Plantar Fasciitis: Causes, Symptoms, and How We Can Help
- staystrongtherapy
- Jun 30
- 6 min read
All information in this blog is supported by NICE guidance and peer-reviewed research. Reference numbers appear throughout, with the full list at the bottom of the page.
What Is Plantar Fasciitis?
Plantar fasciitis is one of the most common causes of heel pain, resulting from irritation of the plantar fascia, the thick band of connective tissue running along the bottom of the foot that supports the arch, often due to repetitive stress and overuse. ¹ It's defined as a painful condition caused by micro tears or degeneration of the fascia, and can substantially affect quality of life, limiting mobility and daily activity. ²
NICE Clinical Knowledge Summaries cover plantar fasciitis directly, with guidance last revised as recently as December 2024. ³
Common Signs and Symptoms
Sharp, stabbing heel pain, classically worst with the first few steps in the morning or after periods of rest
Pain that may ease somewhat with movement but worsen again after prolonged standing or activity
Tenderness on palpation of the inner heel, near where the fascia attaches
Pain localised to the underside of the heel, occasionally spreading along the arch
Risk Factors
Risk factors for plantar fasciitis are generally categorised into intrinsic and extrinsic, biomechanical, and functional factors:
Intrinsic factors:
High body mass index (BMI) ⁴
Flat feet (pes planus) or other foot arch abnormalities ⁴
Diabetes, associated musculoskeletal tissue changes, including Achilles tendon tightness and increased plantar fascia thickness, are among the most common lower limb complications seen in people with diabetes ⁵
Extrinsic and biomechanical factors:
Prolonged weight-bearing, particularly relevant to occupations involving long periods of standing ⁴
Repetitive stress and overuse, common in runners and people with physically active jobs ⁴
Tight calf muscles (gastrocnemius and soleus) and Achilles tendon, genuinely one of the most consistently supported functional risk factors, since the plantar fascia is mechanically linked to the calf and Achilles complex across the heel, meaning calf tightness directly increases strain on the fascia during walking ⁶ ⁷
Reduced ankle dorsiflexion (limited "toes up" movement), shown to be an important contributing factor ⁶
Tightness in the hamstrings, also identified as a contributing functional risk factor, alongside the calf and Achilles ⁶
How Is It Diagnosed?
Diagnosis relies on a detailed patient history, alongside physical examination, including palpation of the heel, the windlass test (which reproduces pain by extending the big toe while the fascia is under tension), and the heel squeeze test. ⁸ Selective imaging, such as X-ray, ultrasound, or MRI, may be used to confirm the diagnosis and rule out other causes where the picture is unclear. ⁸
It's worth knowing that plantar fasciitis can present similarly to other conditions, making an accurate differential diagnosis genuinely important. Conditions to rule out include tarsal tunnel syndrome, a plantar fascia rupture, a calcaneal stress fracture, Achilles tendinopathy, heel pad atrophy, and inflammatory conditions affecting the foot. ⁸
What to Look Out For
Please seek medical assessment if you experience:
Sudden, severe heel pain following trauma, with inability to weight-bear (possible fracture or fascia rupture)
Numbness, tingling, or burning pain spreading into the foot (possible nerve involvement, such as tarsal tunnel syndrome)
Heel pain with fever or feeling generally unwell
Pain that is constant, severe, and unrelated to weight-bearing
A Useful Phased Approach to Treatment
A recent, comprehensive 2025 evidence-based framework organises plantar fasciitis treatment into four logical phases: initial therapies (such as rest, ice, compression, elevation, stretching, and orthotics) for early symptom relief, intermediate therapies (such as photobiomodulation and extracorporeal shockwave therapy), specialised therapies (such as platelet-rich plasma), and last-resort surgical therapies. ⁸ This stepped approach reflects how most people genuinely improve with the earlier, more conservative stages before anything more involved is needed.
How We Can Help
NICE CKS guidance, alongside professional body recommendations from organisations such as the American Physical Therapy Association, supports a range of conservative approaches as first-line management. ⁹
Osteopathic manual techniques and manual therapy: addressing restriction in the foot, ankle, and lower limb, supporting overall biomechanics that may be contributing to fascia strain.
Deep tissue and sports massage: targeted soft tissue work for the plantar fascia, calf, and surrounding lower limb muscles, particularly the gastrocnemius, soleus, and Achilles complex, given how directly calf tightness has been shown to load the plantar fascia.
Medical acupuncture: used as part of a broader treatment plan to support pain management.
Cupping: this is genuinely interesting given your service offering, dry cupping for plantar fasciitis has been specifically studied in a randomised controlled trial, with a separate critically appraised topic review examining its effectiveness as a treatment option. ¹⁰ ¹¹
Taping: low-Dye taping has shown effectiveness for short-term relief of plantar heel pain in randomised trial evidence, and is a useful early-stage option. ¹²
Footwear and orthotic advice: foot orthoses have been shown to be effective for plantar heel pain in systematic review evidence, and the choice of insole material has also been shown to influence outcomes in more recent trial research. ¹³ ¹⁴
Exercise: A Core, Well-Evidenced Treatment
Stretching exercise specifically targeting the plantar fascia, and the calf and Achilles structures it's mechanically linked to, has strong, long-standing supporting evidence.
