Plantar Fasciitis and Heel Pain: Causes, Symptoms and How Chiropractic Can Help

Plantar fasciitis, the pain is nearly always the same. You put your feet on the floor first thing in the morning, take a couple of steps and the underside of your heel feels as though you have trodden on a stone. After a minute or two the pain eases and by mid-morning you have half forgotten it. Then you stand up later in the day and the pain is back.

This pattern is the most recognisable feature of plantar fasciitis and it is a common foot complaint. Most people who book in to see me have already tried a gel heel cup or have been told there is nothing to do but wait for it to feel better by itself. Heel pain of this kind usually does settle but it tends to be measured in months rather than weeks and what you do in the meantime can make a significant difference to how long it drags on for. This painful foot condition sits within the wider group of problems covered on my leg, knee, ankle and foot pain page.

Line chart of plantar fasciitis pain through a day: severe on the first steps out of bed, easing with movement, returning on standing up after lunch, building again through the evening. — The pattern most people describe, and the reason it is so often dismissed as nothing.

What is plantar fasciitis?

The plantar fascia is a thick band of fibrous tissue which runs from the underside of the heel bone to the base of the toes. It works like the string of a bow, holding tension across the arch so the foot behaves as a rigid lever. Plantar fasciitis is pain where that band attaches to the heel and is usually felt at the inside edge of the heel.

The name is slightly misleading. The “itis” ending implies an active inflammation, but tissue studies of long-standing cases show changes that look more like wear and disorganisation of the collagen. This is why you will increasingly see the terms plantar fasciopathy or plantar heel pain used instead. The phraseology matters because it explains why anti-inflammatory measures alone often don’t work and why rebuilding the tissue’s tolerance to load tends to work better.

Heel spurs cause a good deal of unnecessary worry. They show up on X-rays of plenty of people with no pain at all and finding one rarely changes what should be done.[6] The spur is a consequence of long-term tension but not the source of the symptoms. of heel pain

What causes this type of heel pain

In almost every case, the cause of this heel pain is load exceeding what the tissue can tolerate. The trigger is usually obvious once I examine your foot and ask about your lifestyle: a new job standing on hard floors, a fortnight of holiday walking in flat sandals, a return to running for exercise or a decision to walk further than usual.

Several additional factors make that threshold of pain easier to cross. Reduced ankle movement and a tight calf because a stiff ankle forces the foot to absorb more through the arch. Footwear with a collapsed heel support or no midsole arch support adds to this and carrying additional body weight also increases the load placed on your foot. Foot shape can be blamed: very flat feet and very high arches can be possible contributors too.

Explore our leg, knee, ankle and foot guides

Leg, knee, ankle or foot pain: the main guide

Heel, ankle and foot

Plantar fasciitis and heel pain: pain under the heel (you are here)
Achilles tendinopathy: pain behind the heel, heel cord pain and tight calves
Ankle pain and referred foot pain: rolled ankles and ligament injuries

Knee, thigh and calf

Related guides

When leg pain starts in the back

When leg pain starts in the hip or pelvis

Staying active

Symptoms of plantar fasciitis

The classic description of plantar fasciitis is pain under the heel which is at its worst for the first few steps after rest. That could be when getting out of bed or standing up after a long drive. The pain eases as you move then builds again through a long day spent on your feet. Pressing into the inside of the heel usually reproduces it precisely.

a womans foot showing the area of pain for plantar fasciitis on the sole of the foot

Several other things cause heel pain:

Pain at the back of the heel rather than underneath points towards the Achilles tendon and its attachment. When a pain is felt as a deep, bruised ache in the middle of the heel, worse when barefoot on hard floors and more common in older patients, it suggests thinning of the heel fat pad instead. Burning, tingling or numbness spreading into the sole suggests nerve involvement either locally or referred from the lower back and those factors and details change the assessment. In an active child, heel pain at the back of the heel could be Sever’s disease, a growth plate irritation that settles with time and load management.

How chiropractic may help

Chiropractic care sits within the short-term management of plantar fasciitis. I treat it with soft tissue work to the plantar fascia and calf, mobilisation or manipulation of the foot and the ankle joints where movement may be restricted and the sometimes I use taping to offload the arch while symptoms are most acute. I also assess the knee, hip and lower back, because a long-standing limb problem changes how the whole leg limb loads and because referred pain needs ruling out. Chiropractic assessment is very thorough.

