Plantar Fasciitis: Symptoms, Causes and 6 Exercises That May Help

10 min read  ·  J&J Therapy, New Malden

In short: Around 1 in 10 UK adults may experience plantar fasciitis at some point in their lives (NHS, StatPearls). What helps: NICE recommends conservative care first — stretching, progressive loading and hands-on physiotherapy — with shockwave therapy considered for stubborn cases Next step: You do not need a GP referral. Same-week assessments are available in New Malden.

That sharp, stabbing pain in your heel on the first few steps out of bed — the one that eases after a minute of walking and comes back after a long day standing — is the classic pattern of plantar fasciitis. It is irritation of the thick band of tissue running along the sole of your foot, and it responds well to the right loading and stretching. It rarely settles quickly on its own.

What Is Plantar Fasciitis?

Plantar fasciitis is a painful condition of the plantar fascia — the thick fibrous band that runs from your heel bone to the base of your toes. It supports the arch of your foot and absorbs shock every time you take a step. When repeated load builds up faster than the tissue can recover, microscopic damage accumulates and the inner heel becomes painful.

Think of it like an old elastic band that has been pulled too hard, too often: it does not snap, but it frays and stops coping with the same stretch it used to handle.

Three everyday triggers account for most cases: a sudden increase in walking or running, flat and unsupportive shoes, and tight calf muscles that limit how far your ankle can bend. Standing for long shifts, a rise in body weight, and returning to sport after a sedentary spell all add to the load.

It is common. Lifetime prevalence is estimated at around 10% (NHS, StatPearls). In a UK study of adults aged 50 and over, 9.6% reported plantar heel pain and 7.9% described it as disabling (BMC Musculoskeletal Disorders, 2019). Among runners, prevalence has been reported as high as 22% (StatPearls). It peaks between the ages of 40 and 60, and may be more common in women.

Do I Have Plantar Fasciitis? A 30-Second Self-Check

Read through the five statements below and count how many sound like you.

☑️ Sharp pain on your first steps in the morning.

☑️ Pain eases after a few steps.

☑️ Tender when pressing the inner heel.

☑️ Worse after standing or walking for long periods.

☑️ Worse barefoot on hard floors.

Two or more? It may be plantar fasciitis, and it is worth having it assessed rather than waiting it out.

A physiotherapist confirms the picture with a short physical examination rather than a scan. That usually means firm palpation over the medial calcaneal tubercle — the point on the inner heel where the fascia attaches — plus the Windlass test, in which the big toe is pulled upwards to tension the fascia and see whether your familiar pain is reproduced (De Garceau et al., Foot & Ankle International, 2003). A heel squeeze test helps rule out a calcaneal stress fracture, which needs a different plan entirely.

What Happens If You Just Wait It Out?

The honest answer is that most people do get better. NICE Clinical Knowledge Summaries note that roughly 80–90% of cases improve within 12 months with conservative treatment. That is genuinely reassuring — but it is only half the picture.

The other half comes from long-term follow-up of persistent cases. Hansen and colleagues tracked 174 patients for 5 to 15 years with ultrasound examination and found that, among those whose symptoms had persisted, 80% still had symptoms at 1 year, 50% at 5 years and 45.6% at 10 years (Hansen et al., Orthopaedic Journal of Sports Medicine, 2018). Residual pain intensity was generally mild and manageable, but it did not simply disappear.

There is a second cost as well. When you unconsciously change how you walk to protect a sore heel, the load shifts elsewhere — to the ankle, knee, hip and lower back. Evidence suggests that starting treatment early may help shorten recovery and reduce the risk of these compensation patterns settling in.

What About Steroid Injections or Surgery?

A corticosteroid injection can reduce pain quickly, but the effect is typically short-lived — usually in the range of 4 to 12 weeks (Singapore Medical Journal review, 2015). It calms inflammation without addressing the underlying degenerative change in the tissue, so symptoms often return.

There is also a safety consideration. In a case series of plantar fascia ruptures, 44 of 51 ruptures were associated with corticosteroid injection (Acevedo & Beskin, Foot & Ankle International, 1998). Repeated injections and higher body weight are recognised risk factors, along with fat pad atrophy at the injection site.

Surgery — plantar fascia release or gastrocnemius recession — is generally reserved for cases that have not responded after six months or more of good-quality conservative treatment. Recovery is long and satisfaction varies. For most people, it never becomes the conversation.

How Physiotherapy Can Help

Physiotherapy for heel pain is not one technique — it is a combination, adjusted to how long you have had symptoms and how much load your foot currently tolerates.

1. Hands-on manual therapy. Soft-tissue work releases tension through the calf and the sole of the foot, while joint mobilisation restores movement at the ankle and midfoot so your ankle can bend further without pulling on the fascia. A 2025 systematic review in Physical Therapy Reviews found soft-tissue manual therapy helped improve pain and function in chronic plantar fasciitis. It is a bit like working stiff clay soft again, then oiling a hinge that has seized.

