Stepped out of bed and felt that sharp stab in your heel? You're far from alone. Plantar fasciitis is a common cause of heel and foot pain, particularly in people who spend a lot of time on their feet, walk or run regularly, or have recently changed their activity levels.

While heel pain can be frustrating, understanding what may be contributing to it can help you make informed decisions about managing your symptoms and getting back to the activities you enjoy.

What is plantar fasciitis?

The plantar fascia is a strong band of connective tissue that runs along the bottom of your foot, from the heel towards the toes. It helps support the arch of your foot and plays a role in absorbing and transferring load as you walk, run and jump.

Plantar fasciitis is associated with pain around the plantar fascia, usually near its attachment to the heel. Despite the name, the condition isn't necessarily caused by inflammation alone. Changes in the tissue can occur when the demands placed on the foot exceed its ability to adapt to that load.

What does plantar fasciitis feel like?

Plantar fasciitis often follows a recognisable pattern.

You may experience:

• Sharp or aching pain underneath the heel or along the arch of the foot
• Pain that is particularly noticeable with your first few steps after getting out of bed
• Heel pain after sitting or resting for a period of time
• Symptoms that ease as you start moving, but return after prolonged standing, walking or exercise
• Tenderness when pressure is applied around the bottom or inside of the heel

Everyone experiences heel pain differently, and not all heel pain is caused by plantar fasciitis. If your symptoms persist or are affecting your normal activities, an assessment can help determine what may be contributing to your pain.

Why does plantar fasciitis happen?

There isn't always one single cause. Plantar fasciitis can develop when the load placed through the foot changes or increases faster than the tissues can adapt.

Some factors that may contribute include:

• Suddenly increasing walking, running or sporting activities
• Spending long periods standing or walking
• Changes to your training routine
• Tightness or reduced mobility through the calf and ankle
• Changes in foot and lower-leg strength
• Footwear that doesn't suit your activities or individual needs
• Changes in body weight that increase the load placed through the feet

Often, it's a combination of factors rather than one specific event that contributes to the development of symptoms.

Should I keep exercising?

Complete rest isn't necessarily required. For many people, modifying activity can be a more practical approach while symptoms settle.

This might mean temporarily reducing the amount or intensity of running, walking or other high-impact activities, or choosing lower-impact exercise that is more comfortable.

The goal is to find an appropriate level of activity that allows you to keep moving without continually aggravating your symptoms. A gradual return to your usual activities can then be guided by how your foot responds.

How can an osteopath help with plantar fasciitis?

An osteopath can assess your foot and lower limb to understand how you move and identify factors that may be contributing to your symptoms.

Your osteopath may look at movement and function through areas including your:

• Feet
• Ankles
• Calves
• Knees
• Hips

Depending on your individual presentation, your management plan may include hands-on techniques to address areas of restricted movement or muscle tension, advice around modifying activities, and exercises aimed at improving strength, mobility and tolerance to load.

The aim is to develop a management approach that is appropriate for you and your goals, rather than focusing solely on the painful area.

Every person with heel pain is different, so your osteopath will tailor their assessment and management recommendations to your individual circumstances.

Is there anything I can do in the meantime?

If you're experiencing heel pain, there are some simple things you can consider while waiting to be assessed:

Avoid sudden increases in activity. If you've recently increased your walking, running or training, consider reducing the amount or intensity temporarily.

Choose comfortable, supportive footwear. This can be particularly helpful if you're spending a lot of time standing or walking on hard surfaces.

Keep moving within your tolerance. Complete inactivity isn't always necessary. Look for activities that don't significantly increase your symptoms.

Pay attention to your symptoms. If your heel pain is worsening, persistent or affecting your ability to walk or participate in everyday activities, consider having it assessed.

When should I see someone about heel pain?

Heel pain can have several possible causes, so it's worth getting it assessed if symptoms aren't improving, are getting worse, or are interfering with your normal activities.

An osteopath can assess your symptoms and movement and, where appropriate, develop a management plan with you. If your presentation suggests that another healthcare professional or further investigation would be more appropriate, they can also discuss this with you.

The bottom line

Plantar fasciitis can be painful and frustrating, particularly when those first few steps in the morning remind you that your heel isn't happy.

The good news is that there are a range of ways to manage plantar heel pain. Understanding the factors that may be contributing to your symptoms, modifying activity appropriately and gradually building your foot's capacity can all form part of a management approach.

If heel pain is stopping you from doing the things you enjoy, an assessment can be a useful first step towards understanding what's going on and working out what to do next.