Plantar Fasciitis.
What is plantar fasciitis?
Plantar fasciitis is the most common cause of heel pain, affecting approximately one in ten people at some point in their lives and accounting for around one million GP visits annually in Australia. It involves pain at the origin of the plantar fascia — the thick band of connective tissue running from the medial calcaneal tubercle (the bony prominence on the inner heel) to the toes — where repetitive tensile loading produces microtearing, degeneration and a chronic pain response.
The older name "fasciitis" implies active inflammation, but the histological picture in most chronic presentations is actually degenerative rather than inflammatory — the tissue shows collagen disorganisation and vascular changes similar to tendinopathy rather than the cellular infiltrate of true inflammation. This distinction matters for treatment: purely anti-inflammatory approaches (rest, ice, NSAIDs) address the wrong mechanism for most chronic presentations, while progressive loading — counterintuitive as it sounds — is the most effective treatment.
What are the symptoms?
The hallmark of plantar fasciitis is sharp, stabbing heel pain with the first steps in the morning — the "post-static dyskinesia" pattern — that is typically at its worst with those initial steps out of bed, eases after a few minutes of walking as the tissue warms up, and then returns with prolonged weight-bearing later in the day. Pain at the medial heel, directly over the calcaneal tuberosity and along the medial band of the plantar fascia, is the characteristic location. The pain is reproduced by direct palpation at the fascial origin and by passive dorsiflexion of the toes (the windlass test), which tensions the fascia.
The pattern of morning pain easing with movement then returning with load is clinically diagnostic and distinguishes plantar fasciitis from other causes of heel pain including calcaneal stress fractures, tarsal tunnel syndrome and fat pad atrophy.
What causes plantar fasciitis?
Plantar fasciitis develops when the cumulative load on the plantar fascia exceeds its capacity to adapt and recover. Risk factors include a sudden increase in weight-bearing activity — particularly walking or running on hard surfaces — prolonged standing, obesity, tight calf muscles and limited ankle dorsiflexion (which increases plantar fascia tension during the propulsive phase of gait), flat feet or high arches (both alter plantar fascia loading mechanics), and poor or unsupportive footwear. Age-related tissue changes reduce the plantar fascia's load tolerance from the fourth decade onward, explaining why plantar fasciitis is most prevalent in adults between 40 and 60.
A note on heel spurs
Heel spurs — calcific deposits at the plantar fascial origin visible on X-ray — are commonly found in people with plantar fasciitis, but the relationship is not causal. Heel spurs are present in approximately 15 to 25% of asymptomatic adults and are absent in many people with plantar fasciitis. They are a marker of chronic tensile loading at the fascial origin rather than the cause of pain, and their presence or absence does not change the physiotherapy management approach.
How can physiotherapy help?
Physiotherapy is a common treatment for plantar fasciitis and can help to reduce pain, improve foot function, and prevent future injury.
The most evidence-based physiotherapy interventions for plantar fasciitis are progressive tendon loading, calf stretching, and orthotic management — and understanding why each works is important for consistent adherence.
Progressive loading of the plantar fascia — starting with isometric exercises and progressing through isotonic and eccentric loading — stimulates collagen remodelling and rebuilds the tissue's load capacity. This is the same principle that applies to Achilles tendinopathy and other tendinopathies, and has the strongest evidence base of any single intervention for plantar fasciitis. Isolated plantar fascia stretching — particularly the specific toe extension stretch — has also been shown to produce significant symptom relief and is an important component of the self-management program.
Calf flexibility and eccentric calf strengthening address the limited ankle dorsiflexion that is one of the most consistent biomechanical contributors to plantar fascia overload. A tight gastrocnemius-soleus complex increases the tensile demand on the plantar fascia during the late stance phase of gait, and improving calf extensibility reduces this load.
Orthotics — custom-made shoe inserts — support the foot and relieve pressure on the plantar fascia. Semi-rigid orthotics with medial arch support and heel cushioning provide short to medium-term symptom relief by mechanically offloading the fascial origin. They are most useful during the rehabilitation period, not as a permanent solution that substitutes for the strength and loading capacity that physiotherapy aims to build.
Night splints — worn during sleep to keep the ankle in a neutral or slightly dorsiflexed position — prevent the plantar fascia from contracting to its shortest length overnight, reducing the morning first-step pain that is characteristic and often the most distressing symptom.
Taping or strapping supports the foot and relieves pain during the acute phase and during activities, and calcaneal taping in particular has good evidence for short-term pain reduction.
Manual therapy to the ankle, foot and calf — joint mobilisation and soft tissue techniques — improves the mobility of structures contributing to plantar fascia loading. Dry needling of the intrinsic foot muscles and gastrocnemius-soleus complex assists with pain management and muscle relaxation. Real time ultrasound can monitor fascial thickness and tissue response to loading, providing objective feedback on treatment progression.
Clinical Pilates contributes through intrinsic foot strengthening, calf and lower limb loading in controlled positions, and hip abductor and gluteal work that improves the proximal control of lower limb mechanics — reducing the compensatory foot loading patterns that contribute to plantar fascia overload.
Our physiotherapists Eliane Machado, Bethany Kippen and Emma Cameron all have experience in foot and ankle conditions and are members of the Australian Physiotherapy Association. Eliane's doctoral research in lower limb biomechanics is directly relevant to the gait and foot loading analysis that underpins plantar fasciitis rehabilitation.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Plantar fasciitis is the most common cause of heel pain, affecting approximately one in ten people at some point in their lives and accounting for around one million GP visits annually in Australia. It involves pain at the origin of the plantar fascia — the thick band of connective tissue running from the medial calcaneal tubercle (the bony prominence on the inner heel) to the toes — where repetitive tensile loading produces microtearing, degeneration and a chronic pain response.
