Your feet carry you through life, but when every step feels like a stabbing pain in your heel, something’s wrong. If this sounds familiar, you may have plantar fasciitis—a common cause of foot pain affecting up to 10% of people¹.

Plantar fasciitis happens when the thick band of tissue (plantar fascia) supporting your arch becomes inflamed, often causing the worst pain in the morning. The good news? With the right treatment—stretching, strengthening, and smart footwear—most people recover. Let’s break down what causes it, who’s at risk, and how to manage it.

The Short Version

Plantar fasciitis is irritation of the plantar fascia, the thick band of tissue along the bottom of your foot, and it is the most common cause of heel pain. It is classically worse with the first steps in the morning or after rest. Most cases settle with a mix of calf and foot stretching, strengthening, load management, supportive footwear, and time, though it can be slow. A proper assessment helps confirm the diagnosis and rule out other causes of heel pain — such as a stress fracture, a trapped nerve, or an inflammatory condition — which need different management.

If heel pain is affecting you, a proper assessment is the best place to start.

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What causes Plantar Fasciitis?

Plantar fasciitis is heel pain caused by irritation of the plantar fascia, the thick band of tissue at the bottom of your foot. This tissue supports your arch and absorbs shock when you walk. When it gets overworked or strained, it can become inflamed, leading to stabbing pain, especially in the morning or after resting¹.

How Common is It?

Plantar fasciitis is one of the most common foot problems, affecting up to 10% of people at some point in their lives¹. It’s especially common in runners, athletes, and people who stand all day, like nurses, teachers, and retail workers².

Who is Most at Risk?

Runners & active people – Running, jumping, and high-impact sports put extra stress on the feet².
People on their feet all day – Jobs that require standing on hard surfaces for hours increase foot strain³.
People with high or flat arches – An unusual foot shape changes the way pressure is distributed, making injury more likely⁴.
Overweight individuals – Carrying extra weight puts more stress on the feet¹.
People aged 40-60 – The tissue naturally weakens over time, making middle-aged adults more at risk².

Common Signs and Symptoms of Plantar Fasciitis

Sharp heel pain in the morning – Feels like stepping on glass with the first steps of the day.
Pain after sitting or resting – A sharp, stabbing pain when standing up after rest.
Pain worsens with activity – Walking, running, or standing increases discomfort over time.
Tenderness on the bottom of the heel – Pressing on the heel feels sore, especially near the arch.
Foot stiffness in the morning – The foot feels tight until it loosens with movement.
Pain when barefoot or in flat shoes – Worse without support, improves with cushioned shoes.
Pain in one or both feet – Usually one foot, but can affect both over time.
Pain after exercise, not during – Activity may feel fine, but pain flares up afterward.

Why Does Plantar Fasciitis Happen?

Plantar fasciitis occurs when the plantar fascia—your foot’s shock absorber—becomes irritated and inflamed. This thick band of tissue stretches from your heel to your toes, helping support your arch and absorb impact. Over time, too much stress on the fascia can lead to small tears, inflammation, and long-term pain¹.

How Does the Damage Happen?

Excessive Load on the Fascia

Every step you take puts stress on the plantar fascia. High-impact activities like running, jumping, or prolonged standing increase this strain. Over time, the tiny fibers in the fascia weaken and develop microtears, leading to inflammation and pain².

Tight Calf Muscles and Achilles Tendon

If your calf muscles are too tight, they pull on the heel, increasing strain on the plantar fascia. Limited ankle mobility from a stiff Achilles tendon makes the fascia work harder with each step⁵.

Poor Foot Mechanics

Flat feet or high arches can cause the fascia to stretch or compress abnormally, making it more prone to damage. People with overpronation (rolling the foot inward too much) put extra strain on the tissue⁴.

Repetitive Microtrauma and Chronic Inflammation

The body tries to repair small tears in the fascia, but if the damage happens faster than the recovery, inflammation builds up. This chronic irritation thickens the fascia, making it less flexible and more painful over time⁶.

Why the Pain is Worse in the Morning

When you sleep, your foot naturally points downward, causing the fascia to tighten overnight. The first steps in the morning suddenly stretch the stiff tissue, leading to that sharp, stabbing pain until it loosens up¹.

