Plantar fasciitis: how to keep training around heel pain (and what the evidence supports)

This page replaces a post I published on this site in 2012 under the title “Plantar Fasciitis Treatments: Don’t Let Pain in Heel Keep You Down.” That post was written before the current guideline existed and before the 2015 trial that tested heavy strength training for it. I have been a gym member since the 1990s. Plantar fasciitis is common among people who train because it hits the people who stand, walk and run the most: the JOSPT guideline lists running and weight-bearing work as risk factors. The goal here is narrower than “how to cure it”: how to keep your training going while the heel calms down, and which of the things you will be sold actually have evidence behind them. This is not medical advice. Read it, then talk to a clinician if the red flags below apply to you.

What plantar fasciitis actually is

The plantar fascia is a thick band of tissue that runs from the heel bone to the base of the toes and holds up the arch. Plantar fasciitis is pain where that band attaches at the inside of the heel, and its signature is pain on the first few steps after sleeping or sitting that eases as you move, then comes back after long standing or a run. The 2023 JOSPT clinical practice guideline (Koc et al., J Orthop Sports Phys Ther 2023;53(12):CPG1-CPG39) puts it at roughly 15% of foot complaints, most common between 40 and 60, with a higher incidence in runners and in people whose jobs keep them on their feet. The guideline’s listed risk factors are limited ankle dorsiflexion (a tight calf that will not let the shin travel forward over the foot), high body-mass index in non-athletes, running, and weight-bearing work on surfaces with poor shock absorption.

The “-itis” in the name suggests inflammation, and the guideline is direct that the pathology sits on a spectrum from inflammatory to degenerative. That matters for training: a tissue that is partly degenerative responds to progressive load, not just rest, which is the logic behind the strength protocol below.

One more useful fact from the AAOS page: heel spurs seen on an X-ray are not the cause of the pain. Most people with a spur have no heel pain, and the condition is treated without removing it.

Can I keep working out with plantar fasciitis?

For most people, yes, with one substitution: swap impact for load. The AAOS patient guidance is to decrease or stop the activities that make the pain worse (it names running, dancing and step aerobics), and it explicitly recommends low-impact exercise such as cycling or swimming because it puts less stress on the feet. The NHS gives the same advice and names swimming as an example of exercise that does not put pressure on the feet.

Neither source says to stop lifting, and the treatment trials below have you loading the calf and foot heavily on purpose. The distinction is between impact (each stride or landing yanks the fascia at the heel) and controlled load (a slow heel raise or a leg press, where the force ramps up and down without a collision). Cut the first, keep the second.

What the 2023 clinical practice guideline recommends

The JOSPT guideline is written for physical therapists, but its “Summary of Recommendations” is short enough to read yourself. Here is what it says, condensed. “Should” is the guideline’s action wording; the evidence grade behind it runs from A (strong: stretching, manual therapy, taping, night splints) through B (moderate: dry needling, laser) to C (weak: resistance training). “May” means it is an option; “should not” means the evidence is against it.

Intervention	2023 JOSPT recommendation
Plantar fascia-specific and calf (gastrocnemius/soleus) stretching	Should use, for short- and long-term pain reduction and function
Manual therapy to the joints and soft tissue of the lower leg	Should use
Foot taping (rigid or elastic)	Should use with other treatments, short-term benefit
Resistance training for the foot and ankle muscles	Should prescribe
Night splints, 1 to 3 months	Should prescribe for people with consistent first-step morning pain
Foot orthoses (prefabricated or custom) as the only treatment	Should not use for short-term relief
Foot orthoses combined with other treatment	May use
Dry needling to calf and foot trigger points	Should use
Low-level laser therapy	Should use for short-term pain as part of a program
Therapeutic ultrasound added to stretching	Should not use
Electrotherapy (iontophoresis, interferential current)	Second line; manual therapy, stretching and orthoses come first

Two things stand out for a gym-goer. First, the cheap, do-it-yourself items (stretching, heel raises, a night splint) all carry a “should.” Second, the thing most people buy first, an insole, gets a “should not” when it is used alone for short-term relief. The guideline also notes imaging is usually not needed until conservative care fails; a weight-bearing X-ray is the first study when it is.

