Plantar Fasciitis (Heel Pain)
Pain under the heel, worst with the first steps in the morning. An overloaded band of tissue in the sole, not a bone spur problem. Most people recover within a year.
The heel pain ladder
Slow but reliable. Stack the cheap steps together and give them 6–12 weeks before climbing.
- Step 1 · Self-careEase the load and stretchCut back on long walks, running and standing on hard floors; stretch the calf and the sole of the foot daily.
- Works
- Most people improve; about 8 in 10 are better within a year
- Cost
- Free
- How long
- 6–12 weeks to judge; keep stretching after it settles
- Watch for
- Pain that’s worse at night, with swelling or numbness, isn’t typical. Get it checked.
Barefoot on tiles all weekend and wondering why Monday hurts? Your heel has notes.
- Step 2 · PharmacySupportive shoes, heel cups and off-the-shelf insolesCushioned shoes with a slight heel rise; arch support or taping for busy days.
- Works
- No better than sham insoles in trials, but cheap, low risk and many people find them comfortable
- Cost
- About $20–60 for insoles or heel cups
- How long
- Use while symptoms last
- Watch for
- Thongs and flat, worn-out shoes. Your heel files those under “no”.
Off-the-shelf insoles work about as well as custom ones for most people.
- Step 3 · PharmacySimple pain relief and iceParacetamol, anti-inflammatory gel or a short course of tablets; ice for 10–20 minutes after activity.
- Works
- Little trial evidence; may take the edge off, but doesn’t fix the tissue
- Cost
- About $5–15
- How long
- Days to a couple of weeks at a time
- Watch for
- Anti-inflammatory tablets: stomach and kidney cautions.
Painkillers so you can run 10 km on it? That’s not the brief.
- Step 4 · Allied healthPhysio or podiatristTaping, a strengthening program (such as slow heel raises), footwear advice and orthoses if needed.
- Works
- Modest benefit in trials; worth it for pain lasting more than a few months
- Cost
- About $90–130 a session; Medicare rebates with a GP care plan
- How long
- Usually 6–12 weeks
- Watch for
- Custom orthoses can cost hundreds of dollars; most people do fine with off-the-shelf.
Strong calves and feet are the long-term fix. Massage balls are the trailer, not the movie.
- Step 5 · Allied healthShockwave therapyPulses of sound energy to the heel, usually over 3–5 sessions.
- Works
- About 30–40% more people get a big (60%) drop in pain than with sham; for pain lasting months
- Cost
- About $60–120 a session
- How long
- 3–5 sessions, about a week apart
- Watch for
- Uncomfortable during treatment; bruising.
For the stubborn cases, not a first resort.
- Step 6 · ProcedureSteroid (cortisone) injectionAn injection into the heel, sometimes with ultrasound guidance.
- Works
- Small, short-lived: pain about 0.5 points out of 10 lower than a dummy treatment at 1 month; insoles did slightly better by 3 months
- Cost
- About $0–250 depending on the clinic; sometimes bulk-billed
- How long
- Effect fades over weeks; repeat injections are avoided
- Watch for
- Small risk of the tissue tearing or the heel fat pad thinning. Avoid high-impact exercise for about 6 weeks after.
A short-term loan, not a cure.
- Step 7 · SpecialistSurgeryOnly for severe pain lasting 12 months or more despite good non-surgical care.
- Works
- No good trials; helps some carefully selected people; rarely needed
- Cost
- Free in the public system (expect a wait); private out-of-pocket costs often run to thousands
- How long
- Weeks to months of recovery
- Watch for
- Nerve injury, flattening of the arch, slow recovery.
The last rung, and almost nobody needs it.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Custom orthoticsNo better than off-the-shelf insoles for most people, at several times the price.
- Magnetic insolesNo better than plain insoles in a trial. Magnets are great on fridges.
- PRP injectionsSmall trials with mixed results, and they cost a lot.
- X-rays for heel spursSpurs are common in people with no pain at all, and finding one doesn’t change treatment.
- Low-level laser therapySmall, low-quality studies. May help a little, but not enough to justify a course.
What you can do
- Stretch the calf and sole before you get out of bed and before standing up after sitting.
- Roll the sole over a frozen water bottle after activity.
- Follow our heel pain exercise handout: one printable page with sets and progressions.
- Swap high-impact exercise for cycling or swimming while it settles, then build back up slowly.
- Wear supportive shoes indoors too. Hard floors are part of the problem.
- If you’re above a healthy weight, losing some takes load off every step.
See your GP if
- No better after 6–8 weeks of self-care
- You’re limping or changing how you walk
- Both heels hurt, or you also have back, joint or eye inflammation
- A child or teenager has heel pain
See a doctor promptly for heel pain after a fall or a sudden “pop”, a hot, red or swollen heel, fever, numbness or tingling, or pain that’s bad at night or at rest.
Common questions
Is a heel spur causing my pain?
Usually not. Heel spurs are common in people with no pain at all, and treatment is the same either way. An X-ray is rarely needed.
How long does plantar fasciitis last?
It often takes months. Most people are better within a year, and the right mix of stretching, shoes and load changes speeds things up.
Should I keep exercising?
Yes, but swap high-impact activity (running, jumping) for cycling or swimming while it settles, then return gradually.
Do I need custom orthotics?
Most people don’t. Off-the-shelf insoles work about as well for most and cost much less.
Helpful resources
- Plantar fasciitis exercise handoutPrintable, one page, with sets and progressions. Free, from us.
- MyHEELEvidence-based self-management website built by La Trobe University heel pain researchers. Free.
- Find a podiatristSearch for a podiatrist near your postcode, from the Australian Podiatry Association. Australia.
Evidence and more information
- Healthdirect: Plantar fasciitis
- MyHEEL (La Trobe University): Heel pain treatments
- NICE CKS: Plantar fasciitis
- Cochrane: Steroid injections for heel pain
- Rasenberg et al: Foot orthoses for plantar heel pain (BJSM 2018)
- Aqil et al: Shockwave therapy for plantar fasciitis, meta-analysis (2013)
- Whittaker et al: Insoles vs steroid injection for heel pain, RCT (BJSM 2019)
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