Yoga for plantar fasciitis: sole and calf stretches, foot strength, first steps and what to skip

No trial has tested yoga itself

We found no trial of yoga for plantar heel pain. Yoga can be a way to do the stretches and strength work that do have evidence, and to stay active with less load on your heel.

Sources 1, 2

Stretch the sole before your first steps

In 101 people with heel pain for 10 months or more, a seated stretch pulling the toes back beat a standing calf stretch at 8 weeks for the worst pain and first-step pain. In a best-practice review of 51 trials, stretching the plantar fascia had the largest short-term effect on first-step pain. Bending the toes and the ankle up together stretches it most.

Sources 3, 2, 4

Calf stretches help as part of the mix

In 92 people, 2 weeks of calf stretching on its own was no better than a sham treatment for first-step pain, and across 8 trials the sole stretch eased pain more than calf stretching. Do both, sole first.

Sources 5, 6

Heavy heel raises build strength

In 48 people, slow single-leg heel raises with a towel under the toes every second day gave better foot function at 3 months than daily sole stretching, with no difference at 1, 6 or 12 months. In 180 people, adding heel raises to advice and a heel cup made no clinically relevant difference at 12 weeks. Expect months, not weeks.

Sources 7, 8

Bare feet, mats and long standing

The NHS says "try not to walk barefoot on hard surfaces" and "do not walk or stand for long periods, especially barefoot". Practise on a mat or carpet, keep standing holds short, skip jumping for now, and wear supportive shoes between sessions.

Sources 9, 10

Know the signs that need help

Heel pain after an injury or a fall, a red, hot, swollen foot (especially with a fever), tingling or loss of feeling, and any new foot problem if you have diabetes need prompt help. See a GP if it hasn't improved after 2 weeks of looking after it yourself. The full lists are in the warning signs below.

Sources 9, 10

Plantar fasciitis, in plain words

Plantar fasciitis is pain on the bottom of the foot around the heel and arch, "much worse when you first start walking after sleeping or resting", easing as you move, and worse again after long standing, walking or running. It affects 4% to 7% of people at any one time. The plantar fascia isn't just inflamed, so many clinicians and trials now call it plantar heel pain or plantar fasciopathy.

Our plantar fasciitis and heel pain guides explain the condition and its staged plan, and our plantar fascia guide explains the structure itself.

Sources 9, 2, 8

Who gets it

The NHS lists being aged 40 to 60, starting exercise on hard surfaces, a tight calf, a big rise in standing or running, poorly cushioned shoes and being overweight, and adds that you can get it if you "overstretch the sole of your foot during exercise". In active people, a higher body weight went with it in 16 studies.

Sources 9, 11

What yoga does to the heel

The fascia is stretched most when the ankle and the big toe are both bent up, which is what the seated sole stretch and toes-tucked kneeling do. A sun salutation bends the ankle up about 40 degrees, stretching the calf, and downward dog does the same. Standing poses and long holds load the heel, and jump-backs land on it. Yoga is usually practised barefoot, and no study has measured heel load on a yoga mat.

Sources 4, 12, 9

Yoga itself: not testedMixed evidence

A PubMed search found 13 records mentioning yoga and heel or foot pain, none of them a trial of yoga for plantar heel pain. Popular claims that studies show yoga reduces plantar fasciitis pain have no trial behind them.

Source 1

Stretching the soleEmerging evidence

In 101 people with heel pain for 10 months or more (82 assessed), a seated plantar fascia stretch beat a standing calf stretch at 8 weeks for the worst pain and first-step pain; everyone also had soft insoles, 3 weeks of an anti-inflammatory medicine and an education video. At 2 years, after everyone had switched to the sole stretch, 92% were satisfied and the groups no longer differed.

The best-practice guide (51 trials, 4,351 people, with experts and patients) found plantar fascia stretching had the largest short-term effect on first-step pain, and puts it at the core of care with taping and education. Across 8 trials, the sole stretch eased pain more than calf stretching, on moderate-quality evidence.

Sources 3, 13, 2, 6, 4

Calf stretching on its ownMixed evidence

In 92 people, 2 weeks of calf stretching with a sham ultrasound treatment was no better than the sham alone for first-step pain (7.9 mm better on a 100 mm scale, with a confidence interval that included no difference). Calf stretching is part of the usual mix, but less effective than the sole stretch.

Sources 5, 6, 2

Heavy heel raisesEmerging evidence

In 48 people with ultrasound-confirmed plantar fasciitis, insoles plus heavy single-leg heel raises with a towel under the toes every second day gave a Foot Function Index 29 points better at 3 months than insoles plus daily sole stretching, with no difference at 1, 6 or 12 months. In 180 people, adding heel raises to advice and a heel cup made no clinically relevant difference at 12 weeks, and one session of heel exercise didn't ease pain in 20 people.

