Pain guide · Leg pain
Plantar heel pain, usually called plantar fasciitis, is pain under the heel that is worst on the first steps in the morning or after sitting.
The 2023 heel pain guideline gives its top grade to stretching the plantar fascia and the calf, and recommends strengthening the foot and ankle. This guide starts with a first-steps routine you can do sitting on the edge of the bed, then builds strength.
Exercise is for pain that has been checked or is clearly mild and settling.
Pain under the heel, typically worst on the first steps after rest. The guideline lists limited ankle bend (dorsiflexion), a higher body weight in people who are not athletes, running, and work spent on your feet as risk factors.
The guideline lists conditions that can look similar: inflammatory spondyloarthritis, a thinned heel fat pad, a plantar fibroma, and a stress fracture of the heel bone. If the plan is not helping, get it assessed.
Source 1
The plantar fascia, the Achilles tendon and the calf form one continuous line of tissue down the back of the leg, which is one reason to stretch the calf and the sole together. The trials, not the anatomy, are what justify the advice.
The 2023 guideline gives its top grade to plantar-fascia-specific and calf stretching for short- and long-term pain and function. A 2021 best-practice review found plantar fascia stretching had the largest short-term effect on first-step pain of the self-care options.
In a trial of 101 people who had had heel pain for 10 months or more, a seated stretch that pulls the toes back to tension the sole beat a standard Achilles stretch at 8 weeks for worst pain and first-step pain. At 2 years, after everyone had switched to the sole stretch, 92% were satisfied and the groups no longer differed.
The guideline recommends resistance training for the foot and ankle muscles. In a trial of 48 people, heavy single-leg heel raises with a towel under the toes, every second day, gave better foot function at 3 months than sole stretching (both groups also had insoles); results were similar at 1, 6 and 12 months.
A later trial found self-dosed and pre-set heavy heel-raise programs worked equally, though only 4 of 70 people reached an acceptable level of symptoms within 12 weeks. Expect it to take time.
The guideline recommends taping alongside other treatment for short-term relief, and night splints for 1 to 3 months if first-step pain is consistent. The best-practice review rated taping's effect as smaller than stretching's.
The guideline advises against using shoe inserts (orthoses) alone for short-term pain, but they can be combined with other treatment.
Source 1
This site's suggestion treats the plantar fascia like a tendon: mild to moderate discomfort during loading, up to about 5 out of 10, is acceptable if it has settled by the next morning. It borrows the pain-monitoring rule from an Achilles trial and has not been tested separately for heel pain.
Your first-step pain in the morning is the best guide: it should trend down week to week. Expect some soreness in the first heavy heel-raise sessions; if the heel is clearly worse the next morning, lighten the load.
Start at the first stage. Each move opens a full guide with a 3D demo.
Weeks 0 to 2. Stretch the sole before your first steps in the morning and before standing after a long sit, plus calf stretches twice a day.
Plantar fascia stretch (seated)Beginner · A bench or box3 to 5 holds of 10 to 30 s, 2 to 3 times a day · Before your first steps; the hold length used in trials
Harder: Toes tucked kneeling
3D demoToes tucked kneelingIntermediate · No equipment60 to 90 s · If your knees allow
3D demoWall calf stretch (gastrocnemius)Beginner · A wall3 holds of 30 s each side, twice a day
Easier: Seated calf stretch with a towel · Harder: Peroneals Stretch
3D demoSoleus wall stretchBeginner · A wall3 holds of 30 s each side, twice a day
Easier: Seated calf stretch with a towel · Harder: Peroneals Stretch
3D demoSeated calf stretch with a towelBeginner · Other / check instructions3 holds of 30 s each side · If standing stretches are hard
Move on when: First-step pain is easing.
Weeks 2 to 6. Keep the morning sole stretch going.
3D demoSlow calf raiseBeginner · A wall3 sets of 12 to 15
Easier: Seated bent-knee calf raise (soleus raise) · Harder: Standing dumbbell calf raise
3D demoHeel raise with a towel under the toesIntermediate · A step + Other / check instructions3 sets of 12, both feet then one, every second day · The exercise from the Rathleff trial
Easier: Slow calf raise · Harder: Standing dumbbell calf raise
Move on when: 3 sets of 12 single-leg towel heel raises stay within the pain rule.
Weeks 6 to 12 and on.
3D demoHeel raise with a towel under the toesIntermediate · A step + Other / check instructions3 sets every second day, from 12 reps toward 8 heavier reps · Add a backpack or dumbbell, as in the pre-set trial program
Easier: Slow calf raise · Harder: Standing dumbbell calf raise
3D demoSingle-leg calf raise from a stepIntermediate · A step + A wall3 sets of 10 to 12 each leg
Easier: Slow calf raise · Harder: Single-leg pogo hops
3D demoTreadmill walkingBeginner · Cardio machineBuild your standing and walking time
Harder: Treadmill jogging
3D demoTreadmill joggingIntermediate · Cardio machineWalk-jog intervals · If you run
Easier: Treadmill walking · Harder: Sprint intervals
3D demoFoot-SMRIntermediate · Other / check instructionsOptional, for comfort · Untested either way
Easier: Hamstring-SMR
Move on when: First-step pain is gone or mild, and walking and running stay within the pain rule.
The NHS advises rest, ice, supportive shoes, insoles or heel pads, gentle stretches and low-impact exercise, and avoiding long periods on your feet, high heels, flip-flops and walking barefoot on hard surfaces.
Source 7
No exercise is banned. While first-step pain is high, cut back long spells of standing and high-impact running and build them back in stage 3. In the stretches, pull the toes back, not just the ankle, and never hard enough to hurt at the heel.
No trials of rolling the sole on a ball or roller were found. If it feels good, use it as a comfort option before the stretches; the stretches and heel raises are what the evidence supports.
The plantar fascia stretch: sitting with the foot across the other knee, pull the toes back until you feel the arch tighten. It beat a standard calf stretch in a trial. Calf stretches, knee straight and bent, are worth doing too.
Yes. The sole stretch and a towel calf stretch can both be done sitting up in bed before your first steps in the morning, which is when they help most.
Yes, in time. Heavy heel raises with a towel under the toes gave better function at 3 months than stretching in one trial, though results evened out by a year. This plan uses both.
They can, alongside other treatment. The guideline advises against relying on insoles alone for short-term pain; the NHS lists insoles or heel pads among the self-care steps.
No trials were found either way. If it feels good, use it for comfort; the stretches and heel raises are what the evidence supports.
Often months. In one trial only 4 of 70 people were satisfied with their symptoms after 12 weeks of heavy heel raises, while in another, 92% were satisfied two years after starting a sole stretch. See a GP if it is no better after 2 weeks of self-care.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