Does strength training help? The Rathleff trial

The best-known strength trial is Rathleff et al. 2015 (Scand J Med Sci Sports 2015;25:e292-300). Forty-eight people with ultrasound-confirmed plantar fasciitis all received shoe inserts, then were randomized to either daily plantar-fascia stretching or high-load strength training every second day. The strength exercise was a single-leg heel raise on a step with a towel rolled under the toes so the big toe is pulled up, which tensions the fascia while the calf works. The primary outcome was the Foot Function Index (FFI), a 0-to-100 score where lower is better.

Follow-up	Strength group vs stretch group (FFI)	Statistically different?
3 months (primary endpoint)	Strength group 29 points lower (95% CI 6 to 52)	Yes, P = 0.016
1, 6 and 12 months	No between-group difference	No (P > 0.34)
12 months, change from baseline	Strength: 22-point improvement (95% CI 9 to 36); stretch: 16 points (95% CI 0 to 32)	Both improved

The honest reading: heavy loading got people better faster, and by a year everyone had improved about the same amount. The JOSPT guideline describes the 3-month result as a large effect (0.81) and reports the strength group also had less foot pain at that point, but it also cites a later trial (Thong-On et al.) where a strengthening program and a stretching program were equal at 6 weeks, and concludes there is not enough evidence to name a superior type of exercise. A 2019 trial by Riel et al. (J Physiother 2019;65:144-151), cited in the 2023 guideline, compared a self-dosed heavy-slow heel-raise program to a fixed one progressing from 12-rep max to 8-rep max, every other day, and found no difference, which suggests the exact loading scheme matters less than doing it heavy, slow and consistently.

The protocol as published in the abstract and guideline: unilateral heel raises with a towel under the toes, high load, progressive, every second day. The later Riel trial used heavy-slow reps. If you want a starting point that matches the Riel description, work in the 12-rep-max range and progress toward 8-rep max by adding weight (a loaded backpack or a dumbbell in the free hand). Expect some discomfort during the set; sharp pain that lingers afterward means the load is too high for today.

Which stretch works: plantar fascia or calf?

Both are in the guideline, but if you are going to do one, the evidence favors the plantar-fascia-specific stretch. DiGiovanni et al. 2003 (J Bone Joint Surg Am 2003;85:1270-7) randomized 101 people with chronic heel pain (at least 10 months) to eight weeks of either a plantar-fascia stretch or a standard Achilles stretch. Everyone got soft insoles and a short course of an anti-inflammatory. The fascia-stretch group did significantly better on worst pain (P = 0.02) and first-step morning pain (P = 0.006) and reported higher satisfaction.

The stretch itself, as AAOS describes it: sit, cross the sore foot over the other knee, grab the toes and pull them toward the shin until the band on the sole feels tight, hold 10 seconds, repeat 20 times, best done before your first steps in the morning. The calf stretch (hands on a wall, back knee straight, heel down, hips forward) is a reasonable add because limited ankle dorsiflexion is a listed risk factor.

Do insoles, orthotics and night splints work?

Insoles are where people spend money first, so this deserves precision. The Whittaker 2018 meta-analysis (Br J Sports Med 2018;52:322-328) pooled 19 randomized trials with 1,660 participants. In the short term (up to 6 weeks) there was very low-quality evidence that orthoses do not reduce pain. In the medium term (7 to 12 weeks) there was moderate-quality evidence that they beat sham inserts, with a standardized mean difference of -0.27, which the authors call uncertain in clinical importance. Beyond 12 weeks, again very low-quality evidence of no benefit. Custom and prefabricated inserts were no different at any time point. That last line is the money-saving one: a prefabricated insert is not measurably worse than a custom orthotic.

Night splints get a stronger endorsement, but only for a specific pattern. The JOSPT guideline says clinicians should prescribe a 1- to 3-month program for people who consistently have first-step morning pain. If your pain is mostly after long standing and not first thing in the morning, the splint is aimed at the wrong symptom.

What shoes should I wear?

