Plantar Fasciitis

Heel pain has more than one cause, and the NHS is blunt: don't diagnose it yourself ³. Some patterns are still worth recognising.

• Plantar fasciitis is a sharp pain between your arch and heel, worse when you start walking and better when you rest ³.
• Achilles tendonitis sits at the back of the heel, often felt in the ankle and calf too ³.
• A heel fracture or a ruptured Achilles feels different: sudden sharp pain, swelling, sometimes a popping or snapping sound at the time ³. That needs assessing the same day, not exercises. Call us.
• Bursitis, a neuroma or a stress fracture can also produce heel or foot pain ^2,3.
• In children aged roughly eight to 16, the most common cause of heel pain isn't plantar fasciitis, it's Sever's disease, stress on the heel bone's growth plate ².

And the heel spur question. If a scan has shown a spur, it probably isn't the villain. Plantar fasciitis is often associated with a heel spur, but many people have spurs with no pain at all ¹. About one in 10 Australians are estimated to have them without symptoms, and the spur itself doesn't cause the pain ². Imaging helps rule out other causes, but is often not needed for the diagnosis ¹. Our heel pain article covers the wider picture.

Most of the time this is diagnosed in the room, from your story and a look at your foot. A scan is often not needed ¹. You'll be asked about your symptoms, the work you do and how active you are ¹, because long hours on your feet are one of the recognised causes ¹. Then your feet and calves are checked for soreness, tightness and weakness ¹.

If you're sent for an X-ray or ultrasound, it's to rule out other causes of heel pain ¹. It isn't there to prove this one.

Plantar fasciitis is slow to settle, so we plan it in the three phases of The Well Motion Recovery Path™. What your heel tolerates decides when you step up, not how many weeks have passed.

• Reset: while the heel is irritable. Ice, relative rest, cushioned shoes and heel pads or arch supports ^1,3, supportive taping before activity ¹, and manual therapy if your calves are tight. Expect the first steps of the morning to be the last thing to ease. We move you on once a normal day on your feet no longer leaves the heel worse that night.
• Rebuild: the longest phase. The progressive loading program ⁴, with stretching kept beside it ¹. Expect some soreness as the load goes up. We may add shockwave therapy if the heel stalls. We move you on when single leg heel raises and brisk walking are comfortable.
• Return: full shifts on hard floors, long walks or running, brought back gradually ¹. We test the task you are going back to. You leave with a loading routine and a footwear plan.

How long it usually takes. Plantar fasciitis often lasts for weeks or months ¹. In a study of 105 people treated without surgery, 89.5% had no heel pain within about 11 months ⁹. Yours depends on how long you have had it and how much standing your week demands.

Most of the research here looks at who gets plantar fasciitis, and it points to a few things you can change:

• Keep your weekly running steady. In a year-long study of 1,206 adults, runners covering more than 40 km a week had six times the odds of plantar fasciitis of those running 6 to 20 km ⁶. Bring running back gradually ¹.
• Watch your weight. Pooled studies found a BMI above 27 went with nearly four times the odds, most clearly in people who weren't athletes ⁷. Keeping to a healthy weight is on the national prevention list ¹.
• Wear something supportive. Among 306 Australian navy recruits in 11 weeks of training, contoured insoles meant about a third fewer overuse injuries than flat ones, plantar fasciitis included. The gap was small enough to be chance ⁸. Supportive shoes are still the standard advice ¹, and long spells barefoot are best avoided ³.
• Warm up, and rest between sessions. Both are on the same list ¹.