Plantar fasciitis is one of the most common causes of pain underneath the heel. It can affect runners and athletes, but it is also commonly seen in people who spend long periods standing or walking throughout the day.
A classic feature is heel pain during the first few steps after getting out of bed in the morning or after sitting for an extended period. For some people, the pain settles as they start moving before becoming more noticeable again later in the day.
While the term plantar fasciitis is widely used, persistent plantar heel pain is more complex than simply inflammation of the plantar fascia. Current research supports a combination of education, appropriate load management, stretching and progressive strengthening rather than relying solely on passive treatments (Koc et al., 2023; Morrissey et al., 2021).
At Trilogy Physiotherapy in Sinnamon Park, we assess plantar heel pain to determine what may be contributing to your symptoms and develop a rehabilitation plan around your activity levels and goals.
What Is the Plantar Fascia?
The plantar fascia is a strong band of connective tissue that runs along the underside of the foot from the heel towards the toes.
It plays an important role in supporting the foot and transferring load during activities such as standing, walking and running.
Plantar heel pain commonly develops around the attachment of the plantar fascia near the heel.
Although it has traditionally been called plantar fasciitis, the condition is not always best understood as simply an inflammatory problem, particularly when symptoms have been present for an extended period (Koc et al., 2023).
This is why treatment often needs to focus on gradually improving the capacity of the foot and lower leg rather than simply trying to reduce inflammation.
What Are the Common Symptoms of Plantar Fasciitis?
The most common symptom is pain underneath or towards the inside of the heel.
People with plantar fasciitis may experience:
• Heel pain during the first few steps in the morning
• Pain when walking after sitting for a period of time
• Pain following prolonged standing or walking
• Heel pain during or after running
• Tenderness around the underside of the heel
• Stiffness through the foot or calf
• Symptoms following an increase in exercise or activity
First step pain after rest is one of the characteristic features considered during assessment of plantar heel pain (Koc et al., 2023).
Symptoms can vary considerably between individuals. Some people find the heel becomes more comfortable once they start moving, whereas others notice symptoms progressively increase throughout the day.
What Causes Plantar Fasciitis?
There is rarely one single cause of plantar heel pain.
Symptoms can occur when the demands placed on the plantar fascia and surrounding tissues exceed their current capacity to tolerate those demands.
This may follow changes such as:
• Increasing running distance
• Increasing running speed or hill training
• Returning to exercise after a break
• Starting a new gym or sporting program
• Increasing the amount of walking you are doing
• Spending longer periods standing at work
Other factors such as ankle movement, calf and foot strength, footwear, physical conditioning and general health may also be relevant depending on the individual (Morrissey et al., 2021).
Importantly, plantar fasciitis should not automatically be blamed on having flat feet or high arches. Foot posture is only one possible consideration and does not tell us the entire story.
A physiotherapy assessment should consider the individual rather than assuming everybody with heel pain has the same underlying problem.
Is All Heel Pain Plantar Fasciitis?
No.
Although plantar fasciitis is common, there are other potential causes of heel pain.
These can include:
• Heel fat pad related pain
• Achilles tendon problems
• Bone stress injuries
• Nerve related symptoms
• Other foot and ankle conditions
The location of your pain, how your symptoms behave, your recent activity and the findings from your physical assessment can help determine whether your presentation is consistent with plantar fasciitis.
If your symptoms do not behave as expected or another condition is suspected, further medical investigation may sometimes be appropriate.
Do You Need a Scan for Plantar Fasciitis?
Not necessarily.
Many cases of plantar heel pain can be assessed clinically without immediately requiring an X ray, ultrasound or MRI.
Imaging may be considered when the symptoms are unusual, there has been significant trauma, a bone stress injury is suspected, symptoms are not improving as expected or another diagnosis needs to be investigated (Koc et al., 2023).
Your physiotherapist can discuss whether further medical assessment or imaging may be appropriate based on your presentation.
How Can Physiotherapy Help Plantar Fasciitis?
There is no single treatment that works for every person.
Current evidence supports a combination of education, load management, stretching and exercise, with treatments such as taping, manual therapy or orthoses considered where appropriate (Koc et al., 2023; Morrissey et al., 2021).
Activity and Load Management
One of the first things we look at is what the foot is currently being asked to tolerate.
For example, someone may have recently increased:
• Running volume
• Walking distance
• Sporting activity
• Gym training
• Standing at work
This does not necessarily mean you need to stop everything.
The goal is often to find an appropriate level of activity that does not repeatedly aggravate symptoms while gradually improving the capacity of the foot and lower leg.
Education and management of loading are considered important parts of plantar heel pain rehabilitation (Morrissey et al., 2021).
Plantar Fascia and Calf Stretching
Stretching can form part of plantar fasciitis rehabilitation.
Current clinical guidelines recommend both plantar fascia specific stretching and stretching of the calf muscles for people with plantar heel pain (Koc et al., 2023).
A plantar fascia specific stretch involves positioning the toes to place a more direct stretch through the plantar fascia rather than only stretching the calf.
Your physiotherapist can show you how to perform this correctly and determine how often it should be completed.
Strengthening the Foot and Calf
Strengthening is another important component of rehabilitation.
Current guidelines recommend resistance exercise for the muscles of the foot and ankle in people with plantar heel pain (Koc et al., 2023).
Depending on the individual, exercises may include:
• Double leg calf raises
• Single leg calf raises
• Bent knee calf raises
• Progressive loaded calf raises
• Foot strengthening exercises
• Single leg strength and control exercises
Research has also shown that progressive higher load strengthening can improve pain and function in people with plantar fasciitis (Rathleff et al., 2015).
