Plantar Heel Pain (Plantar Fasciitis)

By Peter Growse, Senior Physiotherapist, Malvern Physiotherapy Clinic

Refreshed and reviewed by Peter Growse on 11 November 2026. This article was first published in June 2023 and has been fully updated.

Plantar heel pain, often called plantar fasciitis, is pain under the heel that is usually worst with your first steps in the morning or after sitting. It is common, often follows a change in the load on your feet, and physiotherapy at Malvern Physiotherapy Clinic in Malvern East may help you manage it.

If you find yourself hobbling to the kitchen each morning until your foot “warms up”, you are not alone. Sore heels are something I see often in our musculoskeletal and sports physiotherapy clinic, and they tend to become more common in late spring and summer, when people walk and run more, spend time barefoot and swap their shoes for thongs.

What is plantar heel pain?

Plantar heel pain is pain on the underside of the heel, where the plantar fascia attaches to the heel bone. The plantar fascia is a thick band of tissue that runs from your heel to the base of your toes and helps support the arch of your foot.

It is one of the most common causes of heel pain in adults. The NHS notes it is more likely between the ages of 40 and 60, although we also see it in younger runners and people who are on their feet all day.

Is plantar heel pain the same as plantar fasciitis?

Yes, they describe the same condition. “Plantar fasciitis” is the older and more familiar name. Many clinicians now prefer “plantar heel pain” because the “itis” suggests inflammation, and research suggests the problem is usually more about the tissue becoming sensitive, thickened and less able to cope with load than about ongoing inflammation. The role of inflammation and the exact source of pain remain unclear. For this reason, “plantar heel pain” is best considered a working diagnosis rather than a diagnosis of a specific tissue problem.

In practice, the plantar fascia behaves a lot like a tendon. It adapts well to gradual change but does not like sudden jumps in how much you ask of it. Our Principal Physiotherapist, Mark Fotheringham, explains this in his earlier article on plantar fasciitis.

What does plantar heel pain feel like?

Most people describe a sharp, stabbing or bruised feeling under the inner part of the heel. Common features include:

Pain with the first steps out of bed in the morning
Pain when you stand up after sitting for a while
Pain that eases after a few minutes of walking, then returns later in the day
Pain after, rather than during, exercise
Pain that is worse barefoot on hard floors or in flat, unsupportive shoes
Tenderness when you press under the heel

According to the NHS, pain when you stretch the sole of your foot, such as climbing stairs or lifting your toes, is also typical.

What causes plantar heel pain?

Plantar heel pain usually develops when the load on the foot increases faster than the plantar fascia can adapt, or when the tissue’s capacity to cope with load drops. It is not always clear why it starts, and it is often a mix of factors.

Common contributors include:

A sudden increase in walking, running or time on your feet
Starting a new sport or exercise on hard surfaces
New, old or worn-out shoes, or a switch to flat shoes or thongs
Limited ankle movement, or tight or weak calf muscles
Carrying extra body weight
Long hours standing at work
A reduced ability of the tissue to cope with load, which may be influenced by stress, ageing, hormonal changes or time spent in a boot or cast

The Better Health Channel also lists standing, running or jumping on hard surfaces and ill-fitting footwear as common causes of heel pain.

You may have read that flat feet cause plantar heel pain. Foot shape can play a part for some people, but it is not a confirmed cause on its own, and plenty of people with flat feet never have heel pain. That is why your physiotherapist will look at the whole lower leg, not just your arch.

Could my heel pain be something else?

Yes. Plantar heel pain is the most common cause, but several other conditions can cause pain around the heel. A thorough assessment is important to determine the most appropriate treatment approach.

Conditions that can cause heel pain include:

Plantar heel pain. Pain under the inner heel. It is usually worst with your first steps and eases as you warm up.
Achilles tendinopathy. Pain at the back of the heel or just above it. It often feels stiff in the morning and sore with hills, stairs or running. Pain can sometimes extend into the arch.
Heel fat pad irritation or bruising. Pain in the centre of the heel pad. It feels bruised and is often worse barefoot on hard floors. It tends to get worse the longer you keep walking, is more common in older people and women, and can start suddenly after a heavy heel strike.
Heel bone (calcaneal) stress fracture. Pain at the sides or across the whole heel that builds with activity and may ache at rest, with swelling and tenderness over the heel bone, often after a big jump in training.
Nerve irritation. Burning, tingling or numbness in the inner heel or arch, sometimes with pain at rest or at night. This is uncommon.
Partial tear of the plantar fascia. A sudden “pop” followed by immediate, severe pain, sometimes in people with previous heel pain or a past injection. This needs prompt assessment.
Sever’s disease. Pain at the back of the heel in active children and young teens, often during growth spurts.
Referred pain. Heel or foot pain that comes with back pain, or pain that spreads down the leg.

