Plantar Heel Pain: What It Is, Why It Happens, and What to Do Next
Written by Samantha Heyfron, Director & Physiotherapist — Whittlesea Physiotherapy & Clinical Pilates
If your heel is sore first thing in the morning, or it hurts when you stand up after sitting, you are not alone. Plantar heel pain is usually called “plantar fasciitis” which is a common foot complaint.
The good news is that for most people symptoms improve significantly with the right mix of load management, strengthening and a clear plan. Below is an evidence-based summary of what causes plantar heel pain, how it is diagnosed, and the treatment options that are likely to help the most.
What Is Plantar Heel Pain?
Plantar heel pain refers to pain on the underside of the heel, typically closer to the inside edge. It is most commonly linked with irritation of the plantar fascia which is a strong band of connective tissue that runs along the sole of your foot and plays a key role in supporting the arch and managing load with every step.
The condition affects approximately 10% of people over their lifetime and accounts for around 15% of all foot complaints presenting to healthcare (Riddle & Schappert, 2004). It is seen across a wide range of people from runners and people that work on their feet all day to less active individuals who have recently changed their footwear or activity levels.
A common myth: the heel spur. Many people are told their pain is caused by a bony heel spur visible on X-ray. Research consistently shows that heel spurs are present in people with and without pain, they are not the source of symptoms and do not need to be treated directly. Understanding this is important because it changes what treatment is needed (Johal & Milner, 2012).
What Causes It?
Plantar heel pain is almost always a “too much, too soon” story.
It develops when the tissues under the heel are asked to handle more load than they are currently conditioned for. This mismatch can build gradually over weeks, or appear more suddenly following a change in activity or lifestyle.
Common triggers include:
- A sudden increase in walking, running, or time spent standing
- A change in footwear — particularly a shift to less supportive shoes or a significant change in heel height
- Returning to activity after a period of rest or reduced movement
- Increased time on hard surfaces (concrete, floorboards)
- Reduced calf and ankle flexibility or strength
- Higher overall training loads without adequate recovery
- Weight gain, which increases load through the heel with every step
It is rarely one single cause. Most people have a few contributing factors that combine to push the tissue beyond its tolerance.
How Is It Diagnosed?
You do not need imaging to get started.
A physiotherapist can usually diagnose plantar heel pain confidently based on:
- Your history: when the pain occurs, what makes it better or worse, how it has changed over time
- The location and behaviour of pain: first-step pain in the morning or after rest is a hallmark feature
- A physical assessment: foot and ankle mobility, calf strength and flexibility, walking mechanics, and load tolerance
When imaging is useful: Ultrasound or MRI may be considered if symptoms are not improving as expected, if the presentation is atypical, or if another diagnosis needs to be ruled out.
Important: not all heel pain is the same. Pain can also arise from nerve irritation (including tarsal tunnel syndrome), fat pad atrophy, stress reactions in the heel bone, or referred pain from elsewhere. This is why an accurate assessment matters, especially if your symptoms do not match the classic pattern or if they are not responding to standard treatment.
What the Evidence Says About Treatment
Current best-practice guidelines support a stepped, progressive approach to plantar heel pain management. With active, load-based treatments forming the foundation, and additional options layered in where needed.
Active Treatments: The Foundation of Recovery
Active treatments are those that rebuild the tissue’s capacity to handle load. These produce the most durable results and are the focus of any good rehabilitation plan.
Load management is the critical first step. Iidentifying and adjusting the activities that are repeatedly aggravating the heel without allowing recovery. This does not mean stopping everything, but it does mean being strategic about what you do and how much.
Strengthening is the key to long-term recovery. Research by Rathleff et al. (2015) demonstrated that high-load calf strengthening produced superior outcomes compared to conventional plantar fascia stretching alone. Building foot intrinsic muscle strength and hip stability also contributes to how load is distributed through the foot.
Progressive return to activity follows a step-by-step increase in what your heel can handle, monitored using morning pain as a practical guide. If morning pain is significantly worse the day after an activity, you have likely done too much and need to adjust.
Footwear plays a meaningful role in load management. Supportive, cushioned footwear (particularly first thing in the morning) reduces heel strain while capacity is being rebuilt. Avoiding barefoot walking on hard surfaces in the early stages is often one of the simplest and most effective changes a person can make.
Stretching the plantar fascia and calf is helpful, though it works best as part of a broader program rather than as a standalone approach (DiGiovanni et al., 2003).
