Plantar fasciitis and heel pain

Sharp heel pain on the first few steps out of bed is the classic presentation. It eases as you move, comes back after you have been sitting, and builds again after a long period standing or walking.

Plantar fasciitis is irritation of the plantar fascia, the thick band of tissue running from the heel to the toes, which supports the arch and takes load with every step. It is common, it is genuinely frustrating, and it responds slowly, which is worth knowing before you start.

What it usually feels like

• Sharp or stabbing pain in the heel, worst with the first steps of the morning
• Aching or burning after long periods standing or walking
• Tightness through the arch and sole
• Discomfort that eases with movement and returns after rest

What causes it

Rarely one thing. The presentations that come through most often involve some combination of:

• A change in load, a jump in running distance, a new surface, a job that moved from sitting to standing, or a holiday spent walking in flat shoes
• Calf and Achilles tightness, which increases the tension the fascia carries through the back half of each step
• Foot mechanics, how the arch loads and how the foot rolls through
• Footwear, particularly worn-out shoes or a sudden switch to something flat
• Hip and pelvis mechanics, which change how the leg is loaded before the foot ever touches the ground

That last one is why the assessment looks above the foot. A foot problem driven from the hip does not settle by treating the foot alone, and treating only where it hurts is the most common reason heel pain keeps returning.

When to see a chiropractor

Early, because plantar fasciitis that has been left tends to take considerably longer, and because the compensations people adopt to avoid heel pain start loading the knee, hip and lower back.

Get it looked at promptly rather than waiting if you have heel pain that came on after a specific traumatic moment, pain that is worse at night or at rest rather than with load, numbness or pins and needles in the foot, or any redness, heat and swelling with feeling unwell, those point away from a straightforward plantar fascia problem and need a different assessment.

What the assessment covers

• A full history, when it started, what changed around then, what your weeks look like in terms of standing, walking or running, and what footwear you actually live in
• Examination of the foot and ankle, including where exactly it is tender, which distinguishes fascia from fat pad from Achilles insertion
• Calf, ankle and big toe range, because restriction in any of them changes how the fascia is loaded
• Assessment of how you walk, and how the hip and pelvis are contributing
• An explanation of what was found, before any treatment

What treatment involves

• Chiropractic adjustment of the foot, ankle and, where the assessment points there, the pelvis and lower limb
• Massage therapy through the calf, the sole and the plantar fascia itself
• Shockwave therapy, which is used for long-standing tendon and fascia presentations where a slower-responding tissue has not settled with hands-on treatment alone
• Dry needling, where the calf musculature is part of it
• Rehabilitation exercises, calf and foot loading work, which is the part that does most of the work over time

Between appointments

More than most presentations, this one is decided outside the clinic. The loading exercises need doing, the shoes may need replacing, and the training or standing load usually needs adjusting for a period rather than continuing unchanged.

The chiropractor will be specific about what to modify and for how long. That conversation is more useful than any single treatment, because plantar fasciitis that keeps being re-loaded does not settle regardless of what is done to it in the appointment.

If chiropractic is not the right answer, you will hear that. Where imaging or specialist care is the next step, you will get a detailed letter outlining the findings and recommendations, including the specialist we believe is best suited to your needs.

Pain at the back of the heel rather than underneath it is a different problem with a similar morning pattern: that one is covered on Achilles pain.