You can read more about tendon problems in our post on tendonitis, about bone stress in stress fractures, and about pain that starts elsewhere in our foot pain guide.

How can a physiotherapist help with plantar heel pain?

A physiotherapist can confirm whether your pain is coming from the plantar fascia, work out what has changed in the load on your foot, and build a plan to settle your pain and then make the tissue stronger. Your physiotherapist will assess how you walk and stand, your footwear, the strength and flexibility of your calf and foot muscles, and how your hip and knee control the leg.

When I assess heel pain, I also ask about what has changed in the last few months: a new job, a new running program, new shoes, or more time on your feet. That history often tells us as much as the examination. At MPC we can also use hand-held dynamometry to measure strength and compare your left and right sides.

Depending on what we find, treatment often includes:

Education. Understanding why your heel hurts and how load affects it. A best practice guide in the British Journal of Sports Medicine, co-written by Australian researchers, recommends individualised education as part of core care.
Load management. Adjusting, not stopping, activity so your heel can settle while you stay active.
Stretching. Calf and plantar fascia stretches.
Strengthening. A gradual program for the calf and foot muscles, progressing to heavier, slower exercises as pain allows.
Taping. Low-Dye or similar taping to offload the plantar fascia in the short term.
Hands-on treatment. Soft tissue and joint techniques for the foot and calf.
Footwear and insoles. Advice on supportive shoes, heel cups or insoles to use alongside other treatment.
Dry needling. For some people, dry needling of the calf and foot muscles may help as part of a broader program.

The 2023 clinical practice guideline from the Academy of Orthopaedic Physical Therapy (published in the Journal of Orthopaedic and Sports Physical Therapy) lists manual therapy, stretching, taping and night splints among its strongest recommendations. It recommends that insoles (orthoses) are used together with other treatment rather than on their own for short-term relief.

If you are not improving as expected after about 4-5 weeks, your physiotherapist can discuss second-line options, such as custom orthoses, and whether a GP or podiatry review would help.

Some people also find remedial massage or myotherapy useful for tight calves alongside their physiotherapy. Treatment recommendations will depend on your individual presentation.

What can I do at home to ease heel pain?

Small changes to your day often make the biggest difference early on. The aim is to calm the heel down without stopping moving altogether.

Things that may help:

First steps in the morning. Gently move your ankle and toes before you stand up, and keep supportive footwear by the bed rather than walking barefoot straight away.
At home. Avoid bare feet on tiles or floorboards. Wear supportive shoes or arch support thongs indoors.
Summer footwear. Flat, thin thongs and sandals can aggravate heel pain. Choose footwear with arch support and a cushioned heel.
Exercise. Avoid big jumps in distance, speed or hills. Increase gradually, and try cycling or swimming while the heel settles.
Work. Standing still on hard floors for hours is a common trigger. Wear cushioned shoes, change position regularly and sit when you can.
Calves. Regular calf stretches and strengthening, especially after long periods without moving.

The NHS also suggests an ice pack wrapped in a towel for up to 20 minutes, and simple pain relief if needed (check with your pharmacist or GP first).

A common strengthening exercise is a slow heel raise: rising onto your toes and lowering slowly, sometimes with your toes resting on a rolled towel to add a gentle stretch to the fascia. Your physiotherapist will set the right starting level for you, as doing too much too soon can flare things up.

If you are looking for supportive summer footwear, we stock Archies arch support thongs at reception. They are everyday footwear, not a treatment, but many patients like having a supportive option for the beach and around the house.

Do I need a scan or X-ray for heel pain?

Usually not. Plantar heel pain is normally diagnosed from your history and a physical examination. Imaging may be useful if your physiotherapist or GP suspects a stress fracture or another condition, or if you are not improving as expected.

Heel spurs are often found on X-rays, but they are also common in people with no heel pain, so a spur on its own does not always explain your symptoms. Our post on when you need an MRI scan explains how we decide.

