Plantar Fasciitis: Why Your Heel Hurts and How Physiotherapy Helps

Plantar fasciitis is one of the most common causes of heel pain, especially in people who spend long hours on their feet, run regularly, or suddenly increase their training load. If you’ve noticed a sharp pain under your heel first thing in the morning, there’s a good chance your plantar fascia is trying to tell you something.

What Is Plantar Fasciitis?

In simple terms, plantar fasciitis is irritation or overload of the plantar fascia, a strong band of connective tissue that runs from your heel bone (calcaneus) to your toes. It acts like a shock absorber and helps support the arch of your foot.

The technical explanation:Plantar fasciitis is a degenerative and inflammatory condition affecting the plantar fascial origin at the medial tubercle of the calcaneus. It’s often not a “true inflammation” but a fasciopathy—a tissue overload problem where the collagen fibres become irritated or micro-damaged over time.

How Do People Get Plantar Fasciitis?

Plantar fasciitis develops when the plantar fascia is overloaded beyond its tolerance. This can happen gradually or suddenly. Common contributing factors include:

Everyday Causes:

• Standing or walking for long hours

• Sudden increase in running or training

• Wearing old, flat, or unsupportive shoes

• Tight calf muscles putting extra load on the heel

• Flat feet or very high arches

• Weight gain or pregnancy increasing load on the feet

  
  

Clinical Factors:

• Reduced ankle dorsiflexion

• Increased pronation or supination patterns

• Weak intrinsic foot musculature

• Poor shock absorption mechanics

• Rapid changes in training load (“load management error”)

• Hard walking or running surfaces

Common Signs and Symptoms

Most people with plantar fasciitis describe classic patterns of pain, which makes diagnosis fairly straightforward for physiotherapists.

Typical Symptoms:

• Sharp, stabbing heel pain with the first steps in the morning

• Pain after sitting, resting, or driving

• Pain eases after a few minutes of walking

• Heel or arch pain after running, long walks, or standing

• Soreness after exercise—not usually during

  
  

Clinical Signs Physiotherapists Look For:

• Pain on palpation at the medial calcaneal tubercle

• Reduced ankle dorsiflexion

• Poor single-leg balance or intrinsic foot control

• Positive Windlass Test (pain when big toe is extended)

• Gait changes—antalgic gait or favouring the lateral foot

Physiotherapy Treatment for Plantar Fasciitis

Physiotherapy is one of the most effective treatments for plantar fasciitis because it targets the root causes, not just the symptoms.

1. Load Management & Education

We help you understand what movements or activities are aggravating the fascia and guide you on how to modify them—not stop training, but train smarter.

2. Strengthening Program

A key part of treatment is progressive loading of:

• Calf complex (gastrocnemius and soleus)

• Intrinsic foot muscles

• Posterior chain muscles if biomechanics contribute

Exercises may include:

• Calf raises

• Toe strengthening

• Short-foot exercises

• Tibialis posterior strengthening

• Plantar fascia loading (e.g., heel raises with toes extended)

  
  

3. Manual Therapy

Depending on your symptoms, physios may use:

• Soft tissue release for calf or plantar fascia

• Joint mobilisations for the ankle or midfoot

• Trigger point techniquesThese help reduce stiffness and improve mobility.

  
  

4. Taping

Low-Dye or modified Low-Dye taping can offload the plantar fascia and give immediate short-term relief.

5. Footwear & Orthotic Advice

Not everyone needs orthotics, but in many cases:

• Supportive footwear

• Temporary orthotics

• Heel cups or gel inserts

can reduce strain on the fascia while strengthening takes effect.

6. Shockwave Therapy 

Extracorporeal shockwave therapy can help stimulate tissue healing and reduce chronic pain.

7. Patient-Specific Return-to-Sport Planning

Runners, gym goers, and athletes will receive a clear, graded plan to return to training safely without flare-ups.

Differential Diagnosis: What Else Could Heel Pain Be?

Physiotherapists always consider alternative diagnoses to ensure you’re receiving the right treatment. Heel pain isn’t always plantar fasciitis.

Common differentials include:

1. Heel Fat Pad Syndrome

• Deep, bruise-like pain in the centre of the heel

• Worse on hard surfaces

• Pain doesn’t follow the classic morning pattern

  
  

2. Achilles Tendinopathy

• Pain at the tendon rather than the heel pad

• Often stiff with first steps, but pain is higher at the back of the heel

  
  

3. Tarsal Tunnel Syndrome

• Tingling, burning, or numbness

• Compression of the posterior tibial nerve

  
  

4. Stress Fracture (Calcaneus or Talus)

• Gradual onset but progressively worsening

• Pain increases with activity rather than decreasing

• Needs imaging if suspected

  
  

5. Plantar Fibromatosis

• Palpable nodules along the fascia

• More rare but important to rule out

  
  

6. Systemic Conditions

• Rheumatoid arthritis

• Spondyloarthropathies

Plantar fasciitis is incredibly common, but with the right assessment and a structured physiotherapy plan, most people recover well and get back to normal activity without long-term issues.

If you’re dealing with morning heel pain, arch discomfort, or ongoing foot stiffness, it’s worth getting assessed early—your plantar fascia will thank you.