Plantar Fasciitis

By Peter Charles, Sports Podiatrist — Shoes Feet Gear, 148 Boundary Rd Bardon

Plantar fasciitis is one of the most common causes of pain underneath the heel. It can also cause pain further forward into the arch and, in some cases, through the middle of the plantar fascia.

At Shoes Feet Gear, we see plantar fasciitis in runners, athletes, active adults, people who spend long periods on their feet and junior athletes.

One of the most important things I have learned from treating plantar fasciitis is that not all plantar heel pain behaves the same way. A straightforward plantar fascia injury will usually respond when the load through the injured tissue is reduced. When pain is unusually severe, changes character, fails to respond to appropriate treatment or behaves differently from typical plantar fasciitis, I start looking for other structures that may also be involved. This is why I don't approach every case of plantar fasciitis in exactly the same way.

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What Is Plantar Fasciitis?

The plantar fascia is a strong band of connective tissue that runs underneath the foot from the heel towards the toes. It helps support and stabilise the foot as we stand, walk, run and jump.

I think about plantar fasciitis primarily as a load-capacity problem. The plantar fascia adapts to the amount of stress placed through it. If the load suddenly increases beyond what the tissue can currently tolerate, some of its fibres can become injured and the fascia temporarily loses some of its capacity to handle load.

This can happen after an obvious increase in running, jumping or sport, but it can also happen after something as simple as a change in footwear or spending a week walking around barefoot when you normally wear supportive shoes. The important point is that the amount of load a plantar fascia can tolerate isn't fixed — it changes with activity, footwear, injury, recovery and rehabilitation.

Where Does Plantar Fasciitis Hurt?

The most common location is underneath the heel, towards the front and inside of the heel where the arch meets the heel. Plantar fascia pain can also occur:

  • Further forward underneath the arch
  • Through the middle portion of the plantar fascia
  • Along the arch
  • Occasionally further towards the forefoot

The exact location of pain is important because it can provide clues about which structure is actually causing the symptoms. Typical plantar fasciitis is usually felt around the plantar fascia as it approaches its attachment to the heel. Pain that is predominantly at the back of the heel, around the edges of the heel, or in a very small and unusually focal area may require a different line of investigation.

What Does Plantar Fasciitis Feel Like?

Typical symptoms can include:

  • Pain with the first steps in the morning
  • Pain after sitting or resting
  • A dull, tight or strained feeling underneath the heel
  • Sharp pain when the foot is loaded
  • A pulling or stretching sensation underneath the arch
  • Pain when walking barefoot
  • Increasing pain with prolonged standing
  • Pain with running, jumping or other high-load activities

Why Does Plantar Fasciitis Hurt With the First Steps in the Morning?

One of the classic symptoms is pain when getting out of bed. When the foot has been unloaded during sleep or prolonged rest, the plantar fascia is not being stretched and loaded in the same way as it is when standing. The first steps suddenly place load through the tissue. For someone with an injured plantar fascia, this transition from unloaded to loaded can produce the characteristic first-step pain. The same thing can happen after sitting for a long period, getting out of a car or standing up after resting.

Is All Heel Pain Plantar Fasciitis?

No. Plantar fasciitis is common, but heel pain is not a diagnosis. The plantar fascia can be involved alongside other structures, and some conditions can produce symptoms that initially look very similar to plantar fasciitis. Depending on the location and behaviour of the pain, I may consider:

  • Plantar fascia injury
  • Baxter's nerve irritation or compression
  • Other nerve-related heel pain
  • Heel fat-pad irritation
  • Achilles tendon problems
  • Bone stress or bone oedema
  • Bursae and other soft-tissue problems
  • Plantar fibromas or other palpable nodules
  • Stress fracture or injury following trauma

Burning, shooting or tingling pain makes me particularly interested in whether a nerve is involved. Pain around the back corner or edges of the heel can also point towards structures other than the plantar fascia.

