How long does plantar fasciitis take to heal?

What is plantar fasciitis?

The plantar fascia is a thick band of tissue that runs along the sole of the foot from the heel bone to the toes and supports the arch. Plantar fasciitis, also called plantar heel pain, occurs when this tissue becomes irritated where it attaches to the heel, usually as a result of repeated overload rather than true inflammation.

The typical symptom is sharp pain under the heel with the first steps in the morning or after sitting, which eases after a few minutes of walking and returns after long periods of standing.

Who is more likely to develop it?

Risk factors include a sudden increase in walking, running or standing, higher body weight, reduced ankle flexibility, especially tight calf muscles, and footwear with little support. It is common in runners and in people who stand for long periods at work.

Heel spurs seen on X-ray are common in people with and without heel pain, so a spur on its own does not explain symptoms.

Which treatments are recommended first?

A clinical practice guideline on heel pain recommends a combination of approaches: stretching of the calf and plantar fascia, manual therapy, taping to support the foot in the short term, prefabricated or custom foot orthoses, night splints for people with morning pain, and education about load management and footwear 1.

Strengthening exercises for the foot and calf muscles are often added as pain allows. Reducing, but not necessarily stopping, the activities that aggravate pain helps the tissue settle.

Does shockwave therapy work?

Extracorporeal shockwave therapy delivers pressure waves to the painful area. A meta-analysis of seven randomised trials of people whose heel pain persisted despite at least three months of conservative treatment found that shockwave therapy improved pain scores compared with placebo 2. People receiving shockwave therapy were more likely to achieve a 60 per cent improvement in heel pain on first steps (risk ratio 1.30) and during daily activities (risk ratio 1.44) 2.

Shockwave therapy is usually delivered over several sessions and can be uncomfortable during treatment. It is typically considered after simpler measures have not been enough.

What about steroid injections and surgery?

Steroid injections can reduce pain in the short term, but the benefit is often temporary, and repeated injections carry risks such as thinning of the fat pad under the heel and, rarely, rupture of the plantar fascia.

Surgery to release part of the plantar fascia is rarely required and is generally considered only after prolonged, well-conducted conservative treatment has failed.

What can I do at home?

Stretching the calf against a wall and the plantar fascia by pulling the toes back before getting out of bed, wearing supportive shoes with a cushioned heel rather than walking barefoot on hard floors, and rolling the arch over a bottle or ball are practical steps.

If running or long walks provoke pain, temporarily replacing some of that activity with cycling or swimming maintains fitness. Gradual weight reduction can reduce the load on the heel.

When could heel pain be something else?

See a doctor if heel pain follows an injury, if there is swelling or bruising, numbness or tingling in the foot, pain at night or at rest, fever, or pain in both heels together with pain in other joints, which may suggest an inflammatory condition.

Pain at the back of the heel is more likely to come from the Achilles tendon and is managed differently.

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