Plantar Fasciitis & Plantar Fasciosis
Pain underneath the heel is common and is often related to the plantar fascia. Our podiatrists at HealthiClinic in Greenwich assess heel pain at all stages—from a recent episode to symptoms that have persisted for months—and develop treatment around the diagnosis, your activity and the factors contributing to the problem.
What is plantar fasciitis?
The plantar fascia is a strong band of connective tissue extending from the heel toward the toes and helping support the arch of the foot. Pain where the fascia attaches to the heel is commonly called plantar fasciitis.
The term is familiar and useful, but longer-lasting plantar fascia pain is not always dominated by inflammation. In persistent cases, degenerative changes within the fascia may be more prominent; the term plantar fasciosis is sometimes used to describe this.
What does plantar fascia pain usually feel like?
- Pain under or toward the inside of the heel
- Pain with the first steps after getting out of bed
- Pain after sitting and then standing
- Symptoms after increased walking, running or standing
- Tenderness near the plantar fascia attachment at the heel
- Pain that may initially ease after moving and then return with prolonged loading
Not every patient follows this pattern. Heel pain can also arise from nerves, the heel fat pad, bone, joints, tendons and other structures, so persistent or atypical symptoms deserve assessment rather than assuming every painful heel is plantar fasciitis.
Why does plantar fasciitis develop?
There is rarely one single cause. A change in load is common—for example, increasing walking or running, prolonged standing, a change in footwear or returning to activity after a quieter period. Foot and ankle mechanics, calf capacity, body mass, work demands and general health may also influence loading of the plantar fascia.
Our aim is not simply to identify a 'flat foot' or prescribe one treatment to everyone. Assessment should identify the factors that are relevant to the individual patient.
How our podiatrists assess plantar heel pain?
Assessment begins with the history of the pain: where it is felt, when it occurs, how long it has been present, what changed before it started and what treatment has already been tried. Our podiatrists then examine the painful structures, foot and ankle movement, strength, footwear and relevant aspects of gait and loading.
Imaging is not necessary for every patient. Ultrasound, X-ray or MRI may be considered when the diagnosis is uncertain, symptoms are atypical or persistent, or another cause of heel pain needs to be investigated.
Treatment Options
Treatment should be matched to the stage of the problem and the individual patient. Most people begin with conservative management.
Load management
Temporarily modifying aggravating activity without unnecessarily stopping all movement
Footwear
Improving cushioning, support or fit where footwear is contributing.
Stretching and rehabilitation
Progressive exercises may address plantar fascia, calf and lower-limb capacity.
Taping or temporary support
Useful for some patients during a painful phase
Orthoses when indicated
Prefabricated or custom devices may help selected patients by changing load and improving comfort; they are not required for everyone.
Pain-relieving Strategies
Selected short-term measures can be used while the underlying loading problem is addressed.
Shockwave therapy
May be considered in selected patients, particularly when symptoms have persisted despite an appropriate initial program.
What if the heel pain does not improve?
Persistent heel pain should prompt a review of the diagnosis as well as the treatment plan. Sometimes the plantar fascia remains the main pain source; in other cases, nerve entrapment, bone stress, fat-pad pathology or another condition may better explain the symptoms.
For selected persistent cases, additional imaging or treatments such as injection-based therapies may be discussed after assessment. Surgery is rarely the first treatment for plantar fascia pain but may be considered for carefully selected patients with substantial ongoing
symptoms after appropriate non-surgical care. Where advanced or surgical assessment is indicated, HealthiClinic can arrange the appropriate clinical pathway.
FREQUENTLY ASKED QUESTIONS
Why is my heel painful when I first get out of bed?
First-step pain is a classic feature of plantar fascia-related heel pain. The tissue is suddenly loaded after a period of rest, although other causes should be considered if the pattern is unusual.
Are plantar fasciitis and plantar fasciosis the same?
They describe overlapping plantar fascia problems. ‘Fasciitis’ is the commonly used term, while ‘fasciosis’ emphasises degenerative rather than predominantly inflammatory change in longer-standing disease.
Do I need an X-ray or ultrasound?
Not routinely. Many cases can be diagnosed clinically. Imaging is useful when the diagnosis is unclear, symptoms are persistent or atypical, or another condition needs to be excluded.
Do heel spurs cause plantar fasciitis?
A heel spur can be seen on X-ray in people with and without heel pain. Its presence does not automatically mean it is the source of symptoms.
Do I need orthotics?
Not everyone does. Orthoses can be useful for selected patients, but they should be prescribed according to symptoms, mechanics, footwear and treatment goals.
Should I stop walking or exercising?
Complete rest is rarely the long-term answer. Temporary load modification may be useful, followed by a progressive return based on symptoms and tissue capacity.
Does stretching help?
Stretching can be part of treatment, particularly plantar fascia-specific and calf strategies, but persistent heel pain often requires a broader plan rather than stretching alone.
How long does plantar fasciitis take to improve?
Recovery varies. Many cases improve with appropriate conservative care, but symptoms can persist for months in some people. Duration, loading factors and the accuracy of the diagnosis all matter.
Are injections needed?
Usually not as a first step. Injection options have different evidence, benefits and risks and should only be considered after diagnosis and appropriate conservative treatment.
Is surgery ever needed?
Occasionally. Surgery is generally reserved for carefully selected persistent cases after appropriate non-surgical treatment and confirmation that the diagnosis is correct.
Book a Plantar Fasciitis & Plantar Fasciosis Assessment
Whether you need routine foot care, help with a new problem or a further assessment of symptoms that have persisted, the first step is to book a podiatry consultation.