Understanding and Managing Plantar Fasciitis

by Chamith Abeyratne

What is Plantar Fasciitis?

Plantar Fasciitis (sometimes more broadly termed “plantar heel pain” or “plantar fasciopathy”) involves damage — often micro-tears and degenerative changes — to a thick band of tissue (the plantar fascia) that runs along the bottom of the foot, connecting the heel bone (calcaneus) to the base of the toes. This tissue supports the arch of the foot and absorbs shock when walking.

Although “-itis” suggests inflammation, modern studies show that in many cases the problem is degenerative rather than an active inflammatory process (sometimes called “fasciosis/fasciopathy”). It is among the most common causes of heel pain seen by foot-care professionals.

Who Gets It — Risk Factors

Plantar fasciitis can affect many people. Some factors that increase risk include: 

• Being between ~40–60 years old. 

• Activities that stress the heel and plantar fascia — long-distance running, ballet dancing, aerobic exercise, or jobs requiring prolonged standing or walking (e.g. retail or teaching) on hard surfaces. 

• Foot shape or biomechanics: flat feet (pes planus), high arches (pes cavus), overpronation or oversupination can add strain

• Tight calf muscles or limited ankle flexibility (reduced ankle dorsiflexion). 

• Excessive body weight (placing more load on feet). Worn-out or unsupportive footwear (thin soles, lack of arch support, minimal cushioning). 

Because of these varied risk factors, plantar fasciitis can occur in both active people (runners, athletes) and less active people, or those whose lifestyle involves long standing or walking.

Typical Symptoms

The classic signs of plantar fasciitis include;

• Sharp, stabbing or aching pain at the bottom of the heel (especially the medial — inner — side), sometimes extending along the arch.

• “First-step pain”: the pain tends to be worst with the first few steps after getting out of bed in the morning, or after sitting/lying down for a while and then standing.

• Pain may ease a little during activity but often worsens after prolonged walking, standing, or vigorous activity — or when barefoot / in unsupportive shoes

• Over time, if untreated, the pain can become chronic and significantly limit daily activities, walking, and mobility.

Because heel pain can sometimes arise from other causes (nerve issues, stress fractures, heel-pad atrophy, etc.), accurate diagnosis — typically via history and physical examination — is important.

Treatment: What Works

The good news is that most cases improve with conservative (non-surgical) care over time — often within months.

First-line & common approaches

• Rest, ice, and activity modification — reduce or avoid activities that stress the heel; apply an ice pack (or roll a frozen water bottle under the foot) for ~15 min several times a day to ease pain and swelling. 

• Stretching and strengthening — calf (Achilles), plantar-fascia and foot muscle stretches are foundational. Do stretches and foot exercises daily if possible. 

• Supportive footwear  shoes with good arch support, cushioning, shock absorption, and where needed heel lifts; 

• Night splints/strapping / taping — sometimes recommended to keep the plantar fascia gently stretched while sleeping or resting.

  
  

When additional or advanced treatments may be needed

If pain is persistent for many months despite consistent conservative therapy, other options may be considered

• Custom Orthotics/insoles - Custom orthotics can significantly reduce strain by; realigning the muscles and joints and redistributing the pressure more evenly throughout the foot. 

• Extracorporeal shock wave therapy (ESWT) — uses sound waves to stimulate healing; 

• Corticosteroid injections 

• Surgery (rarely needed) — e.g. plantar fascia release or calf/gastrocnemius lengthening — only for very persistent, severe cases after exhaustive conservative care.

Prevention: How to Keep Your Feet Healthy

Prevention often works better than cure. Some strategies to reduce the risk of plantar fasciitis:

• Keep calf muscles and plantar fascia flexible through regular stretching.

• Wear supportive shoes — especially if you stand or walk for long periods — and avoid thin-soled, unsupportive shoes.

• Gradually increase activity levels — avoid sudden spikes in running distance or intensity.

• Maintain a healthy body weight to reduce stress on your feet.

• If you spend a lot of time standing, try foot care breaks — sit down, change posture, stretch occasionally.

When to See a Podiatrist

You should book an appointment if:

• Pain is persistent for several weeks despite home care.

• Pain significantly interferes with daily activities or sleep.

• Heel pain is accompanied by swelling, redness, numbness, or unusual symptoms.

• You're unsure what footwear or orthotics to use, or you’d like tailored advice on stretching, gait, or biomechanics.

  
  

Plantar fasciitis is common — and often very treatable. With conservative care, stretching, proper footwear or orthotics, and sensible load management, many people achieve relief and return to normal daily activity within several months.

At On Track Podiatry, we assess foot structure and mechanics, check for contributing factors (like tight calves or poor footwear), and recommend a personalised treatment plan — from conservative therapy to orthotics, to advanced interventions if needed.We encourage anyone experiencing heel pain to get assessed early — the sooner you start appropriate care, the better the outcome tends to be.