Passive and Adjunctive Treatments: Supporting the Plan
Passive options can provide meaningful symptom relief, particularly in the early stages, and work best when combined with active rehabilitation.
- Taping: low-dye or calcaneal taping provides short-term support and can reduce heel load while tissue sensitivity settles
- Orthoses and insoles: may be appropriate to reduce strain through the plantar fascia while strength and capacity are being built; the decision is based on individual assessment
- Extracorporeal shockwave therapy (ESWT): radial ESWT has the strongest evidence of any passive intervention for plantar heel pain, demonstrating superior outcomes at short, medium, and long-term follow-up compared to most alternatives (Dizon et al., 2013). It is particularly effective for persistent cases that have not fully responded to a loading program alone
- Dry needling: may be used in selected cases to address contributing muscle and soft tissue findings
- Corticosteroid injections: can provide short-term pain relief but should be used selectively; evidence does not support them as a long-term solution, and repeated injections carry risk of plantar fascia rupture
- Surgery: reserved for cases that have not responded to a minimum of 6–12 months of comprehensive conservative management
The key principle: a good plan is individualised. What is right for a runner is not always right for someone who stands at work all day. Your presentation, goals, activity demands, and how long the condition has been present all shape the right combination of treatments.
A Practical Starting Point (Next 7–14 Days)
If your symptoms are mild to moderate, these steps are often a sensible place to begin while you arrange an assessment:
- Reduce the biggest aggravator for now: usually long walks, running, or extended standing on hard surfaces
- Wear supportive footwear at home and out, avoid going barefoot on hard floors if it consistently makes symptoms worse
- Start gentle plantar fascia stretching in the morning before your first steps, sitting on the edge of the bed, pull your toes back toward your shin and hold for 30 seconds; repeat several times
- Track your morning pain as this is your best guide. Significantly worse morning pain the day after an activity means you have done too much.
If you have had symptoms for more than a few weeks, or have tried these steps without improvement, a proper assessment is the right next move so you are not guessing, and so the program can be matched to your specific situation.
When to Seek Professional Help
It is time to book an assessment if:
- Pain has not improved after a couple of weeks of sensible load changes
- You are limping, avoiding activity, or symptoms are affecting work or sleep
- Symptoms keep flaring as soon as you increase activity
- You are unsure whether what you are experiencing is plantar heel pain or something else
The longer plantar heel pain is left unmanaged or managed with the wrong approach the more the tissue can sensitise and the longer recovery tends to take. Early, accurate assessment makes a real difference.
How We Can Help at Whittlesea Physiotherapy
At Whittlesea Physiotherapy & Clinical Pilates, we look at the full picture which includes foot mechanics, calf strength and flexibility, walking and running loads, footwear, and the contributing factors specific to your lifestyle and build a step-by-step plan that fits your body and your goals.
We have been helping people in the Whittlesea community manage plantar heel pain for over 20 years. Whether you are a runner wanting to get back on the trails, a nurse on your feet all day, or an active older adult who just wants to walk without pain, we can help you get there.
Book an appointment online at www.whittlesea.physio or call us on 03 9716 2250.
We are open Monday to Saturday at 73 Church Street, Whittlesea.
If someone you know is dealing with heel pain, feel free to share this as getting the right guidance early makes the next steps much clearer.
Whittlesea Physiotherapy & Clinical Pilates has been serving the Whittlesea community since 2005. Our team provides evidence-based physiotherapy, Clinical Pilates, and musculoskeletal care for all ages.
references
- DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. (2003). Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. Journal of Bone and Joint Surgery, 85(7), 1270–1277.
- Dizon JN, Gonzalez-Suarez C, Zamora MT, Gambito ED. (2013). Effectiveness of extracorporeal shockwave therapy in chronic plantar fasciitis. American Journal of Physical Medicine & Rehabilitation, 92(7), 606–620.
- Johal KS, Milner SA. (2012). Plantar fasciitis and the calcaneal spur: fact or fiction? Foot and Ankle Surgery, 18(1), 39–41.
- Rathleff MS, Mølgaard CM, Fredberg U, et al. (2015). High-load strength training improves outcome in patients with plantar fasciitis. Scandinavian Journal of Medicine & Science in Sports, 25(3), e292–e300.
- Riddle DL, Schappert SM. (2004). Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis. Foot & Ankle International, 25(5), 303–310.
This blog is intended as general health information only. It does not replace individualised professional advice. Please consult a qualified physiotherapist for assessment and management of your specific condition.