Sources 7, 8, 14

Foot muscles and toe strengthMixed evidence

People with heel pain have weaker toe and ankle muscles and smaller foot muscles, on very low-certainty evidence. In 83 people, adding foot or foot and hip strengthening to stretching did no better than stretching alone at 8 weeks, and a review couldn't say how much foot-muscle training helps. Foot exercises increased toe strength in 34 people, with or without minimalist shoes, and a 20-person feasibility trial found a foot exercise programme acceptable, with no side effects from the exercises.

Sources 15, 16, 17, 18, 19

Shoes and insolesEmerging evidence

The NHS advises cushioned heels with good arch support, or wide, comfortable shoes with a low heel and soft sole, and insoles or heel pads. On average, insoles worked little better than sham insoles: no better for short-term pain in 20 trials, and a small benefit in the medium term in 19, with custom-made no better than ready-made. In a lab study of 29 women, a cushioned shoe with a higher heel than toe cut peak heel pressure by 15%.

Sources 9, 10, 20, 21, 22

Other treatmentsMixed evidence

If people don't improve with stretching, taping and education, the best-practice guide suggests shockwave therapy, then custom insoles. Dry needling, laser and manual therapy added to home exercise eased short-term pain more than home exercise alone in 24 trials.

Sources 2, 23

Stretch before you stand

First-step pain after sleep or rest is typical of plantar fasciitis. In the trial, people stretched the sole sitting down before their first steps in the morning and before standing after sitting for a while. Sit on the edge of the bed, circle your ankles, then do the sole stretch and a towel calf stretch before you put weight on your foot.

Sources 9, 3, 2

How much

The sole stretch: 3 to 5 holds of 10 to 30 seconds, 2 to 3 times a day, starting before your first steps (the stretch's page). Heavy heel raises every second day, building the load over weeks, as in the 2015 trial (the heel raise's page).

Our editorial starting point: the first block of our 25-minute class every morning, and the whole class 2 or 3 times a week.

Sources 7, 3

What toe yoga isMixed evidence

Toe yoga means lifting your big toe while the other toes stay down, then lifting the other toes while the big toe stays down, then spreading all your toes, a few slow times, sitting or standing (our description). It trains control of the small foot muscles, but no study has tested it for heel pain, and foot strengthening didn't add to stretching in a trial. The towel scrunch, in the strength moves below, is the nearest move in our library.

Sources 24, 16, 17

Toe spacersMixed evidence

Studies of toe spacers are about bunions; we found none in heel pain.

Source 25

Barefoot on the mat: follow the NHSMixed evidence

The NHS says try not to walk barefoot on hard surfaces, and not to walk or stand for long periods, especially barefoot. No study has tested barefoot yoga with heel pain. One small trial (52 people) found that 4 weeks of barefoot treadmill walking eased pain more than walking in shoes, but it's a single small trial, and one session of barefoot walking didn't help in another.

Our suggestion: practise on a thick mat or carpet, not a bare hard floor, keep standing holds short, and if your heel hurts in bare feet, wear supportive shoes for the standing poses.

Sources 9, 10, 26, 14

Between sessionsStrong evidence

Wear cushioned, supportive shoes with a low heel, use soft insoles or heel pads if they help, and avoid high heels, tight pointy shoes, flip-flops and backless slippers, as the NHS advises. The best-practice guide also suggests breaking up long spells of standing still.

Sources 9, 10, 2

Numb feet or diabetes

The NHS asks you to see a GP about foot pain if you have diabetes. Check your feet before and after yoga, keep shoes on for standing poses and use a chair for balance, as our yoga for neuropathy and yoga for diabetes guides say.

Source 9

Keep standing holds short

Long spells of standing are among the NHS's "don'ts" for plantar fasciitis, and the best-practice guide advises breaking up long periods of standing still. In a class, shorten long holds in warrior poses or chair pose, sit between standing poses, and do one-leg balances on your comfortable side or skip them for now (our suggestions; no study has looked at this).

Sources 9, 2

Skip jumping for now

Jump-backs and jump-throughs in sun salutations land on your forefoot and heel. Step back instead until first-step pain is mild (our suggestion).

Downward dog is a calf stretch, not a cure

Downward dog stretches the calves, part of the usual mix, but calf stretching on its own was no better than a sham over 2 weeks. Bend your knees and pedal your heels, as in our yoga for runners routine, and come down if your heel pain is sharp (our suggestion; no study has looked at downward dog and heel pain).

Sources 5, 6

Hot yoga

No study has tested hot yoga with heel pain. Its standing series is long, and the NHS advises against standing for long periods, so we'd shorten or sit out standing poses while first-step pain is high (our suggestion).