How long does plantar heel pain take to settle?

It varies a lot. Some people settle within weeks once the load is right, while for others it lingers for months, especially if it has been present for a long time. Your physiotherapist will give you an honest idea of what to expect after assessing you, and will adjust your plan as you progress.

When should I see a physio for heel pain?

See a physiotherapist if heel pain is affecting your walking, work, sleep or exercise, or if it has not improved after a couple of weeks of sensible self-care. The NHS suggests seeing a health professional if the pain has not improved after two weeks, keeps coming back or stops you doing normal activities.

Consider booking an assessment if:

Your first steps each morning are painful
You are training for a fun run or event and your heel is getting worse
You have tried stretches or new shoes and are not sure what else to do
You have had plantar heel pain before and it is starting to return

You do not need a referral to see a physiotherapist at Malvern Physiotherapy Clinic.

When should I see a doctor instead?

Some heel symptoms need medical review first. See your GP promptly if you have:

Tingling, burning or numbness in your foot
Diabetes and any foot pain or skin changes
Heel pain after a fall or injury, or you cannot put weight on your foot
Redness, heat or swelling around the heel, or you feel unwell or have a fever
Pain that is constant, severe or worse at night
Pain and stiffness in both heels together with other joints

These points are drawn from the NHS and healthdirect. Your physiotherapist also screens for these signs during your assessment and will refer you to your GP if needed. In an emergency, call 000.

Frequently asked questions

Should I stop running with plantar heel pain?

Not always. Many runners can keep running with changes to distance, speed, hills or surface, as long as the pain stays at or below about 2 out of 10 and settles by the next morning. If your heel is worse each morning, it is a sign to cut back. Your physiotherapist will assess you and help you plan a return. Our running injury prevention guide has more tips, and if the pain is in your shin rather than your heel, see our guide to shin splints.

Are thongs bad for heel pain?

Flat, thin thongs can aggravate plantar heel pain because they offer little arch support or heel cushioning. The NHS lists flip-flops (thongs) among footwear to avoid. Thongs with a built-in arch and cushioned heel are a better summer option for many people.

Do insoles or orthotics help plantar fasciitis?

They can help some people, especially alongside exercise and other treatment. The 2023 clinical practice guideline recommends using orthoses together with other treatment rather than on their own. Your physiotherapist can advise whether insoles may suit you, and when a podiatry review would help.

Is a heel spur causing my heel pain?

Not necessarily. Heel spurs are common on X-rays of people who have no heel pain at all. The pain usually comes from the sensitive plantar fascia rather than the spur itself, which is why treatment focuses on the soft tissues and load.

Why does my child’s heel hurt?

In active children and young teens, heel pain is more often Sever’s disease, an irritation of the growth plate at the back of the heel, than plantar fasciitis. It is common during growth spurts and busy sport seasons. A physiotherapist can assess your child and help them stay active.

Can I claim physio for heel pain on my private health insurance?

If you have private health extras cover that includes physiotherapy, you may be able to claim part of the cost. HICAPS is available, and on-the-spot claiming is an option. Check your level of cover with your health fund.

Book a heel pain assessment in Malvern East

If heel pain is making mornings, work or exercise harder, an assessment can help you understand what is going on and what may help.

Book online at malvernphysio.janeapp.com or call our team on (03) 9078 8434. Malvern Physiotherapy Clinic is at 299 Wattletree Road, Malvern East VIC 3145, convenient to Malvern, Armadale, Toorak, Glen Iris and the wider Stonnington area. No referral is needed.

About the author

Peter Growse is a Senior Physiotherapist at Malvern Physiotherapy Clinic with more than 15 years of experience. He holds a Bachelor of Physiotherapy from La Trobe University and a Master’s degree in Musculoskeletal Physiotherapy, and has completed further study in sporting and tendon injuries, including Achilles, patellar and gluteal tendons. Peter has a strong interest in lower limb and sporting injuries, low back and neck pain, headaches and growing bodies, including Sever’s disease. He has been head physiotherapist for Scotch College’s First XVIII football team for more than 10 years, and for Old Scotch.

This article is general information only and is not a substitute for individual assessment or advice. Please book an appointment so we can tailor recommendations to you. All practitioners at Malvern Physiotherapy Clinic are registered with the Australian Health Practitioner Regulation Agency (AHPRA).