The exercise program should gradually become more challenging as the foot becomes capable of tolerating greater loads.
For somebody wanting to return to running or sport, rehabilitation will eventually need to prepare the foot and calf for considerably greater forces than those experienced during normal walking.
Can Taping Help?
Taping can provide short term symptom relief for some people with plantar heel pain and is supported as an adjunct to treatment in current clinical guidelines (Koc et al., 2023).
It may help make walking, standing or work more comfortable while strengthening and rehabilitation are being progressed.
However, taping should generally not be viewed as the entire solution.
The longer term goal is to improve the capacity of the foot and lower leg so that you are less dependent on external support.
Do Orthotics Help Plantar Fasciitis?
Orthotics can be helpful for some people, but they are not required for everybody with plantar fasciitis.
Current clinical guidelines do not recommend using orthotics as an isolated treatment. They may instead be considered as one part of a broader rehabilitation program (Koc et al., 2023).
Some people may respond to a simple prefabricated device, while others may benefit from further assessment by a podiatrist.
At Trilogy Physiotherapy, we can work alongside podiatrists and other health professionals where additional foot assessment or orthotic management appears appropriate.
What About Massage and Manual Therapy?
Hands on treatment can sometimes be useful for reducing symptoms or improving relevant movement restrictions through the foot, ankle and lower leg.
Manual therapy is supported as one potential component of plantar heel pain management when used appropriately (Koc et al., 2023).
However, we generally would not rely on massage or hands on treatment alone.
The longer term aim is to combine symptom management with exercise and progressive loading so that the foot becomes better prepared for the demands of everyday life, work or sport.
Can You Keep Walking With Plantar Fasciitis?
Often, yes.
The amount of walking that is appropriate depends on how irritable your symptoms are and how the heel responds during and after activity.
We generally do not want people to become unnecessarily inactive.
Instead, we may temporarily adjust the amount of walking or standing while gradually building it back up as symptoms and physical capacity improve.
Can You Run With Plantar Fasciitis?
Not everyone with plantar fasciitis needs to completely stop running.
Whether you should continue running depends on factors such as:
• How painful the heel is
• How symptoms respond during the run
• How the heel feels afterwards
• How it feels the following morning
• Your current running volume
• Recent changes to training
• Your strength and physical capacity
For some runners, temporarily reducing distance, speed, hills or frequency can allow them to continue running while rehabilitation begins.
For more irritable presentations, a temporary break from running may be appropriate.
The goal should be to progressively return you to running rather than unnecessarily stopping activity indefinitely.
How Long Does Plantar Fasciitis Take to Get Better?
Recovery time varies.
Some people experience improvement relatively quickly, while longstanding plantar heel pain can take several months to fully settle.
Recovery can be influenced by how long symptoms have been present, activity demands, physical capacity, general health and consistency with rehabilitation.
It is also normal for rehabilitation not to progress perfectly in a straight line.
Temporary increases in symptoms can occur when activity is progressed. What matters is that your overall function, strength and tolerance to activity are moving in the right direction.
What Do We Assess at Trilogy Physiotherapy?
At Trilogy Physiotherapy, your assessment is based on your individual presentation.
Depending on your symptoms and goals, we may assess:
• The location and behaviour of your heel pain
• Ankle movement
• Calf flexibility
• Calf strength
• Single leg calf raise capacity
• Foot and ankle strength
• Balance and single leg control
• Walking
• Running where appropriate
• Recent changes in exercise or training
• Footwear
• Work and sporting demands
This helps us develop a rehabilitation program that is relevant to what you actually need your foot to do.
Physiotherapy for Plantar Fasciitis in Sinnamon Park
Trilogy Physiotherapy provides one on one physiotherapy and exercise rehabilitation for plantar fasciitis and other foot and ankle conditions from our clinic in Sinnamon Park.
Our dedicated rehabilitation gym allows us to progress treatment from early symptom management through to strength, running preparation and return to sport where required.
If heel pain is stopping you from walking, exercising, working or running comfortably, a physiotherapy assessment can help determine what may be contributing to your symptoms and provide a clear rehabilitation plan.
Book online or call Trilogy Physiotherapy on (07) 3148 8785 to arrange an appointment.
References
Koc, T. A., Jr., Bise, C. G., Neville, C., Carreira, D., Martin, R. L., & McDonough, C. M. (2023). Heel pain: Plantar fasciitis revision 2023. Journal of Orthopaedic & Sports Physical Therapy, 53(12), CPG1–CPG39. doi:10.2519/jospt.2023.0303.
Morrissey, D., Cotchett, M., Said J’Bari, A., Prior, T., Griffiths, I. B., Rathleff, M. S., Gulle, H., Vicenzino, B., & Barton, C. J. (2021). Management of plantar heel pain: A best practice guide informed by a systematic review, expert clinical reasoning and patient values. British Journal of Sports Medicine, 55(19), 1106–1118. doi:10.1136/bjsports-2019-101970.
Rathleff, M. S., Mølgaard, C. M., Fredberg, U., Kaalund, S., Andersen, K. B., Jensen, T. T., Aaskov, S., & Olesen, J. L. (2015). High load strength training improves outcome in patients with plantar fasciitis: A randomised controlled trial with 12 month follow up. Scandinavian Journal of Medicine & Science in Sports, 25(3), e292–e300. doi:10.1111/sms.12313.
Read More
To learn more about the common injuries and conditions our physiotherapists treat, visit Common Injuries and Conditions We Treat.
If you have experienced repeated ankle sprains or your ankle frequently feels unstable, read Why Does My Ankle Keep Rolling?
For athletes and runners looking to return to training after injury, learn more about Sports Physiotherapy in Sinnamon Park.