Sources 27, 9

How much discomfort is OK

Our plantar fasciitis guide's rule: mild to moderate discomfort, up to about 5 out of 10 while loading, is fine if it has settled by the next morning, and your first-step pain should trend down week by week. Sharp heel pain in a pose means come out, sit down and use the seated version.

Often months, in a hospital groupEmerging evidence

In 174 patients seen at a hospital and followed for 5 to 15 years, 80% still had symptoms 1 year after they began and half after 5 years; it lasted longer in women and with both heels affected, and a heel spur made no difference. These figures come from a hospital group, so people looked after by their GP may well do better, and few factors that predict how it goes are known. The NHS says see a GP if it hasn't improved after 2 weeks of looking after it yourself.

Sources 28, 29, 9

Call 999 or go to A&E

From our heel pain guide:

• After an injury, you heard a crack, the foot or ankle has changed shape or points at an odd angle, a bone is sticking out, there is a bad cut over it, you're in severe pain, or the toes look blue or white, feel numb or are cold to touch. These can mean a broken bone. Don't drive yourself.
• A foot or leg that is suddenly cold, pale, numb, weak or very painful without an injury. A sudden loss of blood supply is a vascular emergency.
• A red, hot, swollen foot with a very high temperature, feeling hot, cold or shivery, a fast heartbeat or fast breathing, purple patches on the skin, dizziness or confusion.
• You have diabetes and a foot ulcer with a fever or signs of sepsis, an ulcer with poor circulation, or gangrene.

Get help the same day

• If you think you might have broken your heel bone, don't try to treat it yourself. Contact NHS 111 if you have severe heel pain after an injury; you feel faint, dizzy or sick from the pain; your ankle or foot has changed shape or is at an odd angle; you heard a snap, grinding or popping noise at the time; you can't walk, walk on tiptoe or walk up the stairs; or you have swelling and bruising in your calf and ankle.
• A sudden snap or pop at the back of the heel or calf, or a feeling of being kicked there, then walking flat-footed and being unable to push off, stand on tiptoe or climb stairs: it could be an Achilles tendon rupture (from our heel pain guide).
• You have diabetes and a new foot problem, such as an ulcer or wound, signs of infection, or a hot, swollen foot with a change in colour, even if it doesn't hurt: contact your diabetes foot team or GP (from our heel pain guide).

Source 10

See a GP

• Heel pain that is severe or stopping you doing normal activities, is getting worse or keeps coming back, or hasn't improved after 2 weeks of treating it at home.
• Tingling or loss of feeling in the foot.
• Any foot pain if you have diabetes: foot problems can be more serious.
• Heel pain after a fall, pain at night, or one spot on the heel bone you can point to: a possible stress fracture (from our heel pain guide).
• Burning, tingling, shooting pain or numbness under the heel or behind the inner ankle, especially if it builds with standing or at night: a nerve can be trapped there, and it's often mistaken for plantar fasciitis (from our heel pain guide).

Sources 10, 9

During practice

Sharp heel pain in a standing pose or downward dog means come out, sit down and use the seated version (our suggestion). Stop for chest pain, dizziness or unusual breathlessness, and call 999 for chest pain that doesn't go away. Heel pain in an active child who is still growing is a different condition, often Sever's disease, which has its own guide (as our heel pain guide explains).

Sources 30, 31

"Yoga is proven to fix plantar fasciitis"Strong evidence

No trial has tested yoga for heel pain. Yoga can include the sole and calf stretches and some of the strength work that do have evidence.

Sources 1, 2, 3

"Stretching alone fixes heel pain"Emerging evidence

The sole stretch has the largest short-term effect on first-step pain, but calf stretching alone was no better than a sham over 2 weeks, heavy heel raises gave better function at 3 months than stretching, and recovery often takes months whatever you do.

Sources 2, 5, 7, 28

"Go barefoot to strengthen your feet and fix plantar fasciitis"Mixed evidence

The NHS says try not to walk barefoot on hard surfaces. One small trial found barefoot treadmill walking helped more than walking in shoes, but minimalist shoes added nothing to foot exercises in another, and foot strengthening didn't add to stretching. With numb feet or diabetes, keep shoes on.

Sources 9, 10, 26, 18, 16

"Toe yoga or toe spacers cure plantar fasciitis"Mixed evidence

Neither has been tested for heel pain, and foot-muscle training has limited evidence.

Sources 24, 25, 17

"Hero pose stretches the plantar fascia"Emerging evidence

Hero pose points the ankle and toes. The fascia is stretched most with the ankle and toes bent up together, as in the seated sole stretch or toes-tucked kneeling (cadaver study).

Source 4

"A heel spur means it won't get better"Emerging evidence

In a 5 to 15-year study, having a heel spur at the start made no difference to how plantar fasciitis went.

Source 28