One of the most important clues: response to treatment. I also pay close attention to what happens after treatment. If the diagnosis is correct and the treatment is appropriate, I expect to see either less pain, or an increase in what the person can comfortably do. If someone continues receiving appropriate plantar-fascia treatment but their pain is not changing, or their ability to walk and exercise isn't improving, I start questioning whether something else has been missed.

How I Diagnose Plantar Fasciitis

Before examining the foot, I take a detailed history — looking for clues about exactly where the pain is located, how it started, whether there was an increase in activity, first-step pain, running and training loads, barefoot activity, recent footwear changes, previous treatment, and how the pain has responded to treatment. This helps me develop a theory about which structures might be involved before I start the physical examination.

I then examine the plantar fascia directly by bending all five toes backwards to tighten the fascia underneath the foot. With the fascia under tension, I run my thumb along its length looking for tender areas, thickening, changes in the tissue, a clearly reproducible pain, and the location of the most symptomatic part of the fascia. More commonly, the problem is towards the heel where the plantar fascia attaches to the calcaneus — I maintain tension through the fascia and gradually work back towards the heel attachment, looking for the point where the patient's familiar pain can be reproduced.

Looking for Baxter's Nerve Involvement

One of the less obvious causes of persistent plantar heel pain is irritation or compression involving the nerve commonly referred to as Baxter's nerve — the first branch of the lateral plantar nerve. It is a recognised potential contributor to chronic plantar heel pain, although diagnosing it clinically can be challenging and there is not a single definitive test that proves its involvement.

I become suspicious of nerve involvement when the pain is extremely focal, deep, burning or shooting, more severe than expected, not behaving like ordinary plantar fasciitis, or worse with pressure from footwear, taping or an orthotic. A very focal and severe pain response in the deeper tissues underneath the relaxed plantar fascia can provide an important clinical clue that the nerve may be contributing to the symptoms.

What Causes Plantar Fasciitis?

The simplest way I explain plantar fasciitis is: the load placed through the plantar fascia has exceeded what it can currently handle. The tissue can become weaker following periods of reduced activity, and a sudden increase in loading can then exceed its capacity. The increase doesn't have to be dramatic. It can come from:

  • More running or jumping
  • A new training program or increased sport
  • Long days on your feet
  • A holiday involving much more walking
  • Walking barefoot more than usual
  • Changing shoes or a change in the construction of a familiar shoe
  • More flexible football boots
  • A change in school shoes

Foot Mechanics and Plantar Fasciitis

Foot mechanics can influence how much stress is placed through the plantar fascia.

Flat or pronating feet: When the foot pronates or flattens under load, the foot lengthens and this can increase tension through the plantar fascia. This is one reason people often associate plantar fasciitis with flat feet.

High-arched feet can also develop plantar fasciitis: I see plenty of plantar fasciitis in people with high-arched feet. A high arch does not automatically mean the plantar fascia is under less stress. In particular, some high-arched feet have a plantarflexed first ray, where the first metatarsal and big-toe joint sit relatively low. As the foot loads and the big toe dorsiflexes, the plantar fascia can become highly tensioned. This is one reason why I don't use the same orthotic design for every person with plantar fasciitis — a person with a pronated foot and a person with a high-arched foot may require completely different strategies to reduce plantar-fascia loading.

Can Shoes Cause or Aggravate Plantar Fasciitis?

Yes. Footwear is one of the first things I examine. One of the most important features I look at is the stiffness of the shank. When footwear is very flexible through the middle of the shoe, the plantar fascia may have to contribute more to stabilising the foot. A shoe with a sufficiently rigid shank can reduce the amount of movement through the middle of the foot and therefore reduce the demand placed on the injured plantar fascia. This can be particularly important in work shoes, school shoes, running shoes, sports shoes and football boots.

A shoe can look extremely thick, cushioned and supportive but still be surprisingly flexible through the middle. I physically bend the shoe and assess how much it flexes through the midfoot — appearance doesn't tell you everything about how a shoe will load an injured plantar fascia. For example, a shoe such as the Hoka Bondi 9 can look highly supportive because of its thick sole, but the actual stiffness through the shank needs to be assessed rather than assumed from its appearance.