Why Ignoring It Makes It Worse

If left untreated, the plantar fascia keeps getting inflamed, leading to chronic pain, thickening of the tissue, and even heel spurs—extra bone growth in response to stress⁷. Addressing it early with proper stretching, footwear, and therapy can prevent long-term damage.

What Other Conditions Could It Be?

Heel Spurs

Heel spurs are bony growths on the heel, often found in people with plantar fasciitis. However, they don’t always cause pain, and if they do, it’s usually a sharp, pinpoint pain when stepping down⁷.

Achilles Tendinopathy

This causes pain at the back of the heel, not the bottom. It worsens with movement and is linked to tight calf muscles, unlike plantar fasciitis, which hurts most after rest⁵.

Stress Fracture

A stress fracture in the heel hurts more the longer you’re on your feet, while plantar fasciitis loosens up with movement. It’s common in runners and may include swelling².

Tarsal Tunnel Syndrome

This is nerve compression in the ankle, causing burning, tingling, or numbness. Unlike plantar fasciitis, pain worsens throughout the day rather than being worst in the morning⁷.

Rheumatoid Arthritis (RA)

RA affects both feet at the same time, unlike plantar fasciitis, which usually starts in one foot. Pain from RA lasts longer in the morning and is often accompanied by joint stiffness¹.

Common Mistakes When Treating Plantar Fasciitis

Ignoring the Pain

Pushing through the pain only makes it worse. Without treatment, plantar fasciitis can turn into chronic heel pain that lasts for months or years⁷.

Wearing the Wrong Shoes

Flat shoes, flip-flops, and walking barefoot increase strain on the fascia. Supportive, cushioned footwear reduces pressure and speeds recovery⁴.

Skipping Stretching and Strengthening

Tight calves and weak foot muscles put extra stress on the fascia. Daily stretching and strengthening exercises relieve pressure and prevent reinjury⁵.

Relying on Quick addresses

Ice and painkillers reduce symptoms but don’t address the cause. Steroid injections can weaken the fascia if overused.

Stopping Treatment Too Soon

Pain relief doesn’t mean full recovery. Skipping rehab steps can cause the pain to return even worse².

What Happens If You Ignore Plantar Fasciitis?

Untreated plantar fasciitis leads to chronic pain, heel spurs, and joint issues. It can change how you walk, causing knee, hip, and back pain¹.

Types of Scans for Plantar Fasciitis

Ultrasound

An ultrasound is a quick and painless scan that shows the thickness of the plantar fascia. In plantar fasciitis, the fascia is often thicker than normal due to inflammation. It can also reveal small tears or swelling in the tissue⁶.

X-ray

An X-ray doesn’t show soft tissues like the plantar fascia, but it can detect heel spurs—bony growths that sometimes form due to ongoing stress. While heel spurs don’t always cause pain, seeing one on an X-ray can support a plantar fasciitis diagnosis⁷.

MRI (Magnetic Resonance Imaging)

An MRI gives the most detailed view of the foot, showing inflammation, small tears, and thickening of the plantar fascia. It’s usually only needed if symptoms are severe or if another issue like a stress fracture or nerve problem is suspected².

Is Surgery Needed?

For most people, surgery isn’t necessary for plantar fasciitis. Around 90–95% of cases improve with conservative treatments like stretching, proper footwear, and physical therapy¹. But if pain lasts for 6–12 months despite treatment, surgery might be an option.

When is Surgery Considered?

Surgery is usually a last resort. It’s only recommended if:

Severe pain affects daily life – Walking, working, or exercising is unbearable despite treatment.
No improvement after 6–12 months – Stretching, footwear changes, and therapy haven’t helped.
Thickened plantar fascia or heel spurs – Scans show structural changes that likely are unlikely to resolve on their own⁶.

Types of Surgery

The most common procedure is a plantar fascia release, where a surgeon partially cuts the fascia to relieve tension and reduce pain. In some cases, heel spur removal or calf muscle lengthening may be done at the same time⁵.

Why Physiotherapy is Crucial After Surgery

Surgery isn’t a quick address—your foot still needs time and rehab to recover properly. Without proper physiotherapy, the fascia may stay weak, leading to stiffness, pain, or reinjury. Physiotherapy helps by:

Restoring flexibility – Gentle stretches prevent stiffness and scar tightness.
Strengthening foot muscles – Stronger muscles reduce stress on the fascia.
Improving how you walk – Helps you avoid movement habits that can make the pain return².

