You get out of bed, put your foot on the floor, and feel a sharp stab of pain through your heel. After a few minutes of hobbling around, it eases off. But the moment you sit down for a while and stand up again, there it is.
That pattern is the hallmark of plantar fasciitis, and it is one of the most common causes of heel pain we see in practice. It affects runners, people who are on their feet all day, and sometimes people who have done nothing obviously different. It can be stubborn to get rid of, but once you understand what is actually going on, the treatment makes a lot more sense.
What is the plantar fascia?
The plantar fascia is a thick band of tissue that runs along the bottom of your foot, from your heel bone to the base of your toes. Think of it like a strong, flat tendon that supports the arch of your foot. Every time you take a step, it stretches and absorbs load. It is built to handle a lot, but like any structure, it has limits.
When the plantar fascia is overloaded repeatedly, the tissue becomes irritated and painful. Despite the name “fasciitis” (which implies inflammation), research shows it is usually more of a degenerative process than a purely inflammatory one. The tissue breaks down faster than it can repair itself. That is why rest alone often is not enough to fix it. The tissue needs to be gradually reloaded to heal properly.
What does it feel like?
The most recognisable symptom is pain under the heel, particularly:
- First steps in the morning. After a night of sleep, the plantar fascia tightens up. When you put weight on it, the tissue is forced to stretch suddenly, causing a sharp pain that typically eases after a few minutes of walking.
- Standing up after sitting. The same thing happens whenever you have been off your feet for a while. The tissue stiffens, and loading it again is painful.
- After activity, not during. Runners with plantar fasciitis often find that the pain settles once they warm up, but comes back worse after they stop. This delayed response is a sign that the tissue is being overloaded even though it does not hurt at the time.
- A deep ache through the arch. Some people feel the pain more through the middle of the foot than directly under the heel.
What causes it?
There is rarely a single cause. Plantar fasciitis usually develops because of a combination of factors that, together, put more load on the plantar fascia than it can handle.
Too much, too soon. A sudden increase in running distance, a new pair of shoes, starting a walking programme, or ramping up training after a break. The tissue has not had time to adapt to the increased demand. This is the most common trigger in runners.
Tight calves. Research by Bolivar and colleagues (2013) showed a clear link between tight calf muscles and plantar fasciitis. When your calves are tight, your ankle does not bend as far as it should during walking or running. The plantar fascia compensates by absorbing more force with every step.
Weak foot muscles. The small intrinsic muscles of your foot play an important role in supporting the arch and controlling how the plantar fascia loads. When these muscles are weak (which they often are if you spend most of your time in supportive shoes), the fascia takes on more of the work.
Being on your feet all day. Prolonged standing, especially on hard surfaces, puts sustained load on the plantar fascia. Teachers, nurses, retail workers, and hairdressers are all at higher risk.
Body weight. Higher body weight increases the load through the plantar fascia with every step. This does not mean that weight is always the cause, but it is a contributing factor.
Flat feet or high arches. Both extremes change the way load is distributed through the foot. Flat feet tend to overstretch the fascia, while high arches concentrate force on the heel and forefoot.
Poor footwear. Thin-soled shoes, worn-out running shoes, or shoes with no arch support can all contribute. If you are a runner, your shoes should be replaced roughly every 600 to 800 kilometres.
How chiropractic care helps
Plantar fasciitis is not just a foot problem. The way your foot loads is influenced by your ankle, your knee, your hip, and even your lower back. Treating the foot in isolation often misses the bigger picture.
Foot and ankle mobilisation. The joints in your foot and ankle can stiffen up as a result of the pain and altered movement patterns. Gentle mobilisation restores normal joint mechanics and allows the plantar fascia to load more evenly. Research supports manual therapy as part of a multimodal approach to plantar heel pain (Martin et al., 2014).
Soft tissue therapy. Targeted work on the calf muscles, Achilles tendon, and the plantar fascia itself helps reduce tension and improve tissue quality. This is often where patients feel the most immediate relief.
Assessing the whole chain. If your hip is weak on one side, or your knee is not tracking well, or your ankle is stiff, your foot will compensate. Your chiropractor can identify these upstream issues and address them alongside the local foot treatment.
Dry needling. For stubborn cases, dry needling into the calf muscles or the plantar fascia itself can help reset the pain cycle and improve tissue healing.
Load management advice. One of the most important parts of treatment is getting the balance right between resting the tissue enough for it to heal and loading it enough to stimulate repair. Your chiropractor can help you modify your activity without stopping altogether.
