Plantar fasciitis is the most common cause of heel pain in adults, accounting for approximately 80% of presentations according to NICE Clinical Knowledge Summaries. The condition involves inflammation or degeneration of the plantar fascia — the thick band of tissue running along the sole of the foot from the heel bone to the toes. Community pharmacists frequently encounter patients seeking relief, and targeted advice can significantly improve outcomes.
Recognising Plantar Fasciitis in Pharmacy
The hallmark symptom is pain on the underside of the heel, typically worst with the first few steps in the morning or after a period of rest. Patients often describe it as a sharp, stabbing sensation that gradually eases with movement but may return after prolonged standing or walking.
Key features to identify:
| Feature | Typical presentation |
|---|---|
| Location | Medial heel, at the plantar fascia insertion |
| Worst timing | First steps in the morning, after sitting |
| Aggravating factors | Prolonged standing, walking on hard surfaces |
| Easing factors | Gentle movement, rest, ice |
| Duration before seeking help | Typically several weeks to months |
The condition is most common in people aged 40–60, those who are overweight, runners, and people whose work involves prolonged standing — including, notably, pharmacists and pharmacy technicians themselves.
OTC Treatment Options
Oral analgesics
Ibuprofen 400mg three times daily (with food) is the first-line OTC analgesic for plantar fasciitis, combining anti-inflammatory and analgesic effects. For patients who cannot take NSAIDs — those with a history of peptic ulcer disease, asthma triggered by NSAIDs, renal impairment, or who are taking anticoagulants — paracetamol 1g up to four times daily offers analgesic relief without anti-inflammatory action.
A short course of ibuprofen (7–10 days) is generally recommended rather than prolonged use, in line with BNF guidance on OTC NSAID supply.
Topical NSAIDs
Topical ibuprofen gel (5% or 10%) or diclofenac gel applied to the heel and sole can provide localised relief with lower systemic exposure. Evidence for topical NSAIDs in plantar fasciitis specifically is limited compared to their use in superficial musculoskeletal injuries, but NICE CKS lists them as a reasonable option. Advise patients to massage the gel into the affected area three to four times daily.
Insoles and heel cushions
OTC orthotic insoles and silicone heel cups are among the most effective non-pharmacological interventions pharmacists can recommend. A cushioned heel pad redistributes pressure away from the inflamed insertion point, and arch-support insoles can reduce tension on the plantar fascia during walking.
Advise patients to:
- Choose insoles with firm arch support, not just soft padding
- Use them in both shoes to avoid gait asymmetry
- Replace insoles every 6–12 months as they compress with use
- Combine insoles with supportive, well-fitting footwear — avoid flat shoes, flip-flops and worn trainers
Ice application
Applying an ice pack wrapped in a cloth to the heel for 15–20 minutes, two to three times daily, can reduce acute inflammation. Some patients find rolling a frozen water bottle under the arch of the foot particularly effective as it combines cooling with a gentle stretch.
Stretching Advice
Pharmacists can demonstrate or describe two key stretches that NICE CKS recommends:
Calf stretch: Stand facing a wall with the affected foot behind. Keep the back heel on the floor and lean forward until a stretch is felt in the calf. Hold for 30 seconds, repeat three times, perform twice daily.
Plantar fascia stretch: While seated, cross the affected foot over the opposite knee. Pull the toes back gently towards the shin until a stretch is felt along the sole. Hold for 30 seconds, repeat three times, particularly before the first steps of the day.
These stretches are simple, free, and supported by moderate evidence for reducing symptom duration.
When to Refer
Plantar fasciitis is a self-limiting condition in most cases, with 80% of patients recovering within 12 months according to NHS guidance. However, pharmacists should refer to a GP or podiatrist if:
- Pain has persisted for more than two weeks despite OTC treatment and stretching
- The patient cannot weight-bear on the affected foot
- There is numbness, tingling or swelling in the foot
- The pain followed a specific injury or trauma
- Symptoms are bilateral and severe — which may suggest a systemic inflammatory condition
- The patient has diabetes — diabetic foot pathology requires specialist assessment
The Cost of Delay
Many patients tolerate heel pain for months before seeking help, often assuming it will resolve spontaneously. While this is frequently true, delayed management can lead to compensatory gait changes that cause secondary knee, hip or lower back pain. Pharmacists who proactively ask about foot pain — particularly in patients purchasing insoles or pain relief — can identify cases early and improve outcomes.
Pharmacy as First Contact
For the majority of plantar fasciitis presentations, pharmacy intervention with appropriate analgesia, insoles and stretching advice is sufficient. This keeps the patient out of GP waiting lists and provides faster relief. For those who need further investigation, pharmacists can signpost to NHS podiatry services — most areas accept self-referral without a GP appointment.
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