Plantar Fasciitis & Heel Pain Treatment | Cleveland & Greenslopes

At Your Podiatry People, plantar fasciitis treatment is one of the most common services we provide across our Cleveland, Greenslopes and Hamilton clinics. Plantar fasciitis involves degeneration and pain of the plantar fascia, a thick band of connective tissue running along the bottom of the foot that connects the heel bone (calcaneus) to the forefoot. Research shows the plantar fascia bears approximately 14% of total body load during walking and running, making it particularly vulnerable to repetitive stress injury [1].

What Causes Plantar Fasciitis?

Plantar fasciitis develops when repetitive mechanical loading overwhelms the plantar fascia’s capacity to repair itself. Over time, repetitive overload can lead to microscopic damage and a failed healing response within the plantar fascia, most commonly near its attachment to the heel bone [2].

Foot mechanics play a significant role, including factors such as reduced ankle dorsiflexion (lifting the foot upwards), tight calf muscles, excessive foot pronation (rolling in), high arches, and intrinsic foot muscle weakness [3]. In addition, prolonged standing, walking on hard surfaces, and inappropriate footwear can increase strain on the plantar fascia and contribute to symptom development.

Why Does Plantar Fasciitis Hurt Most in the Morning?

During sleep or periods of prolonged rest, the ankle naturally rests in a more plantarflexed position, allowing the plantar fascia to shorten slightly. When you take your first steps in the morning, the plantar fascia is suddenly loaded and stretched from this shortened position. Combined with increased tissue sensitivity, this contributes to the characteristic sharp heel pain experienced during the first few steps [4].

After a few minutes of walking, the tissue gradually warms and loosens. As a result, the pain often eases as you continue moving.

What Happens in Long-Standing Plantar Fasciitis?

In the early stages, plantar fasciitis involves microtearing and an acute inflammatory response. However, when symptoms persist beyond three months, the condition often transitions into a degenerative process more accurately termed plantar fasciosis [5].

At this stage, the body attempts to repair the damaged tissue by remodelling the collagen within the plantar fascia. Rather than fully restoring the normal, highly organised Type I collagen architecture, there is increased deposition of mechanically weaker Type III collagen alongside disorganisation of the existing collagen fibres.

Type III collagen forms thinner, less organised collagen fibrils with lower tensile strength than mature Type I collagen. Together with collagen disorganisation and changes in the surrounding extracellular matrix, this contributes to thickening of the plantar fascia and reduced mechanical efficiency [5,6].

Therefore, early treatment is important. The longer plantar fasciitis remains unaddressed, the more difficult it can become to reverse these degenerative changes.

Plantar Fasciitis Treatment Options

Our podiatrists provide a range of evidence-based plantar fasciitis treatment options tailored to your individual needs.

Custom Foot Orthotics

Custom foot orthotics reduce strain on the plantar fascia by improving foot mechanics, redistributing load away from the fascia, and offloading the heel [7].

Strength-Based Stretching Exercises

Targeted calf and plantar fascia stretching under load can improve tissue capacity and load tolerance. Meanwhile, orthotics can offload the structure during daily activities, allowing us to introduce controlled loading through exercise as part of the rehabilitation process.

Strapping and Taping

Strapping and taping provide short-term offloading of the plantar fascia. Consequently, they can help reduce pain and allow the tissue to recover while other treatments take effect.

PEACE & LOVE Protocol

The PEACE & LOVE protocol represents the current evidence-based approach to soft tissue injury management and has largely replaced the outdated RICE protocol.

PEACE stands for:

• Protect
• Elevate
• Avoid anti-inflammatories
• Compress
• Educate

LOVE stands for:

• Load
• Optimism
• Vascularisation
• Exercise

Together, these principles guide both the initial management and ongoing recovery of soft tissue injuries [8].

Ice and Heat Therapy

Ice can provide short-term pain relief. However, heat may also provide symptom relief for some people by improving comfort and reducing perceived stiffness. Neither ice nor heat has been shown to directly accelerate healing of chronic plantar fasciopathy, so they are best viewed as strategies for short-term symptom management.

Shockwave Therapy

For chronic or resistant cases, shockwave therapy is an accepted treatment option. Research suggests it can reduce pain and improve function in chronic plantar fasciopathy, particularly when incorporated into a comprehensive rehabilitation program that may include load management, exercise therapy and, where appropriate, foot orthoses.

Invasive Treatments

Invasive treatments are rarely required. However, they may occasionally be considered when conservative management has not provided adequate improvement.

These options include:

• Corticosteroid injections
• Surgery

Frequently Asked Questions About Plantar Fasciitis

What is plantar fasciitis?

Plantar fasciitis is degeneration and irritation of the plantar fascia, the thick band of tissue running along the bottom of the foot that connects the heel to the forefoot. It is one of the most common causes of heel pain treated at Your Podiatry People.

What does plantar fasciitis feel like?

The most common symptom is a sharp or stabbing pain under the heel, particularly when taking your first steps in the morning or after periods of rest. Although the pain often eases after a few minutes of walking, it may return following prolonged activity.

What causes plantar fasciitis?

Plantar fasciitis results from repetitive mechanical overload of the plantar fascia. Common contributing factors include reduced ankle mobility, tight calf muscles, excessive pronation, high arches, prolonged standing, and inappropriate footwear.

How long does plantar fasciitis take to heal?

Recovery time varies considerably from person to person. Factors such as foot mechanics, genetics, activity levels, occupation, and the duration of symptoms can all influence healing time.

Therefore, an appointment with Your Podiatry People can help us better understand your condition and develop an individualised treatment plan.

Can a podiatrist treat plantar fasciitis?

Yes. Podiatrists are highly qualified to assess and treat plantar fasciitis. Because treatment should address the underlying cause, a thorough biomechanical assessment is an important first step.

Do I need orthotics for plantar fasciitis?

Custom foot orthotics are an excellent treatment option for many people with plantar fasciitis because they address the underlying foot mechanics that may be driving excess load through the fascia. However, not everyone requires orthotics. Our podiatrists will assess your individual circumstances and determine whether orthotics are appropriate for you.

References

1. Ker RF, Bennett MB, Bibby SR, Kester RC, Alexander RM. The spring in the arch of the human foot. Nature. 1987;325(7000):147–149. https://pubmed.ncbi.nlm.nih.gov/7559672/
2. Trojian T, Tucker AK. Plantar Fasciitis. Am Fam Physician. 2019;99(12):744–750.
3. Irving DB, Cook JL, Menz HB. Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport. 2006;9(1–2):11–22.
4. Latt LD, et al. Evaluation and Treatment of Chronic Plantar Fasciitis. Foot Ankle Orthop. 2020.
5. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234–237.
6. StatPearls. Plantar Fasciitis. NCBI Bookshelf. Updated 2024. https://www.ncbi.nlm.nih.gov/books/NBK431073/
7. Latt LD, et al. Both prefabricated and custom-fitted orthotics have been shown to reduce pain and improve function. Foot Ankle Orthop. 2020.
8. Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2):72–73.