Plantar fasciitis

We ask when the heel pain began, when it is worst, and what changed before it started. More running or hiking, longer shifts on your feet, or a change of shoes are common triggers. Then we examine the heel and the arch. We check calf flexibility, ankle movement, and strength in the foot and calf. We watch how you stand and walk, and how you run if you are a runner.

We also check for other causes of heel pain, such as an irritated nerve, the Achilles tendon, or a stress fracture in the heel bone. If something else is likely, we explain what we found and, when needed, suggest a visit to a doctor or nurse practitioner.

The aim is to build the foot and calf up gradually. Treatment often combines:

• Loading exercises: calf raises and foot-strengthening work, built up in stages so the fascia and calf can take more load.
• Stretching: for the calf and the sole of the foot.
• Taping: tape under the arch can ease pain in the short term while the exercises take effect.
• Footwear and load: supportive shoes, and less of the activity that flares the pain for a while.

Some people find a night splint, which holds the foot gently bent up in bed, eases the first steps of the morning.

If your foot shape or the way it lands adds strain, custom casted orthotics can help spread the load. They are made from a cast of your feet, to fit your shoes.

Shockwave therapy

Shockwave therapy sends focused sound waves (acoustic waves) through the skin into the sore tissue. It does not involve needles or surgery. It is often used for plantar fasciitis that has not settled with exercise and other care, alongside the loading plan.

We build back toward what you want to do, whether that is running, hiking or a full shift on your feet. Runners usually rebuild distance on the flat before adding hills, and hikers build toward long days and steep descents. If heel pain keeps coming back with running, a running assessment looks at your stride and shoes on slow-motion video.

Keep up the calf and foot exercises after the pain settles. Strong calves and feet can help the fascia cope with steep trails.

Book an assessment if heel pain is not settling, stops you from running or hiking, or makes long days on your feet hard. Come in too if the pain started with a sudden pop under the foot.

Go to the emergency department right away, or call 911, if any of these happen:

• severe heel pain after a fall or a jump from a height, and you cannot put weight on the foot
• your foot suddenly turns cold, pale or numb
• the foot is hot, red and swollen, and you have a fever