Plantar fasciitis: symptoms, assessment and treatment

The plantar fascia is a band of connective tissue under the foot that attaches to the heel bone. Plantar fasciitis is an overload of this attachment. The pain is felt under the heel, often at the front edge of the heel bone, and can radiate forward in the foot [2][3].

The name suggests inflammation. NHI writes that more recent research points more towards wear than inflammation [2]. The condition is common among runners and most often affects people from the age of 40 and upwards [2].

Pain under the heel when the foot is loaded is the main sign [2]. It is often worst early in the day or when getting up after rest, and may ease once the foot has warmed up [2][3]. With a lot of loading the pain increases again [2][3].

Early on, the pain is usually only present when the foot is loaded. Later it can also occur at rest, especially in the evening [2][3].

Most cases are caused by overload. Typical triggers are prolonged standing, a lot of walking or running on hard surfaces, activities with many jumps, and footwear that gives little support [2][3].

The guideline lists limited ankle mobility, a high body mass index in people who are not athletes, running, and work involving much standing or walking on surfaces with little cushioning as risk factors [1]. Atypical foot posture, for example a high arch or flat foot, also increases the risk [2][3]. In some rheumatic diseases both feet can be affected [2][3].

The diagnosis is most often made from the history and an examination [2][3]. The guideline points to heel pain that is worst during the first steps after rest, pain triggered by increased loading, and tenderness on pressure over the attachment of the fascia. Findings such as a positive windlass test and limited ankle mobility support the diagnosis [1].

Imaging is usually not necessary when the clinical criteria are met [1][2]. X-ray can be used to rule out other conditions, including stress fracture of the heel bone, and ultrasound or MRI can in some cases confirm the diagnosis [1][2]. On ultrasound, a thickened fascia, more than four millimetres, with a darker tissue appearance is regarded as a typical finding [1].

A heel spur can be seen on X-ray, but is also found in many people who have no symptoms. It can therefore not confirm the diagnosis on its own [2][3].

Manual therapy of joints and soft tissue and stretching of the plantar fascia and calf muscles have the highest grade of evidence in the guideline [1]. The same applies to taping, which is recommended together with other physiotherapy for short-term improvement in pain and function [1]. NHI mentions that stretching can be done with simple exercises and that a physiotherapist can give guidance [2].

Strength training for the muscles of the foot and ankle is recommended as part of the programme, but with a lower grade of evidence [1]. Foot orthoses are not recommended alone for short-term pain relief, but can be used together with other measures [1]. NHI writes that ready-made insoles often work as well as customised ones [2]. A night splint can be used for persistent pain with the first step in the morning, for one to three months, but many find it uncomfortable [1][2]. Therapeutic ultrasound is not recommended to enhance the effect of stretching [1].

As self-care, NHI describes good footwear with shock absorption and support, avoiding walking barefoot, and adapting activity so that running and prolonged walking on hard surfaces are limited [2]. NHI writes that no treatment is clearly better than the others, and that the measures should be adapted to the individual [2].

On shockwave therapy, NHI writes that it can help some people and is relevant when usual treatment has not led to improvement [2]. The guideline gives no recommendation on shockwave therapy [1]. According to NHI, a corticosteroid injection does not appear to give better results than other measures, its effect is short-lived, and it can weaken the tendon [2].

The condition usually resolves on its own, but it can take time. Most people improve within one to two years, and for some it becomes chronic [2][3]. The guideline points out that many seek treatment only after more than a year of symptoms, and that there is little data on the effect of the measures beyond three months [1].

If other treatment has not helped after nine to twelve months, surgery may be considered. NHI stresses that surgery does not guarantee that the symptoms disappear [2].

Pain under the heel that does not improve quickly, becomes more widespread or gets worse should be assessed by a doctor [3]. If you have a disease that reduces sensation in the feet, you should contact a doctor if you get sores or signs of infection [3].

The guideline recommends that other diagnoses are considered if the symptoms do not match plantar fasciitis, or do not subside after treatment [1].

A physiotherapist can examine where the pain is and what triggers it, and together with you make a plan for loading, stretching and exercise. When the diagnosis is uncertain, diagnostic ultrasound may be relevant. Questions about foot posture and footwear can be raised in an assessment of insoles. When usual treatment has not led to improvement, shockwave therapy can be considered as an addition.

What is plantar fasciitis?

Plantar fasciitis is an overload of the band of connective tissue under the foot where it attaches to the heel bone. It causes pain under the heel when the foot is loaded [2][3].

What is the difference between plantar fasciitis and a heel spur?

A heel spur is a finding that can be seen on X-ray. It is also found in many people who have no symptoms, and can therefore not confirm the diagnosis of plantar fasciitis on its own [2][3].

Why is it worst in the morning?

The pain is often worst early in the day and during the first steps after rest. It may ease once the foot has warmed up, and increase again with a lot of loading [2][3].

How long does plantar fasciitis last?

It varies. Most people improve within one to two years, but for some the condition becomes chronic [2][3].

Can I exercise when I have plantar fasciitis?

NHI recommends adapting activity and limiting running and prolonged walking on hard surfaces. Cycling and swimming are alternatives that maintain fitness without loading the foot [2].

The page on plantar fasciitis gives a shorter overview. You can also read about shockwave therapy and find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Koc TA Jr, et al. Heel pain, plantar fasciitis: revision 2023. J Orthop Sports Phys Ther. 2023. Link

2. Plantar fasciitt (hælsmerter) (plantar fasciitis, heel pain). NHI.no. Last updated 22 September 2025. Link

3. Plantar fasciitis og hælspore (plantar fasciitis and heel spur). Patienthåndbogen, sundhed.dk. Last updated 26 September 2025. Link