What Is Plantar Fasciitis?

Plantar fasciitis | Plantar heel pain syndrome

Plantar fasciitis is a common cause of heel pain, often presenting as a sharp, stabbing sensation in the heel that is worst with the first steps in the morning or after prolonged inactivity. It results from overuse or microtears and inflammation of the plantar fascia - the fibrous band connecting the heel bone (calcaneus) to the toes.

Symptoms & Clinical Features

Key symptoms include:

• Intense heel pain on first weight-bearing steps after rest (e.g. morning)
• Pain after prolonged standing or walking
• Increased discomfort after non-weight-bearing activities when resuming walking
• Localized tenderness at the medial calcaneal tuberosity

Conservative Treatment Strategies

Stretching & Strengthening

Numerous studies support stretching the calf muscles and plantar fascia to reduce heel pain and improve flexibility.  

Examples:

• Calf stretch: Lean wall stretch — one leg behind, heel flat on ground, hold 30s × 3 times.
• Towel stretch: Sit, loop a towel around the forefoot, gently pull to flex the toes upward.
• Toe curls / marble pickup: Use toes to grip and lift small objects to strengthen intrinsic foot muscles.

Supportive Footwear & Orthotic Inserts

Choosing shoes with shock-absorbing soles, stable heel counters and good arch support is critical. Custom or prefabricated orthotic insoles help distribute pressure, support alignment and unload the plantar fascia. Clinical trials in the British Journal of Sports Medicine demonstrate significant symptom reduction when orthotics complement stretching regimes. 

Night Splints

Night splints maintain gentle dorsiflexion of the foot overnight. This keeps the plantar fascia and Achilles tendon gently stretched, reducing morning “first-step” pain. Evidence from podiatric and orthopaedic literature supports their use in both subacute and chronic cases. 

Manual Therapy & Self-Massage

Physical therapy, deep tissue massage, myofascial release and joint mobilisations can decrease pain and improve function. Rolling a massage ball or frozen water bottle under the arch (scrolling it gently) is a convenient home method to relieve tension. 

Lifestyle Adjustments & Weight Control

Losing excess body weight reduces chronic stress on the plantar fascia. Low-impact exercises such as swimming, cycling or aquatic therapy provide cardiovascular benefits without aggravating the foot. Studies show weight reduction correlates with symptom improvement in overweight patients. 

Advanced & Adjunctive Therapies

Shockwave Therapy (ESWT)

Extracorporeal Shock Wave Therapy (ESWT) is used when conservative treatments fail. High-energy acoustic waves stimulate tissue repair in chronic plantar fascia lesions. Multiple clinical trials report positive outcomes in pain reduction and functional improvement, especially when combined with other conservative modalities. 

Platelet-Rich Plasma (PRP) Injections

PRP involves injecting a concentrated sample of the patient’s own platelets into the damaged fascia to promote healing and regeneration. Emerging evidence (e.g. *American Journal of Sports Medicine*) suggests measurable improvements in pain and tissue quality for recalcitrant cases. 

Surgery (Last Resort)

Surgical intervention is considered only after 6–12 months of failed conservative care. Techniques include partial release of the plantar fascia or excision of degenerative tissue. Success rates are high, though recovery is lengthy and risks (e.g. arch instability) should be weighed carefully. 

Recovery Timeline & Prognosis

In many cases, patients experience symptom relief within 6–12 weeks with consistent conservative treatment. However, more severe or chronic cases may take several months to fully resolve. The combination of stretching, orthoses, manual therapy and patient adherence is key. 

Considerations & Best Practices

In Australia, clinicians should account for local conditions such as:

• Frequent use of hard surfaces (e.g. concrete, tiles) increasing cumulative load on feet.
• Climate influences on footwear - open shoes, thongs, minimal support footwear may aggravate symptoms.
• Access to public health services and reimbursement constraints on advanced treatments (e.g. ESWT, PRP).
• Encouraging patients to adopt orthoses, strething routines and footwear changes given the outdoor, active lifestyle typical in many regions.