Many modern running shoes are becoming lighter, softer, more flexible and more natural-feeling. When someone has an injured plantar fascia, a shoe designed primarily for flexibility may not provide the reduction in plantar-fascia load that they currently need.

Browse our range of running and sports shoes stocked in clinic.

How We Treat Plantar Fasciitis

The first objective is usually to reduce the load through the injured plantar fascia to a level that it can tolerate. That doesn't necessarily mean stopping all activity. Instead, I try to find the combination of footwear, taping, orthoses and activity modification that reduces the load sufficiently for the person to function comfortably.

One of the useful things about this approach is that we can often demonstrate it immediately in the clinic. A patient may stand and walk barefoot and experience significant pain. We can then change the footwear to a shoe with appropriate characteristics — a stiffer shank, appropriate cushioning, a suitable rocker, adequate overall structure. If their pain immediately drops, we have demonstrated that reducing the mechanical load through the plantar fascia has made a meaningful difference. If they still have pain, we can add strapping. This gives us an individualised loading threshold rather than simply telling everyone to stop sport.

Strapping for Plantar Fasciitis

Correctly applied strapping can be extremely effective for a genuine plantar fascia injury. The purpose is to reduce the stress placed through the plantar fascia, effectively providing additional support while the tissue is injured. It can produce a rapid reduction in pain and can sometimes allow someone to continue participating in sport. For some patients, I use serial taping every second day for a period of time to keep the load reduced while the fascia recovers.

However, taping isn't appropriate in exactly the same way for everyone. If a patient has significant nerve irritation, compressing the tissues with tape can sometimes make the symptoms worse — another reason why identifying what structures are actually contributing to the pain is important.

Do Orthotics Help Plantar Fasciitis?

Orthotics can be a very useful part of plantar-fasciitis treatment, particularly for active people, but there is no one standard orthotic for plantar fasciitis. The orthotic needs to match the mechanics and the structures involved.

When the fascia is extremely painful, I may initially prefer taping or softer cushioning rather than immediately placing a firm orthotic underneath the foot. If a nerve is particularly irritated, a firm orthotic can sometimes aggravate symptoms — in these cases, I may first concentrate on offloading and calming the nerve before designing an orthotic with features that reduce pressure around the symptomatic area.

A pronated foot may require a very different orthotic strategy from a high-arched foot with a plantarflexed first ray. The objective isn't simply to "support the arch" — it is to change the way load is distributed through the foot so the injured tissue can tolerate it. Find out more about our prescription orthotic inserts.

Exercises and Strengthening for Plantar Fasciitis

The plantar fascia itself isn't a muscle, but the muscles surrounding the foot and ankle can help provide support and control. Strengthening is therefore an important part of longer-term management. Depending on the individual, rehabilitation can include:

  • Intrinsic foot strengthening
  • Arch-control exercises
  • Calf strengthening
  • Progressive loading of the plantar fascia
  • Controlled exercises that gradually increase the tissue's capacity

The longer-term goal is to increase the amount of load the plantar fascia and surrounding structures can tolerate.

See our full foot strengthening exercise program →

Can You Keep Running With Plantar Fasciitis?

In many cases, yes. I don't believe that every runner with plantar fasciitis needs to stop running completely. The question is: can we reduce the load enough for the injured fascia to tolerate the level of running required? For runners and junior athletes who are highly committed to training, I can often combine appropriate footwear, orthoses, strapping and selective activity modification to reduce the stress through the plantar fascia enough to allow continued training.

A typical progression might be: reduce load → regain comfort → return to running → increase training → return to competition → reduce reliance on tape → gradually increase exposure to less-supportive footwear → return to normal activity. This is very different from simply telling an athlete to stop sport until the pain disappears.

Why Hasn't My Plantar Fasciitis Improved?

