Plantar heel pain: test yourself first
The first steps in the morning are the giveaway. Before you spend money on anything, here is a test you can do at home that tells you something useful.
Get the one-page sheetWhat it is
Pain under the heel, worst for the first ten or twenty steps of the day, easing as you move, then coming back after a long spell on your feet. That pattern is plantar heel pain, better known as plantar fasciitis.
It usually follows a change in standing hours, footwear, weight or training. The old name points at inflammation, which is part of why people expect it to settle on its own. What the tissue shows under a microscope is wear and disorganisation rather than an angry, hot, inflamed structure. That matters, because it explains why anti-inflammatory approaches so often disappoint.
The heel is rarely weak on its own. It is usually picking up work the calf and foot have stopped doing.
What helps
Start by looking at what changed in the weeks before it started, which is almost always where the answer sits.
Load the calf and the foot. Heel raises with a rolled towel under the toes, so the toes are held bent back. Slowly, three seconds up and three seconds down. Every other day, not daily.
Stretch the sole as well as the calf. Sitting, cross the sore foot over the opposite knee and pull the toes back until the band in the arch tightens. Ten repetitions, ten seconds each, three times a day. Do one round before you stand up in the morning.
Support it while you build. Something cushioned indoors rather than barefoot on hard floors, and an off-the-shelf arch support if it takes the edge off.
Give it longer than you want to. This is measured in months, and a fair number of people still have some of it a year on. Better to know that now than to find out at week six and give up.
What to stop spending on
Rolling a frozen bottle under the foot. It feels lovely and changes nothing by itself. Use it for relief if you enjoy it, not as the treatment.
Expensive custom orthotics as a first move. Off-the-shelf supports perform about as well for most people and cost a fraction. An orthosis is a reasonable short-term way to take pain off. On its own it does not change what is underneath.
Where shockwave fits
Heel pain that has not shifted after several months of proper loading is one of the places shockwave has its best case. The effect on pain is real but modest, and it works better as part of a programme than on its own.
It is a second step, not a first one, and we would rather say so than sell you a course on day one.
Try this first
- Do the heel raise test on both legs and write the two numbers down
- Heel raises with a towel under the toes, slowly, every other day
- Sole stretch before your feet hit the floor in the morning
- Change one thing at a time so you know what worked
Get it looked at if
- Numbness, pins and needles, or burning in the sole rather than ache
- Pain in the heel at rest and at night that does not ease when you take weight off
- A sudden pop or tear in the arch with bruising or inability to walk on it
- Heel pain in both feet under 45 with back or joint stiffness as well
- Three months of consistent loading and no change
What we would do
We run the heel raise test properly and measure it, along with the calf and the foot, because weakness up the chain is usually part of the picture. You leave with your numbers, a plan built around them, and a retest date.
Want this as a one-page sheet?
The version we hand out in clinic. Print it, stick it on the fridge, work through it.
Related: Plantar fasciitis and heel pain treatment · All patient guides · Our blog
This guide is general information about a common problem, not a diagnosis of yours. If something is not settling, or it does not match what is written here, come and get it looked at.