Plantar Fasciitis: Understanding Heel Pain and How to Fix It

What is Plantar Fasciitis?

Plantar fasciitis is one of the most common causes of heel pain, affecting people of all activity levels—from runners and athletes to those who spend long hours on their feet at work. It occurs when the plantar fascia, a thick band of tissue that runs along the bottom of the foot, becomes irritated or inflamed. This can lead to a sharp, stabbing pain, particularly with the first few steps in the morning or after long periods of rest.

Not All Heel Pain is the Same

While plantar fasciitis is a leading cause of heel pain, other conditions can mimic its symptoms, including:

  • Heel Spurs – Bony growths that can develop at the heel due to chronic stress.

  • Achilles Tendinitis – Pain at the back of the heel, rather than underneath it.

  • Tarsal Tunnel Syndrome – A nerve-related pain that can cause burning or tingling sensations. This can sometimes occur along with plantar fasciitis.

  • Stress Fractures – Tiny cracks in the bone, typically seen in runners or those with osteoporosis.

A proper diagnosis is key to effective treatment.

What Causes Plantar Fasciitis?

Plantar fasciitis develops due to repetitive strain and microtears in the plantar fascia. Contributing factors include:
✔ Overuse & High-Impact Activities – Running, jumping, or excessive walking can put undue stress on the fascia.
✔ Poor Footwear – Shoes with inadequate arch support, cushioning, or worn-out soles.
✔ Tight Calf Muscles – Limited ankle flexibility increases tension on the plantar fascia.
✔ Obesity & Sudden Weight Gain – Extra weight places more pressure on the feet.
✔ Standing for Long Periods – Jobs that require prolonged standing, like teaching or retail work, can lead to persistent strain.

What Makes It Worse?

  • Walking barefoot on hard surfaces – Lack of support increases strain.

  • Skipping warm-ups & stretching – Tight muscles aggravate the condition.

  • Ignoring the pain – Continuing high-impact activities without intervention can make it worse.

Non-Surgical Treatment: How a Podiatrist or Physio Can Help

Most cases of plantar fasciitis improve with conservative (non-surgical) treatment. A podiatrist or physiotherapist can guide you through:

✔ Stretching & Strengthening Exercises – Focused on the Achilles tendon and plantar fascia to improve flexibility and reduce stress.
✔ Orthotics & Footwear Modifications – Custom insoles or supportive shoes can provide proper arch support and reduce strain. A comfortable silicone heel cup can sometimes work wonders for some patients.
✔ Shockwave Therapy – A non-invasive treatment that stimulates healing in chronic cases. This may work well in some cases.
✔ Taping & Night Splints – Help maintain the foot in a stretched position overnight.
✔ Manual Therapy & Massage – Loosens tight tissues and improves blood flow. Stretching the Achilles tendon is the key player in terms of helping this improve here.
✔ Anti-Inflammatory Treatment – Icing, NSAIDs, and activity modifications help manage pain.

Surgical Options: When is Surgery Beneficial?

If symptoms persist after 6-12 months of conservative treatment, surgery may be considered. Surgical options include:

 Plantar Fascia Release (Open or Endoscopic)

  • Involves cutting part of the plantar fascia to relieve tension.

  • Can be done via an open incision or minimally invasive endoscopic approach (keyhole surgery).

  • Best for patients with persistent pain despite exhaustive nonoperative treatments.

 Gastrocnemius Recession (Calf Release)

  • Involves lengthening the tight calf muscle (gastrocnemius), reducing stress on the plantar fascia.

  • This has revolutionised the treatment for plantar fasciitis as there are now studies suggesting that most patients have a similar outcome compared to plantar fascia release. This means that they have a faster recovery, can start physiotherapy early and will not have any incisions on their feet.

 Ultrasound-Guided Needle Release

  • A minimally invasive procedure where a needle is used to break down scar tissue and stimulate healing.

  • Often combined with platelet-rich plasma (PRP) injections for enhanced recovery, though current research on its effectiveness remains limited.

Postoperative Recovery: What to Expect

Recovery varies depending on the procedure performed, but in general:
✔ Weight-bearing status – Most patients can walk in a boot immediately or within a few days.
✔ Physical therapy – Begins within 2 weeks to restore flexibility and strength.
✔ Return to normal activities – Light walking within a few weeks; high-impact activities (running, jumping) may take 2-3 months.
✔ Long-term outlook – Surgery is generally effective, with 80-90% of patients experiencing lasting relief.

Struggling with Heel Pain? Let’s Fix It.

If heel pain is slowing you down, Naveen is here to help. He’ll take the time to understand your symptoms, confirm a diagnosis, and guide you through a tailored plan to get you moving comfortably again. Book an appointment today to explore your options, from physiotherapy to advanced surgical care—so you can get back on your feet with confidence!