Plantar heel pain is best managed with a combined plan of education, load adjustment, stretching, taping and progressive strengthening; heavy heel raises may speed early improvement but no single treatment is clearly superior
Interpretation
Plantar fasciitis affects 4.5-10% of runners (Lopes 2012, 8 studies, about 3,500 runners). In 48 patients, heavy heel raises beat stretching by 29 Foot Function Index points at 3 months but not at 1, 6 or 12 months (Rathleff 2015); in 70 patients, self-dosed and fixed heavy-slow programmes were similar and few reached an acceptable symptom state by 12 weeks (Riel 2019). A best-practice guide from 51 RCTs (Morrissey 2021) prioritises education, footwear advice, taping and stretching; the 2023 APTA guideline gives stretching, taping and manual therapy grade A and resistance exercise grade C (Koc 2023); a network meta-analysis of 31 RCTs found no treatment clearly superior (Babatunde 2019). Recovery is often slow: 46% of 174 patients still had symptoms about 9 years later (Hansen 2018). Gaps: clinic patients rather than runners or triathletes, small trials, no trials of running load during treatment.
Practical implication
Act early on morning heel pain during a run build: reduce and reshape running rather than stopping all activity, keep fitness on the bike and in the pool, use stretching, taping and progressive heel raises as part of a combined plan, and expect months rather than weeks. Get assessed for pain at rest, at night, with swelling or numbness, or worsening with each run. Based on clinic populations, not triathletes.
Sources
8 sources, independently verified.
Shoe inserts plus progressive high-load single-leg heel raises with a towel under the toes every second day vs inserts plus daily plantar-specific stretching. Foot Function Index 29 points better in the strength group at 3 months (95% CI 6-52, P = 0.016); no between-group differences at 1, 6 or 12 months. Small clinic sample; both groups also used inserts.
12 weeks of heavy-slow standing heel raises, self-dosed (as many heavy sets as possible, load no lighter than 8RM) vs a pre-determined progression. No meaningful difference in pain (FHSQ adjusted MD -6.9, 95% CI -15.5 to 1.7). Only 3/35 and 1/35 reached an acceptable symptom state; neither regimen was sufficient for most people within 12 weeks.
Mixed-methods guide: systematic review of 51 RCTs (4,351 participants), interviews with 14 experts and a survey of 40 patients. Core treatment: education, footwear advice, taping and stretching as self-management; shockwave second-line; custom foot orthoses third-line.
APTA clinical practice guideline. Grade A: manual therapy, plantar fascia and calf stretching, taping for short-term relief, night splints for persistent first-step pain. Grade B: avoid orthoses alone for short-term pain; dry needling. Grade C: therapeutic exercise including resistance training; orthoses combined with other treatment. Risk factors to assess: limited ankle dorsiflexion, running, work-related weight-bearing, higher BMI in non-athletic people.
Network meta-analysis of 31 RCTs (2,450 adults). No commonly used treatment clearly better than others; corticosteroid injection and shockwave ranked most likely effective across time points; exercise beneficial for long-term pain and function. Evidence described as equivocal, with sparse comparisons.
8 studies, about 3,500 runners, 28 running injuries. Main injuries were medial tibial stress syndrome, Achilles tendinopathy and plantar fasciitis; plantar fasciitis incidence 4.5-10.0% and prevalence 5.2-17.5%. General runners, not triathletes.
51 studies (1 prospective, 46 case-control, 4 cross-sectional). Higher BMI was the only significant clinical association, strongest in non-athletic subgroups; thicker plantar fascia and other imaging findings associated; mechanical foot and ankle measures lacked supporting evidence. Mostly case-control designs.
At follow-up 54% were asymptomatic (mean symptom duration 725 days) and 46% still had symptoms. Women and bilateral heel pain predicted persistence; heel spurs did not affect prognosis. Clinic population, not runners.