Plantar heel pain: what works, and how we treat it at Steps

Persistent heel pain can make a working day, a walk or a run difficult. If you have already tried stretches or insoles, the useful question is what should happen next—and why.

For plantar fascia pain, research supports a combination of treatments adapted to the individual. There is no single treatment that reliably works best for everyone. At Steps Podiatry & Gait in Inverness, we use assessment findings, your previous treatment and your activity goals to guide that choice.

First, establish what is causing the pain

Plantar fasciitis, also called plantar fasciopathy, is a common cause of pain underneath the heel. However, heel pain can also involve the fat pad, a nerve, bone or the Achilles tendon. Treatment needs to match the diagnosis. [1,3]

Our heel pain assessment considers your symptoms, changes in activity, footwear and response to previous care. Examination may include the painful tissues, ankle movement, calf strength and how you load the foot. We relate those findings to what you need to do comfortably.

What does the evidence support?

The 2021 best-practice guide recommends plantar fascia stretching, taping and individualised education as the core approach, with an initial review after approximately four to six weeks. This is a review point, not a promise of recovery within six weeks. [2]

The 2023 clinical practice guideline also supports calf stretching and resistance exercise for the foot and ankle. Taping can provide short-term relief alongside other care. Orthoses may be used in combination with treatment; they should not be the only treatment offered. For consistent first-step morning pain, a one- to three-month trial of a night splint is recommended. [1]

How we apply this at Steps

• Make activity manageable. We discuss the demands of work, walking and sport, and agree adjustments to the activities that aggravate your symptoms.
• Choose relevant exercises. Your programme may combine plantar fascia and calf stretches with progressive strengthening. The starting level and progression reflect your examination and tolerance.
• Consider support. Footwear changes, taping or orthoses may help you manage daily activity while rehabilitation progresses. We explain the purpose of each recommendation.
• Measure progress. Useful measures include first-step pain, walking tolerance and your ability to complete the activity that matters to you. These help us decide whether to progress or revise the plan.

This is how we translate the evidence into individual care. If you have already completed a well-structured programme, we review its content and your response rather than automatically restarting it.

When can shockwave help?

Shockwave therapy is a treatment option for persistent plantar fascia pain when an initial programme of exercise, activity adjustment and support has not provided sufficient improvement. The best-practice guide recommends considering shockwave at this stage of care. [2]

At Steps, we assess whether shockwave is appropriate for your symptoms and treatment history. Where recommended, it forms part of a personalised plan alongside rehabilitation and advice on managing activity. We review changes in pain, walking tolerance and function to guide your next steps.

Where does diagnostic ultrasound fit?

Ultrasound can help examine plantar fascia thickness, tissue structure or a suspected tear when these findings would clarify care. A scan supports the history and examination; thickness alone does not determine treatment or readiness to return to sport. [3]

Our diagnostic foot and ankle ultrasound service is integrated with clinical assessment and treatment planning.

A clear next step for persistent heel pain

Your plan should explain the likely diagnosis, what to work on first and how progress will be reviewed. If improvement is limited, we reassess the diagnosis, exercise programme and activity demands before deciding on further treatment.

Explore heel pain assessment at Steps in Inverness and take the next step towards your walking, work or return to sport goals.

Evidence behind this article

1. Koc TA Jr et al. Heel Pain—Plantar Fasciitis: Revision 2023. JOSPT, 2023.
2. Morrissey D et al. Management of plantar heel pain: a best practice guide. BJSM, 2021.
3. Tan VAK et al. Consensus statements and guideline for the diagnosis and management of plantar fasciitis in Singapore. Annals Academy of Medicine Singapore, 2024.

Evidence checked September 2026. This article explains treatment principles; your assessment determines which are appropriate for you.