Plantar fasciitis is the most common cause of heel pain and one of the most frequently seen foot conditions in NHS clinics across the UK. Despite being so common, it is often misunderstood — many people suffer for months before getting the right information. This guide explains exactly what the condition is, why it causes pain, who is most at risk, and what you can do about it.
The plantar fascia is a strong, thick band of fibrous tissue that runs along the sole of your foot. It connects the heel bone (calcaneum) to the base of the toes and spans the entire length of the arch.
It performs two critical functions. First it acts as a shock absorber, cushioning the impact of every step you take. Second it supports the arch of the foot, helping distribute your body weight evenly across the foot during walking, running and standing.
Think of it as a thick elastic band running from your heel to your toes. Every time you walk it stretches and recoils, absorbing force and springing you forward into the next step.
The plantar fascia handles enormous mechanical loads. During normal walking it absorbs forces equivalent to your full body weight with every step. During running this increases to two to three times your body weight. Over thousands of steps per day, even small increases in load can cause cumulative damage.
Plantar fasciitis develops when the plantar fascia is placed under more load than it can comfortably absorb. This causes tiny tears in the tissue — most commonly at the point where the fascia attaches to the heel bone.
These micro-tears trigger an inflammatory response as the body attempts to repair the damage. However if the load continues — through continued walking, standing or activity — the tears accumulate faster than they can heal. Over time the tissue becomes damaged and painful.
In some longer-standing cases, rather than active inflammation, the tissue undergoes a process of degeneration — breaking down structurally rather than becoming inflamed. This distinction matters for treatment, which is why chronic plantar fasciitis (lasting over 6 months) can behave differently to a fresh acute case.
The fascia is stressed beyond its capacity through activity, load or poor biomechanics.
Tiny tears develop at the heel attachment. The body triggers an inflammatory response.
The inflamed or degenerated tissue causes the characteristic pain pattern — worst after rest, easing with movement.
Plantar fasciitis is far more common than most people realise.
People will develop plantar fasciitis at some point in their lifetime
Source: Rotherham Doncaster and South Humber NHS Foundation Trust
Of the general population are affected at any given time — making it one of the most common musculoskeletal conditions
Source: Royal Berkshire NHS, clinical data
More common in women than in men, though it affects all genders
Source: Rotherham Doncaster and South Humber NHS Foundation Trust
The age range where it is most prevalent, though it can occur at any age
Source: University Hospitals Plymouth NHS FT
Plantar fasciitis accounts for approximately 15% of all foot injuries and around 8% of all running injuries. It is also known informally as policeman's heel — a reference to its prevalence in people who spend long hours on their feet.
Plantar fasciitis can affect anyone but certain factors significantly increase the likelihood of developing it. The NHS identifies the following as the main risk factors.
Starting a new exercise programme, significantly increasing your running distance or mileage, or starting a job that involves much more walking or standing than you are used to. The plantar fascia needs time to adapt to increased load.
Source: Hull University Teaching Hospitals NHS Trust
Jobs that involve standing on concrete, tile or other hard flooring for extended periods place sustained load on the plantar fascia with little recovery time. Teachers, nurses, retail workers, chefs and factory workers are particularly affected.
Source: East Lancashire Hospitals NHS Trust
A higher BMI increases the mechanical load on the plantar fascia with every step. The Royal Orthopaedic Hospital NHS FT identifies this as one of the most common contributing factors, particularly in non-athletic populations.
Source: Royal Orthopaedic Hospital NHS FT
Shoes with inadequate cushioning, poor arch support, worn-out soles or a completely flat base all increase strain on the plantar fascia. Walking barefoot on hard floors is also a significant risk factor.
Source: NICE Clinical Knowledge Summary
Tightness in the calf muscles and Achilles tendon limits ankle flexibility (dorsiflexion), which transfers more load to the plantar fascia during walking. The Royal Orthopaedic Hospital NHS FT notes that most people with plantar fasciitis have notably tight calves.
Source: Royal Orthopaedic Hospital NHS FT
Both foot types reduce the foot's natural ability to absorb and distribute impact force efficiently. Flat feet cause the fascia to overstretch. High arches cause it to be placed under constant tension. Neither is more problematic than the other — both increase risk.
