What is Plantar Fasciitis?
Running and sport are cornerstones of a healthy lifestyle, but they come with a price when load outpaces recovery. Plantar fasciitis is one of the most prevalent musculoskeletal complaints seen in active populations — affecting an estimated 10% of people over their lifetime and accounting for up to 15% of all running-related injuries.
At CoreMVMT, we see it regularly in Bayside runners pounding Beach Road, gym-goers adding plyometrics to their programs, and everyday people who've simply changed their footwear or ramped up their step count. The good news: when managed properly, it responds extremely well to targeted rehab.
What is plantar fasciitis?
The plantar fascia is a thick band of connective tissue that runs along the sole of the foot, connecting the heel bone (calcaneus) to the base of the toes. Its primary role is to support the arch of the foot and absorb load during walking, running, and jumping.
Plantar fasciitis refers to pain and inflammation — or more accurately, degeneration — of this tissue, typically at its origin on the inner heel. It is a load-related condition, meaning it develops when the tissue is consistently asked to do more than it can currently handle.
The term "fasciitis" implies acute inflammation, but research now suggests plantar fasciitis more closely resembles a tendinopathy — a degenerative process involving failed tissue healing rather than classic inflammation. This distinction matters for treatment: prolonged anti-inflammatories and rest alone are rarely sufficient.
What causes plantar fasciitis?
Plantar fasciitis is driven by an interplay of load-related, biomechanical, and individual factors. There is rarely a single cause — but the common thread is repetitive stress exceeding the tissue's capacity to recover.
1. Training load spikes A sudden increase in running volume, intensity, or frequency — or returning to activity after time off — is the most common trigger. The plantar fascia hasn't had time to adapt, and the cumulative stress leads to microtearing and degenerative changes at the heel attachment.
2. Reduced ankle dorsiflexion Limited ankle mobility — often from tight calves or a stiff Achilles — forces the foot to compensate during push-off, placing excess tension on the plantar fascia with every step.
3. Foot posture and arch mechanics Both flat feet (overpronation) and high-arched feet (supination) alter load distribution across the plantar fascia. Neither posture is inherently problematic — but when combined with high training loads, the risk increases significantly.
4. Calf and intrinsic foot muscle weakness The calf complex and the small muscles within the foot play a critical role in shock absorption and arch support. When these are weak or fatigued, the plantar fascia must take on a greater share of the load.
5. Footwear Sudden transitions to minimalist shoes, worn-out running shoes, or prolonged time barefoot on hard floors can all increase plantar fascial stress beyond what the tissue is conditioned for.
6. Occupational and lifestyle factors Long periods of standing on hard surfaces, increased body weight, or a sedentary period followed by a sudden return to activity all contribute to higher baseline load on the foot.
Risk factors
Age 40–60 (tissue resilience decreases with age)
Runners with high weekly mileage or recent training escalation
Limited ankle dorsiflexion range
Reduced calf and foot intrinsic strength
Elevated BMI
Standing-based occupation
Transition to minimalist or unsupportive footwear
Previous episode of plantar fasciitis
Symptoms
The presentation of plantar fasciitis is fairly characteristic, which makes it recognisable — but it should still be properly assessed to rule out other causes of heel pain.
Sharp or aching pain at the inner heel, worst with the first steps in the morning
Pain that eases after a few minutes of walking, then worsens again with prolonged activity
Tenderness on palpation of the heel and medial arch
Increased pain after periods of rest (getting up from a chair, after a car ride)
Tightness or stiffness along the sole of the foot
Pain that worsens when standing on tiptoes or stretching the toes back toward the shin
In more persistent or severe cases, pain may be present during activity — not just after — and can significantly affect running gait, step count, and quality of life.
How is it diagnosed?
Diagnosis is primarily clinical. A thorough subjective history combined with a hands-on assessment is usually sufficient to confirm plantar fasciitis and identify contributing factors. At CoreMVMT, this includes:
1. Subjective history Onset, location, behaviour of pain (morning vs activity vs rest), training background, footwear, recent load changes, and any relevant medical history.
