Plantar Heel Pain: From First Steps to Long-Term Recovery by Mark Corry APA Physiotherapist
Plantar heel pain — especially that sharp pain under the foot when you get out of bed in the morning — is one of the most common foot problems we see in the clinic.
Two recent articles in the British Journal of Sports Medicine give us both a practical roadmap for treatment and a new way of thinking about what happens when pain lingers. Together, they show how to manage plantar heel pain in both the short and long term.
Step 1: Start With the Basics
A 2021 best-practice guide reviewed over 50 clinical trials, expert interviews, and patient feedback. It found three things that work best in the early stages (Barton et al., BJSM 2021):
1. Taping the heel and arch - can quickly reduce “first-step” pain.
2. Stretching the plantar fascia - proven to reduce morning pain.
3. Education & supportive footwear - understanding the condition and wearing shock-absorbing shoes helps you take control. Think of this as your starter toolkit. Many people improve with these simple steps.
Step 2: Add Extra Support if Needed
If pain doesn’t settle after a few weeks, more options may help:
• Shockwave therapy - a machine that delivers sound waves to the heel. Research
shows it can reduce pain when the basics aren’t enough.
• Custom orthoses - can reduce strain and improve comfort, especially if pain
persists after months.
Step 3: When Heel Pain Becomes Long-Lasting
But what about people whose heel pain doesn’t improve after 3 months or more? This is where a newer article helps us rethink what’s going on (Plinsinga et al., BJSM 2025).It turns out that chronic heel pain isn’t always about ongoing injury. In fact, scans often show that the plantar fascia looks normal, even when pain continues.
So why does it still hurt?
• Nervous system sensitivity: Your nerves can become “overprotective,” turning up the pain alarm, even for everyday loads like standing or walking.
• Stress, sleep, and mood: These can amplify pain signals. Pain isn’t “in your head,” but the brain and body work together in how pain is experienced.
• Fear of movement: If you’re worried about making things worse, you may move less. Unfortunately, this can make tissues weaker and the nervous system even more sensitive.
A Whole-Person Approach
For long-lasting heel pain, we need to look at the bigger picture:
• Keep up with the basics (stretching, supportive footwear, taping).
• Add progressive loading exercises to build tissue tolerance and confidence.
• Stay active — movement helps calm an over-sensitive nervous system.
• Improve lifestyle factors like sleep, stress management, and general fitness.
• Remember: “Sensitive, not broken.” Persistent pain doesn’t always mean ongoing damage.
Takeaway
Heel pain is very treatable. If it lasts, it doesn’t mean your foot is damaged beyond repair - it just means we need to consider factors beyond just the foot.
Plantar heel pain recovery often follows a stepwise journey:
1. Start simple - taping, stretching, education, supportive footwear.
2. Add options - shockwave or orthoses if needed.
3. If pain persists - look beyond the heel. Nervous system sensitivity, stress, and lifestyle all play a role.
With the right plan, recovery is possible, whether your pain is new or has been around for months.
References
• Barton CJ, et al. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. Br J Sports Med. 2021;55(19):1106–1118.
• Plinsinga ML, et al. Rethinking chronic plantar heel pain management: moving beyond mechanical models. Br J Sports Med. 2025;59(13):883–884.