The older name "fasciitis" implies active inflammation, but the histological picture in most chronic presentations is actually degenerative rather than inflammatory — the tissue shows collagen disorganisation and vascular changes similar to tendinopathy rather than the cellular infiltrate of true inflammation. This distinction matters for treatment: purely anti-inflammatory approaches (rest, ice, NSAIDs) address the wrong mechanism for most chronic presentations, while progressive loading — counterintuitive as it sounds — is the most effective treatment.
What are the symptoms?
The hallmark of plantar fasciitis is sharp, stabbing heel pain with the first steps in the morning — the "post-static dyskinesia" pattern — that is typically at its worst with those initial steps out of bed, eases after a few minutes of walking as the tissue warms up, and then returns with prolonged weight-bearing later in the day. Pain at the medial heel, directly over the calcaneal tuberosity and along the medial band of the plantar fascia, is the characteristic location. The pain is reproduced by direct palpation at the fascial origin and by passive dorsiflexion of the toes (the windlass test), which tensions the fascia.
The pattern of morning pain easing with movement then returning with load is clinically diagnostic and distinguishes plantar fasciitis from other causes of heel pain including calcaneal stress fractures, tarsal tunnel syndrome and fat pad atrophy.
What causes plantar fasciitis?
Plantar fasciitis develops when the cumulative load on the plantar fascia exceeds its capacity to adapt and recover. Risk factors include a sudden increase in weight-bearing activity — particularly walking or running on hard surfaces — prolonged standing, obesity, tight calf muscles and limited ankle dorsiflexion (which increases plantar fascia tension during the propulsive phase of gait), flat feet or high arches (both alter plantar fascia loading mechanics), and poor or unsupportive footwear. Age-related tissue changes reduce the plantar fascia's load tolerance from the fourth decade onward, explaining why plantar fasciitis is most prevalent in adults between 40 and 60.
A note on heel spurs
Heel spurs — calcific deposits at the plantar fascial origin visible on X-ray — are commonly found in people with plantar fasciitis, but the relationship is not causal. Heel spurs are present in approximately 15 to 25% of asymptomatic adults and are absent in many people with plantar fasciitis. They are a marker of chronic tensile loading at the fascial origin rather than the cause of pain, and their presence or absence does not change the physiotherapy management approach.
How can physiotherapy help?
Physiotherapy is a common treatment for plantar fasciitis and can help to reduce pain, improve foot function, and prevent future injury.
The most evidence-based physiotherapy interventions for plantar fasciitis are progressive tendon loading, calf stretching, and orthotic management — and understanding why each works is important for consistent adherence.
Progressive loading of the plantar fascia — starting with isometric exercises and progressing through isotonic and eccentric loading — stimulates collagen remodelling and rebuilds the tissue's load capacity. This is the same principle that applies to Achilles tendinopathy and other tendinopathies, and has the strongest evidence base of any single intervention for plantar fasciitis. Isolated plantar fascia stretching — particularly the specific toe extension stretch — has also been shown to produce significant symptom relief and is an important component of the self-management program.
Calf flexibility and eccentric calf strengthening address the limited ankle dorsiflexion that is one of the most consistent biomechanical contributors to plantar fascia overload. A tight gastrocnemius-soleus complex increases the tensile demand on the plantar fascia during the late stance phase of gait, and improving calf extensibility reduces this load.
Orthotics — custom-made shoe inserts — support the foot and relieve pressure on the plantar fascia. Semi-rigid orthotics with medial arch support and heel cushioning provide short to medium-term symptom relief by mechanically offloading the fascial origin. They are most useful during the rehabilitation period, not as a permanent solution that substitutes for the strength and loading capacity that physiotherapy aims to build.
Night splints — worn during sleep to keep the ankle in a neutral or slightly dorsiflexed position — prevent the plantar fascia from contracting to its shortest length overnight, reducing the morning first-step pain that is characteristic and often the most distressing symptom.
Taping or strapping supports the foot and relieves pain during the acute phase and during activities, and calcaneal taping in particular has good evidence for short-term pain reduction.
Manual therapy to the ankle, foot and calf — joint mobilisation and soft tissue techniques — improves the mobility of structures contributing to plantar fascia loading. Dry needling of the intrinsic foot muscles and gastrocnemius-soleus complex assists with pain management and muscle relaxation. Real time ultrasound can monitor fascial thickness and tissue response to loading, providing objective feedback on treatment progression.
Clinical Pilates contributes through intrinsic foot strengthening, calf and lower limb loading in controlled positions, and hip abductor and gluteal work that improves the proximal control of lower limb mechanics — reducing the compensatory foot loading patterns that contribute to plantar fascia overload.
Our physiotherapists Eliane Machado, Bethany Kippen and Emma Cameron all have experience in foot and ankle conditions and are members of the Australian Physiotherapy Association. Eliane's doctoral research in lower limb biomechanics is directly relevant to the gait and foot loading analysis that underpins plantar fasciitis rehabilitation.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
If you are unsure about which appointment type is right for you, please don't hesitate to get in touch with our friendly reception staff by calling 07 3706 3407 or emailing [email protected].
