Plantar Fasciitis

Plantar fasciitis is one of the most common causes of heel pain, affecting the thick band of tissue connecting your heel to your toes. Our physiotherapists use evidence-based treatments to address both symptoms and underlying causes for lasting relief.

Understanding Plantar Fasciitis

What Goes Wrong

• Tissue Degeneration: Not just inflammation but tissue changes
• Microtears: Repetitive stress causing small tears
• Thickening: Plantar fascia becomes thickened and painful
• Morning Stiffness: Tissue tightens overnight

Risk Factors

• Sudden increase in activity
• Poor footwear choices
• Tight calf muscles
• High or low foot arches
• Excess body weight
• Prolonged standing
• Running on hard surfaces

Symptoms and Presentation

Classic Signs

• Morning Pain: First steps are most painful
• Start-Up Pain: Pain after periods of rest
• Improvement with Activity: Often feels better once warmed up
• End-of-Day Pain: Worsens after prolonged standing

Pain Location

• Bottom of heel (most common)
• Along arch of foot
• Sometimes into midfoot
• Usually one foot, can be bilateral

Biomechanical Assessment

Foot and Ankle

• Arch height and flexibility
• Heel alignment
• Ankle mobility
• First toe flexibility
• Foot pronation patterns

Contributing Factors

• Calf muscle tightness
• Achilles tendon tension
• Hip weakness
• Core stability deficits
• Gait abnormalities

Treatment Approach

Phase 1: Pain Relief (Weeks 1-2)

• Load Management: Activity modification
• Manual Therapy: Soft tissue mobilization
• Taping: Support and offloading
• Ice Therapy: Pain and inflammation control
• Footwear Advice: Appropriate shoe selection

Phase 2: Mobility (Weeks 2-4)

• Stretching Program: Calf and plantar fascia
• Joint Mobilization: Ankle and foot joints
• Soft Tissue Release: Manual and self-techniques
• Neural Mobilization: If nerve involvement

Phase 3: Strengthening (Weeks 4-8)

• Calf Strengthening: Progressive loading
• Intrinsic Foot Muscles: Toe exercises
• Hip Strengthening: Gluteal exercises
• Balance Training: Proprioception work

Phase 4: Return to Activity (Weeks 8-12)

• Gradual Loading: Progressive return to running/sport
• Technique Correction: Running gait analysis
• Maintenance Program: Ongoing exercises
• Prevention Strategies: Long-term management

Advanced Treatments

Shockwave Therapy

• Stimulates healing response
• Breaks down scar tissue
• Improves blood flow
• 3-5 sessions typically needed
• 70-80% success rate

Dry Needling

• Releases trigger points
• Reduces muscle tension
• Improves blood flow
• Targets calf and foot muscles

Orthotic Therapy

• Custom or off-shelf options
• Arch support provision
• Load redistribution
• Heel cushioning
• Activity-specific designs

Self-Management Strategies

Daily Exercises

• Morning calf stretches before standing
• Plantar fascia stretching
• Towel scrunches for foot strength
• Frozen bottle rolling
• Eccentric calf raises

Activity Modifications

• Avoid barefoot walking initially
• Reduce high-impact activities
• Cross-training alternatives
• Gradual return to running
• Surface selection

Footwear Guidelines

• Supportive shoes at all times
• Avoid flat or worn shoes
• Replace running shoes regularly
• Consider heel lifts temporarily
• Indoor supportive footwear

Common Mistakes to Avoid

• Ignoring early symptoms
• Too much rest (complete inactivity)
• Aggressive stretching when acute
• Returning to activity too quickly
• Not addressing contributing factors
• Relying on passive treatments only

Prevention Strategies

For Runners

• Gradual training increases (10% rule)
• Regular calf stretching
• Strength training program
• Appropriate footwear
• Surface variation

For Workers

• Supportive work shoes
• Anti-fatigue mats
• Regular stretch breaks
• Weight management
• Calf strengthening

Expected Recovery

Timeline

• Weeks 1-2: Initial pain reduction
• Weeks 2-4: Improved morning stiffness
• Weeks 4-8: Progressive improvement
• Weeks 8-12: Return to activities
• 3-6 months: Full resolution typical

Success Rates

• 90% improve with conservative treatment
• Most resolve within 12 months
• Early treatment improves outcomes
• Chronic cases may need advanced treatments