Persistent plantar heel pain deserves another look. If appropriate treatment isn't producing either less pain or greater functional capacity, I start asking why. Possibilities include:

  • The original diagnosis isn't completely correct
  • The plantar fascia is still being overloaded
  • Footwear is contributing to the problem
  • The treatment doesn't match the person's foot mechanics
  • A nerve is involved
  • There is another soft-tissue problem
  • There is bone involvement
  • Activity has progressed faster than tissue capacity
  • The fascia hasn't yet regained sufficient strength

One of the most important things I tell patients is that plantar fasciitis does not always occur in isolation. The foot contains nerves, bones, muscles, tendons, fat pads and connective tissues that can all contribute to heel pain. When symptoms don't behave as expected, those structures need to be reconsidered.

Case Study: When Plantar Fasciitis Wasn't the Whole Problem

One patient had experienced severe heel pain for approximately four months. It had initially behaved like typical plantar fasciitis, beginning with first-step pain after a long weekend of hiking. The symptoms persisted for several months before suddenly becoming much more severe, with stabbing pain developing over the following weeks. The patient had already been treated with strapping and an orthotic, but both made the pain worse. Interestingly, soft Crocs were more comfortable than the patient's more supportive shoes with the orthotic.

On examination, there was some evidence of plantar-fascia involvement, but the most severe pain was much deeper and extremely localised to a tiny area on the inside of the heel. This changed the treatment approach. Rather than continuing to aggressively support the plantar fascia, the immediate priority became offloading the suspected nerve involvement. Soft cushioning and appropriate slides were used for a period of time, including at home. Within a week, the extreme stabbing pain had reduced substantially.

Once the nerve had settled, we could return to treating the plantar fascia. Strapping was reintroduced carefully, avoiding the sensitive area, and the orthotic was redesigned with an area to reduce pressure around the nerve. The heel pain gradually reduced and the patient returned to normal activity over the following weeks.

The lesson: A treatment that is appropriate for an injured plantar fascia can be inappropriate if another structure is also highly irritated. When treatment consistently makes symptoms worse, reassessing the diagnosis can be more useful than simply increasing the treatment.

Severe Chronic Plantar Fasciitis and Bone Involvement

Most plantar fasciitis can be assessed and managed clinically without imaging. Occasionally, however, I see patients with extremely severe and persistent plantar heel pain that has failed to respond to appropriate treatment. In selected cases, I will arrange an MRI. Occasionally the MRI shows significant bone marrow oedema extending from the plantar-fascia attachment deeper into the calcaneus.

When this occurs, I consider the bone and periosteal tissues around the plantar-fascia attachment to be an important part of the clinical problem. These patients may respond poorly to simply continuing to treat the plantar fascia. A period of full offloading, sometimes using a high-quality walking boot such as an Aircast, may be required to allow the bone and surrounding tissues to recover. These are not typical cases of plantar fasciitis — they represent the severe end of the spectrum and require a different level of assessment and management.

Plantar Fasciitis in Teenagers and Junior Athletes

Plantar heel and arch pain can also occur in young athletes. I see junior athletes who participate in multiple sports, sometimes while wearing several completely different types of footwear every week. A particularly important factor is that footwear can change from one season to the next even when the athlete believes they are wearing "the same type" of shoe. Football boots with a very flexible shank can substantially change the loading through the foot, and school shoes also matter — students can spend thousands of steps each week walking around school.

Case Study: A Junior Athlete and a Change in Football Boots

A 12-year-old boy who played soccer and rugby union had been participating in sport since the age of six without previous foot problems. During the season, he developed pain through both arches while playing soccer and rugby. The symptoms gradually became worse until he was experiencing pain even while walking around school. Examination confirmed strain through the plantar fascia in the middle of both arches.

I then examined his football boots. The shank of his Nike football boots was extremely flexible — and importantly, much more flexible than the boots he had previously used. This provided a straightforward explanation for the sudden increase in loading through both plantar fasciae. We used strapping and changed his football boots to a stiffer-shank design. The pain resolved quickly.

