will need to wear the splint for at least 6 hours a night for about 8 weeks. Some people find that this helps reduce pain. But some people find them too uncomfortable to wear while sleeping.

Medicine for pain relief

Your doctor might prescribe painkillers called non-steroidal anti-inflammatory drugs (NSAIDs for short). NSAIDs might help heel pain in the short term, but there’s limited research on this

More-severe heel pain

If your pain is very bad and you find that resting, stretching, and supporting your foot don't help, you can ask your doctor about other treatments for heel pain.

Corticosteroid injections

Corticosteroids (often just called steroids) can help reduce heel pain in the short term. You receive these through an injection in the bottom of your foot. However, these injections can cause side effects in some people, including damage to the tissue of the foot.

Foot cast

If your pain is severe your doctor might suggest putting your foot in a cast, in the same way as if you had a broken bone. This can help with morning pain and stiffness, and help you not to put too much weight on your foot. This treatment works well in many people.

Other treatments

Your doctor might try some other treatments depending on your situation and preferences. They might refer you to a physiotherapist or podiatrist for treatments like deep tissue massage, phonophoresis or iontophoresis.

Phonophoresis involves applying a special gel onto your skin, and then using ultrasound waves to help the medicine in the gel get absorbed into your heel. Iontophoresis is the same, except a small electric current is used instead of ultrasound waves.

Your doctor might also suggest low-level laser treatment to help pain in the short term.

Heel pain that doesn't improve with usual treatments

If other treatments haven’t helped after about 6 months, and your pain is so severe that it stops you from doing normal daily activities, your doctor might recommend more advanced treatment.

Extracorporeal shock wave therapy (ESWT for short)

ESWT is where a physiotherapist uses a device to send short energy waves into the painful tissue.

The device is placed on top of the skin ('extracorporeal' means outside the body) in the same way as an ultrasound device. This can help some people with severe heel pain. You might need to have several sessions.

Surgery

Some people have surgery to release nerves that are trapped or compressed. This is only suggested as a last resort for severe heel pain that doesn't improve with other treatments. It seems to work well for many people but, as with all types of surgery, there are risks. In particular surgery for heel pain can sometimes cause nerve damage.

What will happen to me?

Heel pain can often cause discomfort and can affect your daily life. It’s important to remember that your heel pain should eventually get better by itself - especially if you rest your foot when possible and don't do anything that risks making the pain worse.

It might take several months for you to get back to normal. Most people with heel pain will be pain-free within one year