The first steps out of bed are painful. The bottom of your heel or arch feels sharp and sore, then eases as you get moving. Later in the day, especially after sitting or after being on your feet, the pain comes back. You can’t think of an injury that started it. It just began and won’t go away.
This pattern is common with plantar fasciitis, an irritation of the thick band of tissue (the plantar fascia) that runs along the bottom of your foot from your heel to your toes.
Pain at the back of your heel instead? That’s usually a different problem. Read about posterior calcaneal bursitis. Pain in the ball of your foot instead? Read about metatarsalgia.
What Causes Plantar Fasciitis?
Understanding the cause is the key to getting better.
Plantar fasciitis is usually a repetitive strain injury, meaning stress that builds up slowly over time rather than from one event. It often starts with small mechanical problems in the foot and ankle, such as:
- Hyperpronation: when your foot rolls inward and your arch flattens too much as you walk or run. This is one of the most common contributing factors
- A stiff ankle or tight calf
- Stiff or restricted joints in the foot
- Muscle weakness
At first you don’t notice these problems because your body compensates. But the compensation changes how your foot and ankle move and puts extra strain on the plantar fascia, which acts like a tie rod supporting your arch with every step. Over time, that stress can build into pain and damage where the fascia attaches to the heel.
Our Approach: It’s Two Problems, Not One
It’s important to realize that plantar fasciitis isn’t one problem. It’s two.
Problem #1: The injured fascia. The plantar fascia itself needs to heal and get stronger. Our treatment combines:
- Shockwave therapy, which helps stimulate tissue healing. Research shows it can be an effective treatment for plantar fascia and tendon problems.
- Progressive loading exercises. This is the foundation of rehab, and it works much like tendon rehab. The exercises have to be challenging enough to trigger healing, but not so hard that they flare things up. They then need to be progressed over time as the tissue gets stronger. That balance is why a customized program works better than generic exercises from YouTube or TikTok.
What about rolling and stretching? Many people with heel pain roll their foot on a lacrosse ball or a frozen water bottle. This can ease symptoms for a while, but it doesn’t promote tissue healing or make the fascia stronger. Stretching can help some people, but it’s generally not the key either. If rolling and stretching were enough, most people would already be better. What the injured tissue needs is progressive loading.
Problem #2: What caused it in the first place. This is the part that’s often missed, and it’s just as important. Most people, and many treatment plans, focus only on the pain. But if the mechanical problems that overloaded the fascia, including hyperpronation, are never addressed, the tissue keeps getting stressed. That’s why these conditions can be so stubborn and keep coming back, even after a period of rest or treatment.
To find the cause, we perform a thorough exam to identify the specific muscle and joint restrictions and weaknesses behind your problem, and to assess how your foot moves, including whether it’s pronating too much. We then make correcting these issues a major part of your treatment plan. This includes:
- Active Release Technique (ART): a hands-on soft tissue method that releases tight, restricted muscles in the calf and foot that are hard to reach on your own
- Joint manipulation: to restore normal movement to stiff joints in the foot and ankle, when appropriate
- Home stretches and exercises
A note on orthotics: If hyperpronation is part of your problem, an orthotic can sometimes help, and we can prescribe custom orthotics in our clinic. But an orthotic is rarely enough on its own. It supports the foot from below, but it doesn’t address the muscle weakness, muscle tightness, and joint restrictions that are driving the problem. That’s why we treat it as one possible piece of your plan, not the whole plan.
Treating both problems is what gives you the best chance of not just feeling better, but staying better.
What to Expect
Your first visit. We take a full history and perform a detailed exam. This confirms your diagnosis and uncovers what is driving the problem in your case. Only then do we build your treatment plan.
Timeline. This is not a quick fix. Injured tissue takes time to heal. We can help it heal faster and better, but most plans run about 8-12 weeks, though this varies from person to person.
Visits. Treatments like ART and shockwave can’t be done at home, so we see you in the office, usually twice a week at first, then less often as you progress.
Home exercises. Your rehab program is prescribed in our office but done at home, typically about 30 minutes a day. Please consider this commitment before booking, since the exercises are the key to getting the fascia stronger.
When Should You Get It Checked?
It’s worth having your foot assessed if:
- The pain has lasted more than a couple of weeks
- It’s worst with your first steps in the morning or after sitting
- It improves with rest or rolling but keeps coming back
- It’s starting to affect walking, exercise, or work
Heel problems are generally easier to treat when they’re caught early, before months of compensation have built up.
Seek urgent medical care instead if you felt a sudden pop or snap, can’t put weight on your foot, or have significant swelling, bruising, numbness, or redness and warmth with a fever.
See How We Treat It
Here’s a short video on how we assess and treat foot pain in our office.
Ready to Get Started?
If heel pain has been hanging around, we can help you find the cause and build a plan to fix it. Book your appointment here or call us at (905) 685-7227.