Plantar Fasciitis: Causes, Symptoms & Best Treatment for Heel Pain

Plantar fasciitis is one of the most common causes of heel pain, often felt as sharp or stabbing discomfort under the heel, especially with the first steps in the morning or after rest. This condition arises when the plantar fascia — a thick band of connective tissue on the bottom of the foot — becomes overloaded and irritated over time, leading to pain and reduced function.

Plantar fasciitis can significantly impact daily activities, exercise, and overall quality of life. Understanding the causes, symptoms, and evidence-based management strategies helps you recover stronger and more confidently.

What Is Plantar Fasciitis?

The plantar fascia connects the heel bone to the base of the toes and supports the foot’s arches while absorbing shocks during walking and running. Unlike what many people think, heel spurs seen on X-rays rarely cause pain — the discomfort usually comes from how the tissue is being loaded rather than the spur itself.

Common Symptoms of Plantar Fasciitis

People with plantar fasciitis often report:

  • Heel pain first thing in the morning

  • Pain after sitting and standing

  • Pain after exercise, not usually during

  • Discomfort with prolonged weight-bearing or walking

What Causes Plantar Fasciitis?

Plantar fasciitis typically develops from a combination of factors that overwhelm the tissue’s ability to tolerate load, such as:

  • Sudden increases or decreases in training load (e.g., returning from a break)

  • Changes in physical activity — longer distances, different terrain, or new shoes

  • Previous injuries or altered movement patterns

  • Biomechanical and strength deficits throughout the lower body

While short-term rest can ease symptoms, effective long-term recovery focuses on improving tissue capacity and movement quality. This often means assessing movement mechanics not just in the foot, but also at the ankle, knee, hips, pelvis and trunk.

How Is Plantar Fasciitis Treated?

Successful management involves a multi-pronged approach that includes load management, therapeutic exercise, and symptom relief strategies.

1. Load Management

Rest or modify activities that aggravate your heel pain. Reducing high-impact movements temporarily allows the inflamed tissue to calm. Avoid walking barefoot on hard surfaces whenever possible.

2. Targeted Strengthening & Movement Control

Strengthening both the foot and lower leg is crucial, including:

  • Foot intrinsic exercises (e.g., toe curls, marble pickups)

  • Calf strengthening (e.g., heel raises)

  • Progressive loading exercises that improve tolerance over time

It’s also important to address tightness or stiffness around the ankle and knee, and control in the hips and trunk to improve overall loading mechanics.

Best Exercises for Plantar Fasciitis

Physiotherapists commonly use exercises like:

  • Toe curls and marble pickups

  • Calf raises (straight and bent-knee)

  • Arch strengthening and balance

  • Heel drop progressions for load tolerance

Consistency is key — performing these exercises several times weekly helps build strength and resilience in the plantar fascia and related muscles.

Pain Relief and Symptom Management

During flare-ups, combine exercise with symptom control:

  • Ice therapy: Apply ice or use a frozen water bottle roll for 10–15 minutes to reduce pain after activity.

  • Self-massage: Rolling with a ball or bottle can help reduce tension.

  • Taping: Techniques such as Low-Dye taping can temporarily reduce load on the fascia before walking or exercise.

  • Manual therapy: Hands-on treatment for tight joints and muscles can support range of motion and pain relief.

  • Supportive options: Heel lifts and prefabricated orthotics can provide a temporary reduction in foot strain while tissue capacity improves.

  • NSAIDs: Non-steroidal anti-inflammatory medications or topical creams may be used temporarily when appropriate and advised by a healthcare provider.

When to See a Physiotherapist

Consider professional help if:

  • Pain persists longer than 4–6 weeks

  • Pain interferes with daily activities

  • Self-management isn’t improving symptoms

A physiotherapist can tailor a personalised rehabilitation program, assess your movement mechanics, and guide progression safely.

Summary

Plantar fasciitis is common but highly manageable with the right approach:

  • Understand the causes and symptoms

  • Modify aggravating activities

  • Strengthen foot and lower limb muscles

  • Use pain-relief strategies alongside targeted rehabilitation

  • Get personalised guidance from a physio when needed

With consistency and the right program, most people can reduce pain, improve function, and return to an active lifestyle.