The short answer
- Most runners can keep running if first-step pain the next morning stays at its usual level.
- Plantar heel pain is slow. In a Danish hospital cohort, half still had symptoms five years after they started, so expect months rather than weeks.
- In a trial of 180 people, advice and a heel cup gave a meaningful improvement within 12 weeks. Adding heavy heel raises, or heel raises plus an injection, made no meaningful difference.
- Start with the basics for 4 to 6 weeks: plantar fascia stretching, taping if it helps, supportive shoes and a plan for load.
- If nothing has changed after 4 to 6 weeks, shockwave is the next step with the best evidence.
The first steps out of bed are the worst. By the time you reach the kitchen the heel has eased, and on an easy run it might barely register. Then you sit through a long meeting, stand up, and it's back.
That is plantar heel pain, often called plantar fasciitis. It's rarely serious. It is slow, and most of the frustration comes from expecting it to heal on the timeline of a calf strain.
What's going on under your heel
The plantar fascia is a thick band of connective tissue that runs from the heel bone to the base of the toes. The pain usually sits at the front and inner edge of the heel, where the fascia attaches, and it's worst on the first steps after rest1,2.
For runners it's a load problem, and a common one: it accounts for an estimated 8% of running injuries1. In a Czech cohort of 1,206 adults followed for a year, runners doing more than 40 km a week had six times the odds of developing it compared with runners doing 6 to 20 km. Runners overall weren't clearly more likely to get it than non-runners, and only 28 people developed it in total, so read the number as a direction rather than a precise risk3. Body weight adds load on every step, and higher body mass was a risk factor in a meta-analysis of physically active people4.
How long it takes
Months, and for some people considerably longer. The most sobering numbers come from a Danish hospital.
This was a hospital cohort, so it probably holds more stubborn cases than the typical runner with a sore heel. The trial in the next section paints a kinder picture of the first year. Both point the same way: six weeks is the wrong expectation.
What the trials say helps
Here heel pain differs from Achilles pain. The largest trial so far found that the simple things did most of the work.
Three treatments, one year
| Group | Week 0 | Week 4 | Week 12 | Week 26 | Week 52 |
|---|---|---|---|---|---|
| Advice and heel cup | 44.4 | 57.9 | 64.6 | 76 | 81.8 |
| Plus heel-raise training | 46 | 61.4 | 66.7 | 75.1 | 81.8 |
| Plus training and injection | 44.2 | 64.6 | 72.7 | 72.6 | 79.4 |
The advice covered what the condition is, what raises the risk and how to manage load: stay active, and cut back on what aggravates the pain2. It's worth knowing who took part. Most were women in their late 40s, recruited through general practice and social media, so the trial doesn't tell us exactly how runners respond.
A best practice guide built from 51 trials, interviews with experts and a patient survey lands in the same place. It recommends a core of plantar fascia stretching, taping and education tailored to the person, used together for about 4 to 6 weeks before anything else is added1.
The basics, done properly
Stretch the fascia, not only the calf
Sit, cross the sore foot over the other knee, and pull your toes back towards the shin until you feel the stretch along the arch. In a trial of 101 people with long-standing heel pain, this non-weight-bearing stretch beat a standard calf stretch for first-step pain after eight weeks9. We ask runners to do it before their first steps in the morning and before standing up after long sitting.
Tape for the hard weeks
A simple arch taping, called low-Dye taping, reduced first-step pain after one week compared with sham treatment. Experts in the best practice guide also use it to test whether an insole is likely to help1.
Wear shoes that take load off the heel
Comfort comes first. The experts favoured cushioning and a small heel-to-toe drop, and a heel cup in everyday shoes was part of the treatment every group got in the trial above1,2.
Break up long spells of standing
Standing still loads the fascia for long periods. Reducing that is part of load management in the best practice guide1.
Running with heel pain
No trial has tested whether runners with heel pain should keep running. The advice in the trial above was to stay active and cut back on what aggravates the pain2, and that's how we approach it.
The next morning tells you whether a run was the right dose. It's the same idea we use for Achilles pain: pain during the run can be acceptable, as long as the heel is back to its usual level by the following morning.
When it isn't improving
If the basics haven't changed your first-step pain after 4 to 6 weeks, there are sensible next steps. In the best practice guide, focused shockwave improved first-step pain in the short, medium and long term, and radial shockwave in the short and long term. Side effects were minimal, though patients found the treatment unpleasant. Custom foot orthoses come after that, with a modest effect on pain in the short and medium term and mixed results between trials1.
Injections deserve a straight answer. In the trial above, the group that also got an injection more often felt they needed no further treatment by 12 weeks: 21 of 59, against 11 of 62 with advice and a heel cup alone. By six months the pain scores were level again. Repeated injections have never been tested against placebo, and there is concern they may weaken the fascia2.
When to get it looked at
These signs point to other causes, such as a bone stress injury, an irritated nerve or inflammatory joint disease, and they need a different plan.