Neither the guideline nor the trials grade footwear, so this section is patient guidance rather than trial evidence. The NHS advises shoes with cushioned heels and good arch support, insoles or heel pads, and says not to wear high heels, tight pointed shoes, flip-flops or backless slippers, and to avoid walking barefoot on hard floors. AAOS makes the same point mechanically: each heel strike puts tension on the fascia, and a cushioned shoe or insert reduces that tension. It also notes that soft silicone heel pads are inexpensive. If you train in flat, hard-soled lifting shoes, that is fine for the platform but a poor choice for the walk from the parking lot; change shoes.

Training swaps that keep volume without heel impact

The point of the swap is to keep your weekly minutes and your strength work intact while removing the collision. Here is how the common options compare. Heel impact is described, not measured; the AAOS and NHS pages support cycling and swimming as low-impact choices, and the ratings in the other rows are reasoning about where the force goes, not measurements or trial results.

Activity	Heel impact	What it keeps	Watch for
Running, jumping, step class	High, every stride	Nothing you cannot get elsewhere for now	This is what you cut
Stationary bike	Low; force through the forefoot on the pedal	Cardio volume, leg endurance	Set the seat high enough that the heel is not dropping under load
Rowing machine	Low; heel presses into the footplate on the drive	Full-body cardio, back and legs	Some people feel the heel on the catch; loosen the strap and test
Swimming, pool running	Near zero	Cardio without any foot load	Push-offs from the wall on the sore heel
Elliptical	Low	Cardio volume	Long sessions can still irritate a very sore heel
Seated or supine lifting (leg press, hamstring curl, bench, rows, pulldown)	Near zero	Strength and muscle	Leg press with the heel fully loaded may sting; shift pressure to mid-foot
Standing heavy lifts (squat, deadlift)	Low but the heel is loaded	Strength	Fine for many; stop if it reproduces the sharp heel pain
Single-leg heel raises with a towel under the toes	The treatment itself	Calf and foot strength	Every second day, not daily, per the trial

A simple weekly template: two or three bike or row sessions for the cardio you would have run, your normal upper-body and machine lower-body lifting, the heel-raise protocol three or four times a week on alternating days, and the fascia stretch every morning before standing. Total volume stays roughly where it was; only the impact minutes change.

When should I see a clinician?

Self-care is reasonable for a typical case, but the NHS lists specific triggers for seeing a clinician: pain that is severe or stops normal activities, pain that keeps getting worse or keeps coming back, no improvement after 2 weeks of self-care, tingling or loss of feeling in the foot, and any foot pain if you have diabetes. AAOS lists the conditions a doctor is ruling out on exam: insertional Achilles tendinitis, calcaneal stress fracture and plantar nerve entrapment. The JOSPT guideline adds spondyloarthritis, fat-pad atrophy and plantar fibroma to the differential when symptoms do not match the classic pattern or do not respond to treatment. A stress fracture in particular does not get better with “train through it,” so a heel that hurts with every step rather than mainly on the first steps deserves a look.

If simple care stalls, the escalation path both sources describe is physical therapy, then options such as corticosteroid injection or shockwave therapy, with surgery rare. Also worth knowing: AAOS advises not to use over-the-counter NSAIDs for more than a month without talking to your primary care doctor.

Where to buy / how to save

• Planet Fitness is one of the cheapest ways to get the swaps above under one roof: bikes, rowers, ellipticals and a machine circuit. On 09/28/2026 the Classic membership started at $15 a month and the PF Black Card at $24.99, plus a startup fee that varies by club, the $49 annual fee and taxes. If you are cutting running for two or three months, a low-cost membership is a cheaper bridge than buying a bike. Some clubs attach a 12-month commitment to Classic, so for a two- or three-month bridge pick a no-commitment plan. See the Planet Fitness deals page for the current offers and the referral terms.
• Garmin watches earn a place here for one reason: they log the swap. If you track cycling, rowing and pool time as separate activities, you can see that your weekly minutes (and, on models that report it such as the Forerunner 570 and 970, your training load) stayed the same while your running minutes went to zero, which keeps the “I am losing fitness” feeling from pushing you back to running too early. Buy one for that, not as a treatment.

Neither merchant sells anything that treats plantar fasciitis. The interventions with a guideline “should” behind them cost a step, a towel and something heavy to hold.