# Plantar fasciitis Plantar fasciitis is pain under the heel from the thick band of tissue that runs along the sole of the foot (the plantar fascia). It is often worst with the first steps in the morning, and common in runners, hikers and people who stand all day at work. We ease the pain and build up the foot and calf so they can take load again. ## Symptoms - Sharp pain under the heel with the first steps of the day - Pain after sitting for a while that eases as you walk - Pain on the inside of the heel when you press on it - Pain that builds after long walks, runs or a shift on your feet - Aching in the arch of the foot - Tight calves or a stiff ankle ## Assessment 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. ## Treatment 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](https://backinactionphysiotherapy.com/services/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](https://backinactionphysiotherapy.com/services/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. ## Getting back to sport 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](https://backinactionphysiotherapy.com/services/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. ## When to come in 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 ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) - [Michael Pearce, Physiotherapist, BSc PT](https://backinactionphysiotherapy.com/team/michael-pearce) - [Kelsey Rey, Physiotherapist, MPT, BHK](https://backinactionphysiotherapy.com/team/kelsey-rey) - [Keeley Wentzel, Physiotherapist, BSc Physiotherapy (Hons)](https://backinactionphysiotherapy.com/team/keeley-wentzel) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Shockwave Therapy](https://backinactionphysiotherapy.com/services/shockwave-therapy) - [Custom Casted Orthotics](https://backinactionphysiotherapy.com/services/custom-casted-orthotics) - [Running Assessment](https://backinactionphysiotherapy.com/services/running-assessment) - [Registered Massage Therapy (RMT)](https://backinactionphysiotherapy.com/services/massage-therapy) ## Frequently asked questions ### Why does my heel hurt most in the morning? Overnight stiffness. While you sleep, the foot rests pointing down, and the fascia and calf tighten. Your first steps stretch the sore tissue suddenly, which hurts, then it eases as the foot warms up. The same thing can happen after sitting for a while. Gentle calf and foot stretches before you stand up can soften those first steps. ### Will plantar fasciitis go away on its own? Often, yes. But it can be slow, and it tends to linger if the load that caused it carries on. Pain that has lasted a long time, or keeps coming back, usually needs a plan for the calf and foot. Pushing through sharp pain, or stopping all activity, can both keep it going. ### What shoes should I wear with plantar fasciitis? Supportive, cushioned ones. A shoe with a firm back, some arch support and a slightly raised heel can take some strain off the fascia. Try not to go barefoot on hard floors, or wear flat, thin-soled shoes, while it is sore. Bring the shoes you wear most to your appointment, and we will look at them with you. ### Does shockwave therapy hurt? It can. Most people feel a strong tapping in the heel during the session, which can be uncomfortable, and the area may be sore afterward. We adjust the strength to what you can manage. Shockwave is not suitable for everyone, so we check your health history before we start. ## Massage for recovery Massage therapists do not diagnose, so start with a physiotherapist. Once you have a diagnosis and a plan, our registered massage therapists can help with the recovery. [About massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy) *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*