The lesson: Sometimes the most important treatment isn't a new exercise or an orthotic. It is identifying what changed immediately before the injury developed.

When Should Plantar Heel Pain Be Investigated Further?

Most straightforward plantar fasciitis does not require imaging. However, I consider further investigation when the symptoms don't fit the expected pattern or aren't responding appropriately. Depending on the clinical findings, this might include:

  • MRI — useful when there is concern about deeper structures such as bone stress, bone oedema or more complex chronic heel pain
  • Ultrasound — can be useful for assessing soft tissues and palpable abnormalities such as plantar fibromas
  • X-ray — may be appropriate after trauma or where there is concern about a bony injury

The important principle is that imaging should answer a clinical question. A heel X-ray showing a spur, for example, doesn't automatically tell us that the spur is causing the pain.

How Long Does Plantar Fasciitis Take to Recover?

There isn't one recovery time that applies to everyone. Some people improve relatively quickly once the load through the plantar fascia is reduced. Others develop persistent symptoms because the tissue continues to be overloaded, rehabilitation hasn't restored its capacity, or another structure is contributing to the pain. I focus less on an arbitrary timeframe and more on whether the patient is progressing — less pain → more comfortable walking → greater activity tolerance → increased running and training capacity → return to full activity.

Book an Assessment with our Bardon Podiatrists →

Frequently Asked Questions — Plantar Fasciitis

Is plantar fasciitis the same as a heel spur?

No. A plantar heel spur and plantar fasciitis are different things. A spur seen on an X-ray does not automatically mean that it is the source of the pain.

Why does plantar fasciitis hurt when I first get out of bed?

The first steps suddenly load the plantar fascia after a prolonged period without weight-bearing. An injured plantar fascia can be particularly sensitive to this sudden change from unloaded to loaded.

Can I keep running with plantar fasciitis?

Often, yes. The important question is whether the load can be reduced enough for the injured fascia to tolerate running. Footwear, taping, orthoses and selective training modifications can sometimes allow athletes to continue running while the tissue recovers.

Do orthotics help plantar fasciitis?

They can be very useful for some people, but the design should match the individual's foot mechanics and symptoms. Orthotics aren't simply a universal treatment for every case of plantar fasciitis.

What shoes are best for plantar fasciitis?

There isn't one shoe that is best for everyone. I pay particular attention to the stiffness of the shank, overall construction, cushioning and forefoot characteristics. A shoe that looks supportive isn't necessarily stiff through the middle.

Should I stop all activity with plantar fasciitis?

Not necessarily. The goal is usually to reduce the load to a level the injured plantar fascia can tolerate, rather than automatically eliminating all activity.

Why is my plantar fasciitis getting worse with treatment?

If an apparently appropriate treatment consistently makes symptoms worse, the diagnosis or the structures being treated should be reassessed. Nerve involvement is one possibility, but other causes of heel pain should also be considered.

When do I need an MRI for plantar fasciitis?

Most straightforward cases don't require MRI. Imaging becomes more useful when pain is unusually severe, persistent, atypical or resistant to appropriate treatment, or when there is clinical concern about deeper structures such as bone.

Plantar Fasciitis Treatment in Bardon and Brisbane

If you have persistent plantar heel pain, particularly if it is affecting running, sport, work or everyday walking, a detailed assessment can help determine whether the plantar fascia is actually the primary source of the pain.

At Shoes Feet Gear in Bardon, Peter Charles provides sports podiatry assessment for plantar fasciitis, plantar heel pain and other lower-limb injuries. The focus is not simply on treating the painful area — it is on identifying what is being overloaded, why it has become overloaded, whether other structures are involved, and how to progressively restore the foot's capacity to handle load.

Shoes Feet Gear — Sports Podiatry, Bardon, Brisbane.

Related Pages

This information is educational and does not replace an individual clinical assessment. Persistent, severe or unusual heel pain should be assessed by an appropriately qualified health professional.