- Plantar fasciitis
- Foot pain
- Physical therapy
Plantar fasciitis: why your heel hurts on your first steps
If your heel hurts when you get out of bed, it may be plantar fasciitis. We explain how to recognize it, what you can do at home, and which treatments the 2023 clinical guideline supports.
PainManagement ER Published 3 min read
You get out of bed, put your foot down and feel a stab in your heel. After a short walk it eases, but it comes back after a while on your feet. That’s the typical pattern of plantar fasciitis, which causes pain on the bottom of the foot, around the heel and arch. It comes from straining the plantar fascia, the tissue that connects the heel bone to the toes.[1]
How to recognize it
According to the NHS, it is more likely to be plantar fasciitis if:[1]
- The pain is much worse on your first steps after sleeping or resting.
- It eases once you start moving, but returns after long periods of standing, walking or running.
- It hurts to stretch the sole of your foot, such as when raising your toes or climbing stairs.
Risk factors
It isn’t always clear why it happens. The NHS lists these factors:[1]
- Being 40 to 60 years old
- Starting exercise on hard surfaces
- Having a tight calf or heel
- Overstretching the sole of the foot during exercise
- Doing much more standing or walking than usual
- Wearing shoes with poor cushioning or support
- Being overweight
What to do at home
| Do | Don't |
|---|---|
| Rest and raise your foot | Stand or walk for long periods |
| Apply ice wrapped in a towel, for up to 20 minutes every 2 to 3 hours | Wear high heels or tight, pointed shoes |
| Wear cushioned shoes with arch support, insoles or heel pads | Wear flip-flops or backless slippers |
| Do gentle stretches | Walk barefoot on hard surfaces |
| Choose low-impact exercise, such as swimming |
Source: NHS, "Plantar fasciitis" (2025).[1]
What the 2023 clinical guideline recommends
The clinical practice guideline published in 2023 in the Journal of Orthopaedic & Sports Physical Therapy reviews the evidence on physical therapy treatments for plantar fasciitis. These are its main recommendations:[2]
| Treatment | What the guideline says | Grade |
|---|---|---|
| Manual therapy | Use it on the joints and soft tissues of the leg and foot to reduce pain and improve function | A |
| Stretching | Of the plantar fascia and calf, to reduce pain and improve function in the short and long term | A |
| Foot taping | Rigid or elastic, together with other treatments, for short-term improvement | A |
| Night splints | A 1- to 3-month program if you consistently have pain with the first step in the morning | A |
| Therapeutic exercise | Include resistance training for the foot and ankle muscles | B |
| Dry needling | On trigger points in the calf and sole of the foot, to reduce pain | B |
| Low-level laser therapy | As part of rehabilitation, to reduce pain in the short term | B |
| Foot orthoses | Do not use them as the only treatment for short-term pain relief; they may be used combined with other treatments | B / C |
| Therapeutic ultrasound | Do not use it to enhance the benefits of stretching | A |
Source: Koc TA Jr, et al. JOSPT 2023.[2] Grade A = strong evidence; B = moderate; C = weak. The guideline focuses on physical therapy treatments and does not assess other medical options.
The practical takeaway: orthoses can help, but they aren’t enough on their own. The guideline’s strongest recommendations (grade A) are manual therapy, stretching, taping and night splints.[2]
If that doesn’t help, the NHS mentions other options, such as steroid injections and shock-wave therapy. Surgery is less common.[1]
When to see a doctor
The NHS advises seeing a doctor if:[1]
- The pain is severe or stops you from doing normal activities.
- The pain is getting worse or keeps coming back.
- It hasn’t improved after 2 weeks of home care.
- You have tingling or numbness in your foot.
- You have diabetes and foot pain, as this can be more serious.
If your heel hurts every morning, an assessment can confirm the cause and help you start the right physical therapy plan.
Sources
- Plantar fasciitis . NHS (UK National Health Service) , reviewed February 14, 2025.
- Heel Pain – Plantar Fasciitis: Revision 2023 (clinical practice guideline) . Koc TA Jr, et al. Journal of Orthopaedic & Sports Physical Therapy 2023;53(12):CPG1–CPG39 , December 2023.
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