Plantar fasciitis exercises: what actually helps, according to the 2023 guideline

I'm not a clinician. I'm the co-founder of a small exercise app for heel pain, and that job has meant spending a lot of time with the 2023 clinical practice guideline on heel pain. This is my plain-language summary of what it says about exercise, plus the couple of studies behind it. It's not medical advice. If your heel hurts, a physio or doctor who can look at your foot is the right person to ask.

The heel pain that starts before breakfast

Most people with plantar fasciitis describe the same morning. The first few steps out of bed are the worst. There's a sharp pull under the heel, it settles a bit once you're walking around, and then it comes back when you stand up after sitting for a while.

The plantar fascia is a thick band of tissue that runs from the heel bone to the toes. When it's irritated, it usually hurts right where it attaches to the heel. The 2023 guideline calls plantar fasciitis the most commonly recognized cause of pain under the heel.

The guideline is useful because it grades each option by how strong the evidence is, with A as the top grade.

What the guideline actually recommends

The parts I found most useful:

• Stretching the plantar fascia and the calf gets an A.

• Strength training for the calf gets a B.

• Manual therapy, meaning hands-on work done by a clinician, gets an A when it's paired with stretching.

• Night splints worn for one to three months get an A for people who keep having pain on their first steps in the morning.

• Insoles and arch supports on their own get a B against. In other words, don't rely on them alone. Combined with stretching and strength work, they get a C.

• Learning to adjust the load on your feet at work, in sport and in daily life gets an E, which means it rests on expert reasoning rather than trials.

So the two things you can do at home, with the best support behind them, are stretching and building calf strength.

Stretching the calf and the arch

Three stretches keep coming up.

Plantar fascia stretch. Sit down, cross the sore foot over the other knee and pull your toes back toward your shin. You should feel it along the arch, not in the calf.

Calf stretch. Hands on a wall, sore leg back, knee straight, heel on the floor, hips forward. You feel this one higher up. A tight calf keeps tugging on the heel, so it still matters.

Soleus stretch. Same position, but bend the back knee. The stretch drops lower, closer to the heel. That's the deeper calf muscle, and it only really lets go with the knee bent.

Timing seems to matter as well. In a 2003 trial of 82 people with long-term heel pain, one group did the plantar fascia stretch before standing up in the morning, before their foot touched the floor. After eight weeks they had less pain on those first steps than the group who only stretched the calf. Stretching on the edge of the bed, before you limp to the kitchen, is an easy habit to try.

Strength work and the towel heel raise

A 2015 trial followed 48 people with plantar fasciitis. Everyone got shoe inserts. One group stretched the plantar fascia every day. The other group did slow, heavy heel raises every other day.

The heel raise was done standing on one leg on a step, with a rolled-up towel under the toes. Three seconds up, a two second pause at the top, three seconds down. The towel bends the toes back, so the plantar fascia is under tension while the calf does the work. As it got easier, people added weight, like a backpack.

At three months, the heel raise group was clearly ahead on pain and daily function. At twelve months, the two groups were about even. So the strength work didn't seem to make the end result bigger. It got people there sooner. That's a big part of why the guideline supports doing both.

One honest caveat: the towel version is hard. If your heel is very sore, starting straight away with loaded one-leg raises can be too much. A gentler path is seated heel raises first, then raises on both feet, then holding at the top, and only then the towel version. A simple rule that works for a lot of people: if an exercise pushes your pain to around 6 out of 10, stop for the day.

What to ease off on

The guideline doesn't ban specific exercises. It talks about load. The real question is whether what you did today is more than your heel can recover from overnight.

The usual suspects are jumping, sprinting and walking barefoot on hard floors first thing in the morning, when the tissue is at its stiffest. If you run, you don't necessarily have to stop. Keep the stretches going and cut back whatever makes the next morning worse. Your first steps the day after are a pretty honest report card.

If you also have pain at the back of the heel, near the Achilles, be careful with deep heel drops off the edge of a step and get that side checked first.

How long it usually takes

The honest answer is months, not weeks. A 2020 review reported that about 90 percent of people get better with non-surgical care like stretching and shoe inserts, often within three to six months. Some take longer, and a smaller group still has pain after a year.

Nobody can promise you a timeline. What the research does suggest is that sticking with stretching and calf strength work, and not overloading the heel, gives it a fair chance.

When to see a clinician first

Exercise isn't the right first step for every sore heel. Talk to a doctor or physio before starting if:

• the pain started after an injury or a fall

• you can't put weight on the foot, or you're limping

• there's numbness, tingling, burning, swelling, warmth or redness

• you have a fever or feel unwell

• the pain wakes you at night

• it's sharp, or getting worse even after easing off

• squeezing the sides of the heel hurts, or the pain built up after you added running mileage, since both can point to a stress fracture

• you have diabetes, reduced feeling in your feet or poor circulation

• both heels hurt and other joints are swollen or stiff

• it hasn't improved after several weeks of exercise and a lighter load

Where to go from here

If you'd like the exercises laid out with starting doses, pictures and the study references, there's a free guide to plantar fasciitis exercises on our site.

My short version: stretch before your first steps, build calf strength slowly, and notice how your heel feels the next morning.

This article is general information, not medical advice. I'm not a doctor or physical therapist. Please talk to a qualified clinician about your own heel pain.

Rahim Hudaykylyyev is the co-founder of Walkito, an exercise app for heel pain and flat feet. He is not a clinician.