Tissue-specific plantar fascia stretching: a landmark study found this specific stretching technique improved outcomes in people with chronic heel pain, with benefits maintained at two-year follow-up, making it one of the most well-evidenced exercise interventions for this condition. ¹⁵
Calf and Achilles stretching: given how strongly tight calf and Achilles tissue has been linked to plantar fascia strain, addressing this tightness directly is a genuinely important part of treatment, not just a supporting measure. ⁶ ⁷
Hamstring stretching: addressing this additional contributing source of tightness identified in the research. ⁶
Ankle dorsiflexion mobility work: directly targeting the reduced "toes up" range of movement shown to be a meaningful contributing factor.
Foot intrinsic muscle strengthening: supporting the structures of the arch alongside the fascia itself.
Gradual return to activity: particularly relevant for runners, managing training load while symptoms settle.
Your practitioner will guide a structured programme, typically combining fascia-specific stretching with broader calf, Achilles, and lower limb work.
What to Expect at Your First Appointment
We will take a thorough history, including any relevant risk factors such as diabetes, occupational standing, or training load, and carry out a hands-on assessment, including the windlass and heel squeeze tests, alongside an assessment of calf and ankle flexibility, to confirm the diagnosis and rule out other potential causes of your heel pain. We will explain clearly what we find and build a progressive, evidence-based treatment plan, generally starting with the well-established conservative approaches before considering anything more involved.
Frequently Asked Questions
Do I need a scan? Not always. Diagnosis is usually based on history and physical examination, with imaging reserved for cases where the diagnosis is unclear or other conditions need to be ruled out.
Will I need surgery? Very rarely. Surgical treatment is considered a genuine last resort, reserved for cases that haven't responded to a thorough course of the earlier, conservative treatment phases.
Why is my heel pain worst first thing in the morning? This is a classic, well-recognised feature of plantar fasciitis, related to the fascia tightening overnight and then being suddenly stretched with the first steps of the day.
Is my plantar fasciitis connected to my diabetes? It can be, genuinely. Diabetes is associated with tissue changes affecting the Achilles tendon and plantar fascia, contributing to the same calf and fascia tightness mechanism seen in plantar fasciitis more generally.
How long will it take to improve? This varies, but consistent, structured treatment, particularly fascia-specific and calf stretching, has shown genuine, lasting improvement in research, including positive results maintained at two years.
Recognise these symptoms? Get in touch using the contact form and we will assess and build the right treatment plan for you.
References
Comprehensive Review and Evidence-Based Treatment Framework for Optimizing Plantar Fasciitis Diagnosis and Management. Cureus. 2025;17(7):e88745. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12294660/
A concise review of plantar fasciitis: Diagnosis, treatment, and management. World Journal of Advanced Research and Reviews. 2024;23(02):1985-1990. Available at: https://wjarr.com/sites/default/files/fulltext_pdf/WJARR-2024-2553.pdf
National Institute for Health and Care Excellence (NICE). Plantar fasciitis. Clinical Knowledge Summary. Last revised December 2024. Available at: https://cks.nice.org.uk/topics/plantar-fasciitis/
PLANTAR FASCIITIS: A REVIEW OF 2024. Journal of Sports Science and Health. 2025;26(1):19-38. Available at: https://he02.tci-thaijo.org/index.php/spsc_journal/article/view/273414
Plantar fasciitis in patients with type 1 and type 2 diabetes: A contemporary cohort study. Foot and Ankle Surgery. 2019. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1056872719305458
Plantar Fasciitis: Background, Etiology, Pathophysiology. Medscape. Available at: https://emedicine.medscape.com/article/86143-overview
Botulinum Toxin Type A Injection Into the Medial Gastrocnemius for Refractory Plantar Fasciitis: A Case Series. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12801088/
Comprehensive Review and Evidence-Based Treatment Framework for Optimizing Plantar Fasciitis Diagnosis and Management. Cureus. 2025. Available at: https://www.cureus.com/articles/386132-comprehensive-review-and-evidence-based-treatment-framework-for-optimizing-plantar-fasciitis-diagnosis-and-management.pdf
Physiotherapy for plantar fasciitis: a UK-wide survey of current practice. Musculoskeletal Science and Practice. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0031940616000298
Ge W, Leson C, Vukovic C. Dry cupping for plantar fasciitis: a randomized controlled trial. Journal of Physical Therapy Science.
Szlosek PA, Campbell M. Effectiveness of dry cupping as a treatment for plantar fasciitis: a critically appraised topic. Journal of Sport Rehabilitation. 2023;32:227-233.
Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of low-Dye taping for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskeletal Disorders. 2006;7:64.
Whittaker GA, Munteanu SE, Menz HB, et al. Foot orthoses for plantar heel pain: a systematic review and meta-analysis. British Journal of Sports Medicine. 2018;52(5):322-328.
Taseh A, Mathur V, Weaver B, et al. Role of insole material in treatment of plantar fasciitis: a randomized clinical trial. Foot and Ankle Surgery. 2024;30:524-528.
DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia stretching exercise improves outcomes in patients with chronic heel pain: a prospective, randomized study. Journal of Bone and Joint Surgery (American). 2003.
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