Best practice guidance puts individualised education, stretching and taping at the core of management with other treatments added if progress stalls.[1] Plantar fascia specific stretching has held up well over two years of follow-up.[4] High-load heel raise strengthening produced faster improvement at three months than stretching alone, although the advantage had gone by twelve months and only forty-eight patients took part.[3] Reviews of manual therapy report improvements in pain and function but note that the trials behind them are small and of low to moderate quality.[5] A network meta-analysis found no single treatment standing clearly above the others.[2]

In practice I expect some change within four to six weeks of consistent work, with fuller resolution taking three to six months. If nothing improves we change the plan or I refer you on. Treatment is individualised to you and your lifestyle. The plan for a nurse who is on their feet for twelve hours differs from the plan for a runner training perhaps along the seafront at Canford Cliffs.

If heel and foot pain from plantar fasciitis is getting in the way of things you do, come and talk it through. I offer a free 15-minute consultation, you can come in for a short no-obligation chat with no examination or treatment.

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Or call for a chat on 01202 937568

Red flags: when to seek medical attention first

The majority of heel pain is mechanical and not a sign of anything sinister.

However, sudden severe pain in the arch during activity, sometimes with an audible snap, can mean a tear of the fascia. Heel pain after a fall from a height or an inability to weight bear after an injury needs an X-ray to rule out a fracture. Pain that is present at rest and at night, particularly with fever, redness, heat or unexplained weight loss, needs medical assessment. Heel pain in someone under forty alongside morning back stiffness lasting more than half an hour or pain in several joints, can sometimes be an early sign of inflammatory arthritis and you need your GP. If you cannot put weight through the foot after an injury go to A&E.

Your first visit to Bournemouth Chiropractic

At your first full chiropractic appointment visit I take a full medical history covering when the pain in your foot started, what changed in the weeks beforehand, what your footwear is like and I will ask you about your typical day on your feet. I will then examine the foot and ankle, test calf length and ankle movement, check sensation in the sole of your foot and look at how you walk. I will tell you what I think is going on and whether chiropractic care is likely to help you and what the plan looks like including the parts you do at home between visits to support your treatment and recovery.

Frequently Asked Questions

Can a chiropractor help treat plantar fasciitis?

Yes, for short-term management a chiropractor can help with plantar fasciitis. Manual therapy to the foot, ankle and calf, with taping and a loading programme, may help reduce pain and improve function. I will talk about what to expect and will refer you on if care is not helping.

How long does plantar fasciitis take to settle down?

Plantar fasciitis takes longer than most people realise to settle down. With consistent management, many cases improve substantially within three to six months as a guide, but some take longer. Morning pain is usually the first thing to ease and the last thing to go. Stopping the exercises as soon as the pain eases is the most common reason that the pain returns.

Would plantar fasciitis show up on an X-ray or a scan?

Plantar fasciitis does not usually show up on an X-rays and can show up on a scan. The best scan is a diagnostic ultrasound, however it can also be seen on an MRI or a CT scan. Plantar fasciitis is mainly diagnosed from your history and examination and imaging rarely changes what should be done.[6] Scans are reserved for cases that do not respond as expected or where a stress fracture, a fascial tear or a nerve problem needs excluding.

Are insoles and heel cups worth buying for plantar fasciitis pain?

They can help with pain relief from plantar fasciitis for some people in the short term by reducing load through the arch and they are cheap and worth trying. What the research does not support is the idea that expensive custom devices reliably outperform simple prefabricated ones.

When should I go to A&E about my foot rather than book an appointment?

Go to A&E if you cannot put weight through the foot after a fall or if you felt a sudden snap in the arch followed by severe pain and swelling. Heel pain with fever, spreading redness or heat needs same day medical attention rather than a chiropractic appointment.

Whatever is behind your heel pain, come and find out

Heel pain that hurts in the first few steps of the morning has a way of altering the way you do things and by the time it is affecting your walking, your running or standing most will people want an answer about what is actually going on with their foot. At a first full chiropractic appointment I will take a full medical history, examine the foot, the calf and the way you load through the leg and give you an honest opinion on what is driving your pain and discomfort.

Plantar fasciitis and heel pain are common reasons people come to see me here in Bournemouth and a lot of them are walkers and runners who use the promenade and the cliff paths.

For the short-term management of plantar fasciitis, hands-on care combined with the loading and stretching work carries the strongest evidence and is a well-tolerated option worth considering and I will explain clearly what I think will help in your particular case when I see you. If I believe you would be better served by your GP, a podiatrist or another practitioner I will say so and help point you in the right direction.

Book an appointment online and you can choose what suits you: a first appointment, which is the full visit with a detailed history, examination and treatment where appropriate or select a free 15 minute consultation, which is a no-obligation 15 minute chat about your problem with no examination or treatment. If you are not sure which you need, call the clinic on 01202 937568 and we will work it out.

Call or message me, whatever is easiest and we will take it from there.

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