2. A progressive exercise programme. Two approaches have the strongest research support. Plantar fascia-specific stretching produced high patient-rated satisfaction at two-year follow-up (DiGiovanni et al., Journal of Bone and Joint Surgery, 2006), and high-load strength training led to faster improvement in function at three months compared with stretching alone (Rathleff et al., Scandinavian Journal of Medicine & Science in Sports, 2015). The skill is in progressing the load at the right pace for your foot.

3. Shockwave therapy for stubborn cases. Extracorporeal shockwave therapy (ESWT) delivers acoustic pulses into the painful tissue to stimulate the body's own healing response. NICE guidance (HTG200, formerly IPG311) states that the evidence raises no major safety concerns but that current evidence on its efficacy is inconsistent, so it should be used with special arrangements for clinical governance, consent and audit. It is considered for refractory cases — heel pain that has persisted beyond about three months despite conservative care — and typically involves 3 to 6 sessions, around 15 to 20 minutes each. In one randomised trial of 245 patients, radial ESWT produced a greater reduction in pain at 12 weeks than placebo (Gerdesmeyer et al., American Journal of Sports Medicine, 2008).

Timing matters as much as technique. In August 2025 the Chartered Society of Physiotherapy reported that 372,560 people were waiting for community MSK physiotherapy in England. At J&J Therapy in New Malden, appointments are usually available in the same week, seven days a week, and you can refer yourself without going through your GP first.

6 Home Exercises for Plantar Fasciitis

These are the exercises most often prescribed for heel pain, drawn from NHS patient guidance and published trials. Mild discomfort during a stretch is normal. Sharp or increasing pain is not — stop and get it checked.

1. Plantar Fascia-Specific Stretch

Sit down and cross the painful foot over the opposite knee. Use your hand to pull your toes back towards your shin until you feel the sole of your foot stretch. Hold, then release slowly.

Dosage: Hold 10 seconds × 10 reps · 3 times a day.

Doing one round in bed before your first step of the day is the single most useful habit for morning pain.

2. Frozen Bottle or Ball Roll

Sitting in a chair, place a frozen water bottle, tennis ball or golf ball under your arch. Roll it slowly back and forth along the sole, pausing on tender spots. The frozen bottle gives you the stretch and a cooling effect in one move.

Dosage: 3–5 minutes · a few times a day.

3. Calf Stretch — Gastrocnemius

Face a wall with both palms flat at shoulder height. Step the painful leg back, keep that knee straight and the heel pressed to the floor, and bend your front knee until you feel the calf stretch. Keep the back foot pointing straight ahead.

Dosage: Hold 15–30 seconds × 2–4 reps, each leg.

4. Calf Stretch — Soleus

Take the same position at the wall, but this time bend the back knee slightly while keeping the heel flat on the floor. You should feel the stretch lower down, closer to the ankle.

Dosage: Hold 15–30 seconds × 2–4 reps, each leg.

5. Towel Scrunches

Sit with a bare foot flat on a small towel laid on a hard floor. Keeping your heel anchored, use only your toes to scrunch the towel towards you, then push it back out. Once it feels easy, place a tin at the far end of the towel to add resistance.

Dosage: 8–12 reps × 1–2 sets.

6. Heel Raises — High Load

Stand with the balls of your feet on the edge of a step and a rolled towel under your toes, holding a rail for balance. Raise your heels over 3 seconds, hold at the top for 2 seconds, then lower over 3 seconds. The towel keeps your toes lifted, which loads the fascia through the windlass mechanism.

Dosage: Every other day. Start at 3 sets of 12, progress after about 2 weeks to 4 sets of 10 with a loaded rucksack, then 5 sets of 8 (Rathleff protocol).

A note on doing this alone: Home exercises help, but without an assessment it is possible to miss a stress fracture, nerve entrapment or fascia rupture that needs a different approach. Loading that is too light achieves little, and loading that is too heavy too soon can flare symptoms and raise the risk of recurrence. Best practice: The Morrissey 2021 best-practice guide in the British Journal of Sports Medicine suggests trialling core measures such as stretching, taping and education for around 4 to 6 weeks before adding options like shockwave or orthoses.

When to Seek Help Right Away

🚩 Sudden tearing pain in the sole after a trauma or misstep, suggesting a possible fascia rupture.

🚩 Numbness, pins and needles, or pain at rest and at night, which may point to nerve involvement.

🚩 Fever, redness, heat or swelling around the heel, which may indicate infection.

🚩 Sharp, pinpoint pain on the heel bone itself that worsens with activity, raising the possibility of a calcaneal stress fracture.

🚩 Pain in both heels alongside joint pain, back stiffness, rashes or eye inflammation, which warrants screening for inflammatory conditions.

If any of these apply to you, contact a physiotherapist, your GP or NHS 111 promptly rather than continuing with home exercises.

Frequently Asked Questions

Do I need a GP referral to see a physiotherapist for heel pain?