Exercises that help
These exercises target the main contributing factors: tight calves, weak foot muscles, and the plantar fascia itself. Consistency is key. A few minutes daily will do more than one long session a week.
1. Wall calf stretch (gastrocnemius)
Stand facing a wall with one foot forward and one foot back. Keep your back knee straight and your heel on the ground. Lean into the wall until you feel a stretch through the back of your lower leg. Hold for 30 seconds. Repeat 3 times on each side.
This targets the gastrocnemius, the larger calf muscle that crosses the knee.
2. Bent-knee calf stretch (soleus)
Same position as above, but this time bend your back knee slightly while keeping your heel on the ground. You should feel the stretch lower down, closer to your Achilles tendon. Hold for 30 seconds. Repeat 3 times on each side.
This targets the soleus, the deeper calf muscle that plays a bigger role in walking and running.
3. Plantar fascia stretch
Sit down and cross your affected foot over your opposite knee. Pull your toes back toward your shin with your hand until you feel a stretch through the arch of your foot. You should be able to feel the plantar fascia tighten like a guitar string under your fingers. Hold for 15 to 20 seconds. Repeat 10 times. This is particularly useful first thing in the morning before you take your first steps.
4. Towel scrunches
Place a towel flat on the floor. Sit in a chair and use your toes to scrunch the towel toward you, then push it away. Do this for 2 to 3 minutes. This strengthens the small intrinsic muscles of your foot that help support the arch and reduce load on the plantar fascia.
5. Eccentric heel drops
Stand on the edge of a step with just the balls of your feet on the step. Slowly lower your heels below the step level over 3 to 4 seconds, then push back up. Start with both legs and progress to single-leg as it gets easier. Do 3 sets of 12 to 15 repetitions.
Research by Rathleff and colleagues (2015) found that high-load strength training, including heel raises, produced better results than stretching alone for plantar fasciitis. The key is slow, controlled loading that stimulates the tissue to repair and strengthen.
How long does it take to get better?
This is the part nobody wants to hear. Plantar fasciitis typically takes 6 to 12 weeks to resolve with consistent treatment and the right exercises. Some cases take longer, particularly if it has been going on for months before treatment starts.
The good news is that most people notice meaningful improvement within the first few weeks. The morning pain is usually the first thing to ease up.
The important thing is not to stop treatment as soon as it starts feeling better. The tissue needs time to fully remodel and strengthen. Returning to full activity too quickly is the most common reason for it to come back.
When to get help
Plantar fasciitis responds best to early intervention. The longer it goes on, the more the tissue degenerates and the harder it becomes to treat. See a professional if:
- Your heel pain has lasted more than two weeks and is not improving
- The pain is stopping you from exercising or doing your normal activities
- You are limping or changing the way you walk to avoid the pain
- You have tried rest and stretching and it is not getting better
- The pain is getting worse despite your efforts
Walking differently to avoid heel pain can lead to problems further up the chain, including knee pain, hip pain, and lower back pain. The sooner you address the foot, the less likely you are to develop secondary issues.
You do not have to stop running
This is probably what you wanted to hear. In most cases, you do not need to stop running completely. You may need to reduce your distance or intensity temporarily while the tissue heals, but complete rest is rarely the answer. The plantar fascia needs controlled loading to repair. Your chiropractor can help you find the sweet spot between doing too much and doing too little.
If you are dealing with heel pain that will not go away, get in touch or book an appointment. We can assess what is driving it and get you back on your feet.
References
- Martin RL, Davenport TE, Reischl SF, et al. Heel Pain: Plantar Fasciitis. Revision 2014. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(11):A1-A33.
- Rathleff MS, Molgaard CM, Fredberg U, et al. High-Load Strength Training Improves Outcome in Patients with Plantar Fasciitis. Scandinavian Journal of Medicine & Science in Sports. 2015;25(3):e292-e300.
- Bolivar YA, Munuera PV, Padillo JP. Relationship Between Tightness of the Posterior Muscles of the Lower Limb and Plantar Fasciitis. Foot & Ankle International. 2013;34(1):42-48.
- Whittaker GA, Munteanu SE, Menz HB, Tan JM, Rabusin CL, Landorf KB. Foot Orthoses for Plantar Heel Pain: A Systematic Review and Meta-Analysis. British Journal of Sports Medicine. 2018;52(5):322-328.
- Digiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-Specific Plantar Fascia-Stretching Exercise Enhances Outcomes in Patients with Chronic Heel Pain. Journal of Bone and Joint Surgery. 2003;85(7):1270-1277.