When to Have Heel Pain Assessed in Person

Most heel pain is plantar fasciitis and is not dangerous, but a few warning signs point to other problems that need a proper check. It is worth being assessed in person if you notice any of the following:

Heel pain after a fall, hard landing, or sudden impact, or pain so severe you cannot put weight on the foot — this can suggest a calcaneal (heel bone) stress fracture rather than plantar fasciitis.
Burning, tingling, numbness, or pins and needles spreading into the foot — this can point to a trapped nerve (such as tarsal tunnel syndrome) rather than the fascia.
Heel pain in both feet together, especially with morning stiffness, swelling, or pain in other joints — this can be a sign of an inflammatory or systemic condition (such as rheumatoid arthritis) and is worth investigating.
A hot, red, swollen heel with fever or feeling generally unwell (possible infection)
Pain that is steadily worsening, or not improving at all despite several weeks of sensible care

These signs do not always mean something serious, but they are worth checking properly rather than guessing. When in doubt, get assessed in person.

Treatment Options for Plantar Fasciitis

As a physiotherapist, my goal is to help you reduce pain, support your foot’s recovery, and get back to moving without discomfort. There are several treatments that may help that can make a big difference. Here’s what I recommend:

Exercise Therapy

Gentle exercises help loosen tight muscles and strengthen weak areas to take pressure off your plantar fascia. Key exercises include:

Calf and toe stretches
Foot strengthening – Helps build arch support and improve balance⁵.

Myofascial Release

This hands-on technique targets tight spots in your foot and helps increase blood flow to speed recovery.

Orthopedic Manual Therapy

This involves joint mobilization and soft tissue techniques to:

Improve foot flexibility
Correct movement patterns that may worsen pain
Reduce tension in the plantar fascia⁴

Laser Therapy

Low-level laser therapy uses painless light that may help reduce inflammation and pain, though the evidence is mixed⁸. It’s especially helpful in stubborn or chronic cases.

Dry Needling

This technique targets tight muscle knots (trigger points) in your calf and arch. It can reduce tension and relieve pain short-term. It’s often used alongside exercise and manual therapy².

Strapping (Taping the Foot)

Taping supports the arch and reduces stress on the fascia. It helps by:

Limiting excessive foot movement
Providing extra support during daily activity
Reducing morning pain by keeping the fascia in a better position overnight²

Orthotics and Proper Footwear

Supportive shoes with good cushioning take pressure off the fascia. Custom or over-the-counter orthotics can correct poor foot posture and reduce strain⁴.

Frequently Asked Questions

How long does plantar fasciitis take to settle?

It varies and can be slow. Many people improve over a few months with consistent stretching, strengthening, and load management, though some take longer. A physiotherapist can help set a realistic timeline and adjust the plan as you go.

Why is the pain worse in the morning?

During rest, the plantar fascia tightens, so the first steps in the morning stretch it suddenly, which is often when pain peaks. It tends to ease a little as you move and the tissue warms up, then can return after long periods on your feet.

Should I keep running or exercising with plantar fasciitis?

Often you can stay active, but it usually needs adjusting. Low pain that settles quickly afterwards is generally acceptable, while sharp or worsening pain is a sign to reduce load and get assessed. A graded plan tends to work better than pushing through or stopping completely.

Do I need orthotics or special shoes?

Supportive footwear and, for some people, insoles or orthotics can help reduce strain on the fascia, but they are one part of a plan rather than a stand-alone answer. What suits you depends on your foot, activity, and symptoms, which is where an assessment helps.

When should I see a physiotherapist about heel pain?

It is worth getting assessed if your heel pain is not improving, keeps returning, or is limiting your activities. Seek a prompt check for heel pain after an impact or injury, pain you cannot weight-bear on, or burning or numbness spreading into the foot.

Conclusion

Plantar fasciitis doesn’t have to limit you. With the right treatment—stretching, strengthening, and proper support—you can recover and move comfortably. I’ve helped many people overcome it by staying consistent and making small daily changes.

Recovery takes patience and commitment, but every step forward counts. Stick to your plan, listen to your body, and trust the process. I’m here to guide you and help you get back to doing what you love—without pain slowing you down.

Ready to take the next step? Book a session at Daniel da Cruz Physiotherapy in Sandton.