No. Many NHS MSK physiotherapy and podiatry services in England accept self-referral, and private clinics do not require a referral at all. At J&J Therapy you can book directly and be assessed the same week, which is a practical difference given that the Chartered Society of Physiotherapy reported 372,560 people waiting for community MSK physiotherapy in England in August 2025.

How many physiotherapy sessions will I need?

It varies with how long you have had symptoms and how your foot responds. Best-practice guidance suggests reviewing progress after around 4 to 6 weeks of core treatment (Morrissey et al., British Journal of Sports Medicine, 2021). Where shockwave therapy is indicated, a course is typically 3 to 6 sessions at weekly intervals. Your physiotherapist will give you a clearer estimate after the initial assessment.

Does treatment for plantar fasciitis hurt?

Manual therapy is usually comfortable, though working on a tender heel or a tight calf can feel intense at times. Shockwave therapy can feel uncomfortable during the session, but the intensity is adjusted to what you can tolerate and each session lasts around 15 to 20 minutes. Tell your physiotherapist at any point and the settings will be changed.

Can I keep walking and exercising?

In most cases yes, with adjustments. The aim is to reduce the spikes in load rather than stop moving altogether — so shorter walks more often, supportive footwear instead of bare feet on hard floors, and lower-impact options such as swimming or cycling while symptoms settle. Returning to running is usually safest once morning pain has been consistently mild, progressing gradually through a walk-run pattern.

Will plantar fasciitis come back?

It can, particularly if the original triggers return — a sudden jump in walking or running volume, unsupportive shoes, or calf tightness creeping back. Keeping up calf and fascia stretching, progressing training load gradually, and using supportive footwear are the main things that help reduce that risk. If early symptoms reappear, addressing them quickly is usually easier than waiting.

Book an Assessment in New Malden

If your heel pain has lasted more than two weeks, or the morning stiffness is starting to shape your day, an assessment will tell you what you are actually dealing with and what load your foot is ready for.

📍 J&J Therapy, CI Tower, New Malden, KT3 4TE — 2 minutes from New Malden station, free parking. Opening hours: Open 7 days a week, 9am–7pm. Same-week appointments. No GP referral needed. Languages: English, Korean, Cantonese and Mandarin. Areas served: New Malden, Kingston upon Thames, Raynes Park, Wimbledon and Worcester Park. 📞 07935 869938 — Reception, 9am–7pm, call or text. 📞 07882 943540 — 24-hour bookings, call, text or WhatsApp anytime.🌐 Online: www.jjtherapy365.com — book, reschedule or cancel anytime.[ Book Now ]

About the author: Valton Lam, MSK Physiotherapist — MSci Physiotherapy (Keele University), HCPC-registered (PH148704), member of the Chartered Society of Physiotherapy. Valton specialises in musculoskeletal assessment, progressive loading rehabilitation and manual therapy, and is a Storz Medical certified shockwave practitioner at J&J Therapy, New Malden.

This article is for general information and does not replace individual clinical assessment. Symptoms, recovery times and responses to treatment vary from person to person. If you are concerned about heel or foot pain, please speak to a qualified healthcare professional.

Sources

NICE — Extracorporeal shockwave therapy for refractory plantar fasciitis (HTG200, formerly IPG311).

NICE Clinical Knowledge Summaries — Plantar fasciitis.

NHS — Plantar fasciitis; NHS United Lincolnshire Hospitals — Plantar fasciitis exercises.

Hansen L et al. Long-Term Prognosis of Plantar Fasciitis. Orthop J Sports Med. 2018;6(3).

DiGiovanni BF et al. Plantar fascia-specific stretching exercise, two-year follow-up. J Bone Joint Surg Am. 2006;88(8):1775-81.

Rathleff MS et al. High-load strength training in plantar fasciitis. Scand J Med Sci Sports. 2015;25(3):e292-300.

Morrissey D et al. Management of plantar heel pain: a best practice guide. Br J Sports Med. 2021;55(19):1106-18.

Gerdesmeyer L et al. Radial extracorporeal shock wave therapy in chronic recalcitrant plantar fasciitis. Am J Sports Med. 2008;36(11):2100-9.

Acevedo JI, Beskin JL. Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int. 1998;19(2):91-97.

Singapore Med J. The effectiveness of corticosteroid injection in the treatment of plantar fasciitis. 2015.

Plantar heel pain in middle-aged and older adults: population prevalence. BMC Musculoskelet Disord. 2019;20:337.

De Garceau D et al. The association between diagnosis of plantar fasciitis and Windlass test results. Foot Ankle Int. 2003;24(3):251-55.

Effectiveness of soft tissue manual therapy in chronic plantar fasciitis: a systematic review. Physical Therapy Reviews. 2025.

StatPearls — Plantar Fasciitis (NCBI Bookshelf NBK431073).

Chartered Society of Physiotherapy — NHS waiting lists rise (14 August 2025).