LASER therapy for heel pain: what the 2025 review found about plantar fasciitis

Introduction

We see heel pain every day in clinic: weekend runners with a niggle that becomes persistent, parents bringing in kids stiff first thing in the morning after school sport, netballers who swear the pain is worse after ladders and change of direction. A January 2025 systematic review in Lasers in Medical Science pooled controlled trials of LASER therapy for plantar fasciitis and found generally reduced pain scores and no reported adverse events. That sounds promising. The question for us is where LASER fits into real-world heel pain treatment on the Central Coast, and which patients might benefit.

What we see

Patients describe sharp or burning pain around the heel on first steps in the morning, pain with prolonged standing or after a run, or gradual worsening over weeks. On examination we commonly find focal tenderness at the medial calcaneal border, a positive windlass test, tight calves, reduced single-leg heel raise endurance and sometimes a thickened plantar fascia on ultrasound. Runners often report recent load spikes, new shoes or changes in training surface. Kids can present similarly after repetitive jumping in school sport. Plantar heel pain and plantar fasciitis are the terms we use most, but the clinical picture is what guides us.

Why it's happening

Heel pain in plantar fasciitis is primarily a load problem. The plantar fascia and surrounding tissues are exposed to repetitive tensile and compressive forces; if recovery is insufficient the tissue becomes painful. Contributing factors we see in clinic include calf weakness or tightness, poor foot posture, sudden increases in running volume or intensity, and pressure patterns that overload the medial heel. There are biochemical and microvascular changes in and around the fascia that relate to pain, which is why treatments that change loading and improve tissue tolerance are central. LASER is proposed to reduce pain and inflammation and improve local microcirculation, but it does not fix the load issue by itself.

What we test

Our assessment targets load tolerance and movement. Typical tests we perform are:

• Palpation of the medial calcaneal tubercle and plantar fascia along its length
• Windlass test and single-leg heel raise to assess plantar fascia and calf function

When needed, we also measure strength so rehab is based on more than symptoms alone.

• Ankle dorsiflexion range, subtalar and midfoot mobility
• Gait and running assessment, looking for overstriding, cadence issues or excessive pronation
• Pressure or force mapping when available to show heel loading patterns (we use pressure analysis occasionally to guide footwear and offloading)
• Imaging only when the diagnosis is unclear or conservative care fails

These tests tell us what is driving the pain and what we need to change. LASER addresses symptoms; our job is to identify the mechanical drivers.

What actually changes it

Effective heel pain treatment is multi-factorial: reduce offending load, rebuild strength and capacity, and address pain so the patient can progress. From our clinic experience and the 2025 review, LASER looks useful as an adjunct for symptom relief. The review found that both high-intensity and low-intensity LASER protocols, across a small number of studies, tended to reduce pain scores versus comparators and did not report adverse events. Study methods and dosing were variable, so it is not a single recipe.

How we use that information in clinic

• Start with load management: modify running volume or sport load, use relative rest rather than complete rest, and remove sharp load spikes. For school-aged kids this might mean temporary limits on jumping or match minutes.
• Address calf and intrinsic foot strength with progressive, task-specific loading. We prescribe graded heel raises and functional strength that transfer to running and netball movements.
• Correct footwear and consider temporary offloading with taping or an orthotic if pressure mapping or exam suggests it.
• Introduce LASER selectively when pain is limiting rehab progression despite initial load and strength adjustments. The review suggests LASER can reduce pain and help patients engage with strengthening and return-to-sport plans. In our practice we use it as part of a package rather than a standalone cure.

Practical notes on LASER in clinic

• Expect variability: the literature used different wavelengths, intensities and treatment schedules. Typical clinical programs in studies ranged from a few sessions to a couple of weeks of therapy. That means we tailor the dose and monitor response rather than copy a single protocol.
• Safety: the review reported no adverse events, which aligns with our experience when contraindications are respected.
• Progression matters: symptom reduction from LASER is useful if it lets a patient tolerate the loading needed to rebuild tissue capacity. Without that, pain may return when activity increases.

When to consider LASER and when to prioritise other options We consider LASER when a patient has persistent plantar heel pain after 4 to 8 weeks of sensible load modification and early strengthening, and when pain limits their ability to complete rehab. We prioritise load-based treatments and strengthening first because those produce longer-lasting change in tissue tolerance. If a patient needs quicker pain relief to re-enter training, LASER can be an adjunct. For recalcitrant cases we discuss wider options, including shockwave therapy or imaging-guided interventions, but only after a clear mechanical plan has failed.

What people get wrong

• Thinking LASER is a stand-alone fix. The review supports symptom benefit, but without addressing the mechanical causes, pain commonly returns.
• Misdiagnosis. Heel pad contusion, nerve entrapment or referred pain can mimic plantar fasciitis. Treatment aimed only at the plantar fascia will fail if the problem lies elsewhere.
• Relying solely on stretching. Stretching has a role, but strengthening and graded loading change tissue capacity; that is what reduces recurrence.
• Expecting immediate return to previous training load. Tissue adaptation is slow, and guided progression is essential to avoid relapse.

How we manage running heel pain on the Central Coast A typical runner we see from Tuggerah or Terrigal will get a focused plan: short-term pain control and LASER if indicated, a graded calf and plantar fascia loading program, gait tweaks to reduce peak load, footwear advice and regular follow-up to increase load tolerance. That approach gets people back to running and netball without repeating the same mistakes.

When to come in

If heel pain persists beyond a few weeks despite reducing hard training, or if first-step pain is severe and limits daily activities, come in for a targeted assessment. We'll test strength, movement and loading patterns and discuss whether LASER is a helpful adjunct in your case, whilst we dont surrently have LASER as a treatment option, if desired we can help source that for you.

Final note

LASER therapy for plantar fasciitis looks safe and can reduce pain, but in clinic we would refer for it to support load-based rehabilitation and strength work. That combination is what changes outcomes for runners, weekend athletes and active kids across the Central Coast.