Plantar Fasciitis (Heel Pain)

Overview

The plantar fascia is a thick band of tissue running along the sole of your foot from the heel to the base of the toes. It supports the arch and acts like a spring with every step. Plantar fasciitis develops when this band is loaded beyond what it can tolerate, causing small areas of irritation and thickening where it attaches to the heel bone. Despite the name, it is less an inflammation and more a wear-and-overload problem of the tissue, which is why it tends to be stubborn.

It is the most common cause of heel pain we see in clinic. The classic story is a sharp, stabbing pain under the heel with the first steps out of bed in the morning, or after sitting for a while. It usually eases after a few minutes of walking, then returns after long periods of standing or at the end of a busy day. Some people describe a bruised feeling under the heel; others feel it more towards the arch.

Plantar fasciitis affects runners, people who stand all day at work, those who have recently gained weight or started a new exercise routine, and adults in their 40s to 60s. Most cases improve with the right treatment, but without addressing the cause it can drag on for a year or more.

Causes and risk factors

• A sudden increase in walking, running or standing time
• Flat feet or very high arches, both of which change how the fascia is loaded
• Tight calf muscles and Achilles tendon, which pull on the heel
• Being overweight, which increases the load on the sole
• Wearing flat, unsupportive shoes — thin trainers, flip-flops, ballet flats
• Standing for long hours on hard floors (retail, hospitality, healthcare, teaching)
• Age-related loss of the fat pad under the heel
• A job or sport that involves repeated jumping or hill work

How we may be able to help

Your first appointment is a full assessment. We confirm the diagnosis, check for other causes of heel pain such as nerve irritation or a stress reaction in the heel bone, examine calf flexibility and ankle movement, and assess your foot posture and walking pattern. Understanding why your fascia is overloaded is what allows us to plan properly rather than simply treating the painful spot.

We offer a 3D foot scan to measure how your arches and heel are loading. Where the scan suggests that foot posture is driving the problem, fully custom orthotics are manufactured in the UK from your scan data. These are designed to support the arch and reduce strain on the fascia with every step, which many people find makes a noticeable difference to all-day comfort.

For heel pain that has lasted more than a few months and not responded to stretching and footwear changes, focused shockwave therapy is one of the better-supported options. Evidence suggests it may reduce pain and help the fascia respond to rehabilitation. A typical course is three to six sessions, about a week apart, and you can walk out and continue your day. It is offered after your initial assessment, not as a first visit.

Physiotherapy underpins everything: calf and fascia stretching, strengthening the small muscles of the foot and the calf, manual therapy for stiff ankle joints, dry needling for tight calf or sole muscles, and advice on footwear and activity. Kinesiology taping can support the arch between sessions, and therapeutic ultrasound may be used as an adjunct in some plans.

What you can do at home

• Before getting out of bed, pull your toes back towards you and hold for 30 seconds — repeat 3 times
• Stretch your calves against a wall, with the knee straight and then bent, twice daily
• Roll the sole of your foot over a frozen water bottle for 5 minutes after a long day
• Wear supportive shoes with a cushioned heel at all times, even indoors; avoid walking barefoot on hard floors
• Reduce long periods of standing or running until the heel settles, then build back gradually
• If you are carrying extra weight, even modest weight loss reduces the load on the fascia