Source: Royal Orthopaedic Hospital NHS FT
As we age the plantar fascia naturally loses some of its elasticity and the fat pad under the heel thins, reducing natural shock absorption. This is why the condition is most common in the 40 to 60 age group, though it affects people of all ages including teenagers and young adults.
Source: University Hospitals Plymouth NHS FT
Conditions such as rheumatoid arthritis and ankylosing spondylitis cause inflammation at the points where ligaments and tendons attach to bone (enthesopathy). The plantar fascia attachment at the heel is one of the most commonly affected sites in these conditions.
Source: Royal Orthopaedic Hospital NHS FT
NHS clinicians distinguish between two stages of the condition, and understanding which stage you are in helps set realistic expectations for recovery.
In the acute phase symptoms will typically come and go. You may have several good days followed by a flare-up. During this phase the condition often responds well to consistent stretching, footwear changes and activity modification.
Kingston and Richmond NHS FT advise that acute plantar fasciitis often settles without significant intervention if the right self-care steps are followed.
If symptoms persist beyond 6 months the condition is considered chronic. Chronic plantar fasciitis can be more difficult to treat and may require a combination of interventions including physiotherapy, orthotics, shockwave therapy or in rare cases steroid injection.
The good news is that even chronic plantar fasciitis responds well to treatment — approximately 90% of cases resolve successfully with conservative management.
An important note: NIHR Evidence (2021) reviewed 51 studies and found that plantar fasciitis is NOT simply a self-limiting condition that always resolves on its own. Some people suffer for years without improvement if the right treatment is not applied. This is why consistent exercise and self-care from the start matters.
Yes — the vast majority of cases do improve significantly with the right approach. Approximately 90% of people with plantar fasciitis see successful resolution with conservative treatment alone, without the need for injections or surgery.
However recovery takes time. Most people see meaningful improvement within 6 to 12 weeks of consistent daily stretching and exercise. Full recovery can take anywhere from a few months to 18 months in more persistent cases.
The key word is consistent. Doing your stretches occasionally will produce much slower results than doing them every day. NHS physiotherapy guidance emphasises that consistency matters far more than intensity.
Resolve within 6 to 12 months with consistent self-care, stretching and appropriate footwear.
Take 12 to 18 months, particularly if the condition was chronic before treatment started.
May need NHS physiotherapy, shockwave therapy or steroid injection. Surgery is rarely required.
Plantar fasciitis is a clinical diagnosis. This means your GP or physiotherapist can diagnose it through a conversation about your symptoms and a physical examination of your foot — without the need for scans or blood tests in most cases.
The diagnostic criteria used by NHS clinicians include:
The Windlass Test is a clinical assessment used by physiotherapists and podiatrists. It involves passively extending the big toe while weight-bearing. If this reproduces your heel pain it is a positive result and a strong indicator of plantar fasciitis. The Windlass Test is a clinical assessment performed by a qualified physiotherapist or podiatrist — it cannot be reliably self-administered at home. If you suspect plantar fasciitis, a physiotherapist can perform this test as part of a proper assessment. Self-referral to NHS physiotherapy is available in many areas without needing a GP appointment first.
Imaging such as X-ray or ultrasound is not routinely required. An X-ray may be ordered if a heel spur needs to be identified, a stress fracture is suspected, or symptoms are not responding as expected. An ultrasound can show thickening of the plantar fascia, which supports the diagnosis, but is not needed to begin treatment.
Compare your pain to the full list of plantar fasciitis symptoms and patterns described on our symptoms page.
See Symptoms GuideBegin the NHS-backed 10-exercise programme today. The stretches alone can make a significant difference within days.
Get the ExercisesFrom home care to NHS physiotherapy and shockwave therapy — know what is available to you on the NHS and privately.
See Treatment OptionsThe full breakdown of every symptom with detailed explanations.
Read moreA key risk group — why running causes plantar fasciitis and how to recover.
Read moreEvery treatment option explained from home care to NHS specialist treatment.
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