Plantar Fasciitis: First Steps to Getting Better

Plantar fasciitis - more accurately called plantar fasciopathy given what we now know about the pathology - is one of the most common causes of heel pain, affecting both runners and non-runners. The hallmark is sharp pain in the heel or arch in the first few steps of the morning, which often eases after walking around for a few minutes.

What's actually happening

The plantar fascia is a thick band of connective tissue running from the heel bone to the base of the toes. When load repeatedly exceeds its capacity - from a sudden increase in running, prolonged standing, weight gain, or inadequate footwear - the tissue undergoes the same reactive process as a tendinopathy: disorganisation, thickening, and sensitisation of nerve endings.

What doesn't help

Resting completely is rarely effective long term. The pain returns when activity resumes. Generic calf stretching helps a little but is not sufficient on its own. Night splints reduce morning pain but don't address the underlying load problem. Cortisone injections can provide short-term relief but don't change the underlying pathology and have a risk of fat pad atrophy with repeated use.

What does help

The most effective approach is progressive loading of the plantar fascia itself. Towel toe scrunches and short-foot exercises activate the intrinsic foot muscles. Progression to single-leg heel raises with the toes in extension loads the fascia directly through the windlass mechanism. Combining this with a temporary reduction in running volume and appropriate footwear creates the right environment for recovery.

Timeframe

Most cases improve significantly within six to eight weeks of consistent loading work. Full resolution typically takes three to six months. Running through it at manageable pain levels is generally fine - complete rest is not required and not helpful.