Plantar fasciitis is overload of the plantar fascia where it attaches to the heel bone, causing sharp heel pain that is worst on the first steps of the morning. Most cases settle within 6 to 12 months with stretching, supportive footwear, load management and physiotherapy. Surgery is rarely needed.
Symptoms
- Sharp, stabbing pain under the heel with the first few steps after waking
- Eases within 10–15 minutes of walking, then returns later in the day
- Pain at the inner side of the heel bone where the fascia attaches
- Runners often notice it after — rather than during — a run
Causes & risk factors
- A sudden jump in activity or training load
- Long periods standing on hard floors
- Tight calves and reduced ankle movement
- Unsupportive or worn footwear, or a switch to minimalist shoes
- Higher body weight
Conservative treatment comes first
- Plantar fascia and calf stretching, twice daily for 8–12 weeks
- Load management — swap running for cycling or swimming for a period
- Supportive footwear and off-the-shelf or custom orthotics
- Night splints to hold a gentle stretch
- Shockwave therapy (ESWT) after 3–6 months, arranged through a specialist provider
- An ultrasound-guided corticosteroid injection in selected cases
When surgery is considered
A plantar fascial release (open or keyhole) is reserved for the under 5–10% of people who remain limited after 9–12 months of full conservative care including shockwave. It carries a small risk of changing the arch, so it is a last resort.
Questions & answers
With consistent treatment, most people improve over 3 to 6 months. Left untreated it can drag on for 12 to 18 months or longer.
Often yes, if the pain eases as you warm up and settles back to baseline within 24 hours. Pain that worsens through a run or lingers the next day means you are doing too much.
No. A heel spur shows up on many pain-free feet. The pain comes from the inflamed and overloaded fascia, not the spur, so removing a spur is not the treatment.
Usually not. The diagnosis is clinical. We use ultrasound when the picture is unclear, and reserve MRI for a suspected stress fracture or nerve entrapment.
Sources & further reading
- NHS — Plantar fasciitis
- NICE IPG311
- BOFAS patient information