2. Physical examination Palpation of the plantar fascia insertion, ankle dorsiflexion assessment, foot posture analysis, calf strength and flexibility testing, single-leg heel raise capacity, and functional movement screening.
3. Imaging (when indicated) Ultrasound can confirm fascial thickening and degeneration. MRI may be used to rule out stress fractures or other pathology in atypical presentations or when symptoms fail to improve as expected.
Grading plantar fasciitis
Mild Pain only with first steps in the morning, resolves quickly. No pain during exercise. Typical timeframe: 4–8 weeks
Moderate Morning pain persists longer. Pain after exercise and with prolonged standing. Affects training. Typical timeframe: 8–16 weeks
Severe Pain during exercise, at rest, and with daily activities. Significant impact on function and gait. Typical timeframe: 4–12+ months
Chronic Symptoms present for more than 12 months. Imaging shows significant fascial thickening and degenerative changes. Typical timeframe: Variable — requires comprehensive management
Management and rehabilitation
Plantar fasciitis responds well to a structured, progressive rehabilitation approach. The goal isn't just pain relief — it's restoring the plantar fascia's capacity to handle the loads you're asking of it, and addressing why it broke down in the first place.
Phase 1 — Load management and symptom control The initial focus is reducing provocation without complete rest. Most people can continue modified training (cycling, swimming, pool running) while the acute load is reduced. Taping, orthotics, and night splints can offload the fascia during this period. Manual therapy to the calf and ankle can help restore mobility and reduce tension through the fascia.
Phase 2 — Tissue loading and strength This is the most critical and often most neglected phase. Progressive calf and foot strengthening — particularly eccentric and isometric loading protocols — stimulates tissue remodelling and improves the fascia's load tolerance. Single-leg heel raises are a cornerstone. Each step you take in running places 2–3 times your bodyweight through the foot; the calf must have the capacity to absorb that force.
Phase 3 — Return to sport A graded return to impact activities with careful monitoring of symptom response. Running volume is reintroduced conservatively, with load balanced against strengthening work. Running mechanics and footwear may also be reassessed at this stage to reduce recurrence risk.
At CoreMVMT, we combine hands-on osteopathic treatment with performance-based rehabilitation. Rather than simply treating the heel, we assess the whole kinetic chain — ankle mobility, calf strength, hip function, and running mechanics — to find and fix the root cause. The goal is not just recovery, but a foot that's stronger and more resilient than before.
In cases where conservative management has failed after 6–12 months, referral for corticosteroid injection, high-volume injection, or extracorporeal shockwave therapy (ESWT) may be considered. Surgery is rare and reserved for refractory cases unresponsive to all other treatment.
If you're experiencing heel pain or suspect plantar fasciitis, don't wait for it to become chronic. Early, targeted management makes a significant difference to recovery time and long-term outcomes. Book an assessment at CoreMVMT and we'll get you moving — and staying moving.
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Book an osteopathy assessment at CoreMVMT in Aspendale Gardens. We'll find the root cause and build you a plan that works.
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References
Buchbinder R. (2004). Plantar fasciitis. New England Journal of Medicine, 350(21), 2159–2166.
Rathleff MS, Mølgaard CM, Fredberg U, et al. (2015). High-load strength training improves outcome in patients with plantar fasciitis. Scandinavian Journal of Medicine & Science in Sports, 25(3), e292–e300.
Wearing SC, Smeathers JE, Urry SR, et al. (2006). The pathomechanics of plantar fasciitis. Sports Medicine, 36(7), 585–611.
Goff JD & Crawford R. (2011). Diagnosis and treatment of plantar fasciitis. American Family Physician, 84(6), 676–682.
Martin RL, Davenport TE, Reischl SF, et al. (2014). Heel pain—plantar fasciitis: revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1–A33.