Plantar Fasciopathy Recovery: What This New 12-Month Study Means for Runners and Clinicians | Find Your Stride | Edinburgh Podiatrist

Introduction

Plantar fasciopathy remains one of the most common injuries seen in sports medicine and podiatry clinics. For runners, it can be frustratingly persistent, limiting training volume, altering gait mechanics, and reducing overall quality of life.

A recent Norwegian study by Røe and colleagues sought to answer an important question: How do pain, function, and quality of life change over the first year after treatment for plantar fasciopathy, and can we identify who recovers more slowly? The findings provide useful insights, but they also raise several important questions for clinicians working with active populations.

How do pain, function, and quality of life change over the first year after treatment for plantar fasciopathy, and can we identify who recovers more slowly?

Study Overview

The study followed 200 patients with plantar fasciopathy referred to specialist care in Norway. Participants were randomised to receive:

• Advice plus custom foot orthoses

• Advice plus orthoses and radial extracorporeal shockwave therapy (rESWT)

• Advice plus orthoses and sham-rESWT

• Advice plus orthoses and high-load strength training

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Patients were assessed at baseline, 3, 6, and 12 months for:

• Pain during activity

• Pain at rest

• Foot function

• Physical health-related quality of life

• Mental health-related quality of life

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The authors then examined recovery trajectories over time and explored which baseline characteristics influenced outcomes.

Key Findings

Most Improvement Occurs Early

The most striking finding was that the greatest improvement occurred during the first three months. Pain during activity fell from 6.3/10 at baseline to 4.3/10 at three months and continued improving to 2.8/10 by 12 months. Foot function and quality of life followed a similar pattern. For athletes, this suggests that meaningful recovery should be expected relatively early. If symptoms remain unchanged after several months, clinicians may need to reassess diagnosis, loading strategies, or contributing factors.

Recovery Continues for a Full Year

Although the largest gains occurred early, improvements continued throughout the entire 12-month period. This is important because plantar fasciopathy is often perceived as either “fixed” within a few months or destined to become chronic. The data suggest a more nuanced reality: many patients continue to improve gradually over time. For runners eager to return to peak performance, patience remains an evidence-based treatment strategy.

Bilateral Heel Pain Predicts Worse Outcomes

The most clinically useful finding may be that patients with pain in both heels showed a different recovery trajectory. Individuals with bilateral symptoms improved until around six months but demonstrated little additional improvement between six and twelve months. This pattern was observed for both resting pain and foot function. This has direct implications for sports clinicians:

• Bilateral plantar fasciopathy may represent a more complex condition.

• These patients may require longer follow-up.

• Standard treatment pathways may be insufficient.

• Broader contributors such as training load, systemic factors, central sensitisation, or widespread pain mechanisms may need consideration.

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For runners presenting with bilateral heel pain, clinicians should be cautious about promising a rapid recovery.

What the Study Gets Right

1. It Focuses on Recovery Trajectories Rather Than Endpoints

Many plantar fasciopathy studies focus only on outcomes at one time point. This study examined how recovery unfolds over time, which is arguably more useful clinically. Athletes want to know when improvements should occur, not just whether improvement eventually happens.

2. It Uses Patient-Centered Outcomes

Pain scores, foot function, and health-related quality of life are all highly relevant outcomes for athletes. The inclusion of both physical and mental health measures acknowledges that chronic injuries affect more than tissue pathology alone.

3. It Has Strong Follow-Up

Longitudinal sports injury studies frequently suffer from poor retention. This cohort maintained follow-up rates of approximately 80–90% across the year, strengthening confidence in the findings.

Important Limitations

1. This Was Not a Typical Running Population

One limitation for sports clinicians is that participants were recruited from specialist care.

The average BMI was 28.7, only 23% participated in recreational sport or competition, and nearly half had symptoms lasting more than a year. Consequently, the findings may not translate perfectly to competitive runners, who often present with different biomechanical and training-related drivers.

2. Orthoses Were Given to Everyone

Every participant received customised foot orthoses. While this standardisation helps control variables, it makes it impossible to understand how recovery trajectories compare with modern exercise-only approaches, load management programs, or contemporary running rehabilitation models. Many sports podiatrists now favor individualised loading interventions rather than relying heavily on orthotic therapy.

3. No Untreated Control Group

One of the biggest limitations is the absence of a true control group. Plantar fasciopathy often improves naturally over time. Without a group receiving no intervention, it is impossible to determine how much of the observed recovery resulted from treatment versus natural history.

4. The Shockwave and Exercise Findings Remain Controversial

The study builds upon the authors’ previous work showing no additional benefit from radial shockwave therapy or high-load strengthening when added to advice and orthoses. This contrasts with portions of the broader literature that support shockwave therapy in selected patients. Clinicians should avoid overgeneralising these findings and continue integrating evidence from systematic reviews and clinical experience.

What This Means for Runners

For runners managing plantar fasciopathy, several practical lessons emerge:

• Expect Improvement Within Three Months: Meaningful reductions in pain should typically occur early.

• Don’t Panic if Recovery Is Slow: Progress often continues for up to a year.

• Bilateral Symptoms Deserve More Attention: Pain in both heels may indicate a more persistent condition requiring a broader management approach.

• Function Matters More Than Pain Alone: The study reinforces the importance of tracking functional capacity, not simply pain scores, when guiding return-to-running decisions.

Clinical Takeaway for Podiatrists

This study shifts the discussion from “Which treatment is best?” toward “Which patients recover differently?” The finding that bilateral plantar fasciopathy predicts a distinct and less favorable recovery trajectory may be more clinically valuable than the intervention comparisons themselves. For sports podiatrists, this supports:

• Stratified care pathways

• Closer monitoring of bilateral cases

• Longer-term follow-up beyond six months

• Greater emphasis on individualized rehabilitation and load management

The study also reinforces an uncomfortable reality: despite numerous treatment options, plantar fasciopathy remains a condition where patient education, activity modification, and time continue to play major roles in recovery.

The Bottom Line

Røe et al. provide valuable evidence regarding the natural recovery pattern of plantar fasciopathy and highlight bilateral heel pain as a potentially important prognostic marker. However, clinicians should be cautious when extrapolating the findings to competitive running populations and should recognise the limitations imposed by the lack of a true control group.

The most important message is simple: most patients improve, improvement is greatest in the first three months, and bilateral plantar fasciopathy deserves closer clinical attention.

Citation

Røe C, Heide M, Søberg HL, Brunborg C, Hoksrud AF, Myhre K, Brox JI, Mørk M. One-Year Trajectory of Pain, Function, and Health-Related Quality of Life in Patients With Plantar Fasciopathy. Journal of Foot and Ankle Research. 2025;18:e70067. DOI: 10.1002/jfa2.70067.

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