Plantar Fasciitis & Heel Pain

Heel pain that won't go away is telling you something worth listening to.

Plantar fasciitis is one of the most common causes of heel and foot pain, and one of the most frustrating to manage. The classic presentation — sharp pain on the first steps in the morning, or after periods of sitting — is well recognised. What's less well understood is why it develops and why it persists despite rest and conventional treatment in so many cases.

The plantar fascia is a thick band of connective tissue running along the sole of the foot, connecting the heel to the toes. When it becomes irritated and inflamed at its attachment to the heel bone, the result is plantar fasciitis. But the question of why it loaded to that point is the one worth asking.

Why it's rarely just a foot problem

The foot and ankle are at the bottom of a kinetic chain that extends through the knee, hip, pelvis and lumbar spine. Restricted ankle dorsiflexion — the ability to bend the ankle upward — is one of the most consistent findings in people with plantar fasciitis, and it's rarely addressed by treatments focused only on the foot. Altered hip mechanics and reduced glute strength change how load is distributed through the foot during gait, and often drive the overload that produces the condition.

The plantar fascia also connects through the Achilles tendon and the posterior chain of the leg — which means calf tightness, Achilles stiffness and restricted ankle mobility all contribute to the load at the heel. Treating the fascia locally without addressing these upstream factors is why the condition tends to recur.

How Dr Chase approaches it

Assessment covers the foot and ankle mechanics, the Achilles and calf complex, the knee, the hip and the gait pattern. Ankle dorsiflexion range is measured and compared, hip extension and glute function are assessed, and the full foot posture is evaluated — because overpronation, high arches and altered foot mechanics each drive plantar load in different ways.

Treatment draws from joint mobilisation of the ankle and subtalar joint (which are frequently restricted), myofascial release through the plantar fascia, calf and Achilles, dry needling where indicated, and targeted rehabilitation guidance to address the upstream mechanics driving the condition. Footwear and loading advice is also provided where relevant.

Plantar fasciitis is very treatable when the full picture is assessed. If it's been going on for months, a proper evaluation of the whole kinetic chain is the most important next step.