Patient handout

Plantar heel pain (plantar fasciitis & mimics)

PRODUCTION

1. Your condition

This handout is for plantar heel pain (plantar fasciitis & mimics). Your care team identified this based on: first-step / post-static morning inferior heel pain that eases then worsens with prolonged load (jospt cpg 2023).

Other reasons your team may use this plan: point tenderness at the medial calcaneal tubercle / proximal plantar fascia (jospt cpg 2023); load/running-related inferior heel pain in an active adult (jospt cpg 2014); bilateral heel pain with inflammatory rhythm — screen for systemic enthesitis (jospt cpg 2023; asas).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
education on favourable natural history + activity/load modification + relative rest	—	—	—	Strong recommendation — most resolve within ~12 mo; sets expectations and reduces over-treatment (Crawford Cochrane 2003 PMID 12917892; JOSPT CPG 2023 PMID 38037331)

Plan: Conservative ladder — natural-history-anchored first-line care (JOSPT CPG 2023; ~80–90% resolve <12 mo)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Improving on conservative care

If you have:

First-step pain gradually decreasing over weeks
Able to do stretches and daily activity with manageable pain
No new burning, numbness, or spreading pain

Do this:

Keep doing the plantar-fascia and calf stretches every day — most people improve over many months (JOSPT CPG 2023)
Wear supportive shoes / your orthotic; avoid going barefoot on hard floors
If overweight, continue working toward a healthier weight (a known driver) (Irving 2007 PMID 17506905)
Gradually return to running/standing activity — do not spike your load suddenly

YELLOW — Not improving / plateaued

If you have:

No improvement after ~6–12 weeks of stretching + footwear/orthosis
Pain limiting work or exercise despite first-line care
Chronic symptoms beyond 6 months

Do this:

Contact your provider to review the diagnosis and step up treatment (night splint, supervised rehab, possibly an injection or shockwave therapy) (JOSPT CPG 2023)
Short-course over-the-counter pain relief may help you keep exercising — check with your provider if you have kidney, stomach, heart, or liver problems
Bring up any features that do not fit simple heel pain (both heels, morning stiffness lasting long, night pain, tingling)

Call your provider if:

No improvement after a structured 3–6 month program
Considering a corticosteroid injection — discuss the small chance of fascia tear / heel-pad thinning (Acevedo 1998 PMID 9498581)

RED — Warning features — needs prompt evaluation

If you have:

Sudden "pop"/tearing in the heel or arch collapsing (possible plantar fascia rupture, often after injection)
New numbness, burning, or weakness in the foot
Fever, night pain that wakes you and is not relieved by rest, or unexplained weight loss
Severe heel pain after a sharp increase in running/standing (possible stress fracture)

Do this:

Stop weight-bearing activity / loading and contact your provider promptly
Seek urgent care for fever with heel pain or rapidly worsening neurological symptoms
Tell the clinician about any recent heel injection and your activity history

Call your provider if:

Any of the above red features — these are not typical plantar fasciitis and need imaging or specialist review (JOSPT CPG 2023)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Diffuse heel pain + positive calcaneal squeeze test in a runner / military recruit / osteoporotic / RED-S / training-load-spike patient (JOSPT CPG 2023)
Sudden heel/arch tearing sensation, palpable defect, loss of fascia tension, or arch collapse — especially after corticosteroid injection (Acevedo 1998 PMID 9498581)
Fever, night/rest pain unrelieved by rest, unexplained weight loss, focal bony destruction, or history of malignancy with new heel pain(life-threatening)

5. Follow-up

Counsel that ~80–90% resolve within ~12 months on first-line care (Crawford Cochrane 2003 PMID 12917892; DiGiovanni 2006 PMID 16882901); maintain plantar-fascia/gastroc stretching, weight management, supportive footwear, graded load return. Escalate stepwise only for the refractory minority. Return precautions: sudden heel "pop"/arch collapse (rupture), new burning/numbness (nerve), bilateral/inflammatory features (systemic enthesitis), fever/night-rest pain/weight loss (infection/tumour) (JOSPT CPG 2023)

6. Sources

Guideline: JOSPT/APTA Academy of Orthopaedic Physical Therapy — Heel Pain–Plantar Fasciitis Clinical Practice Guideline, Revision 2023 (Koc, Bise, Neville, Carreira, Martin, McDonough) + 2014 revision (Martin) + Cochrane 2003 (Crawford); reconciled with AOFAS/ACFAS-aligned surgical literature