Plantar Fasciitis

That first step in the morning

If the first few steps out of bed feel like you're walking on a bruised heel, and then it loosens up after a few minutes — that's the classic plantar fasciitis pattern. It's one of the most common foot complaints I see, and one of the most frustrating for patients because it can linger for months if it's not addressed properly.

The plantar fascia is a thick band of connective tissue that runs along the bottom of your foot from the heel to the toes. It supports the arch and acts as a shock absorber during walking and running. When it becomes irritated, it causes a sharp, stabbing pain at the heel — usually at the inside edge where it attaches to the calcaneus.

Why it happens

Plantar fasciitis isn't just a foot problem. It's usually a loading problem.

Calf and ankle stiffness. Limited ankle dorsiflexion is one of the strongest risk factors. When the ankle can't bend far enough, the foot compensates by pronating more, which puts excessive tension on the fascia. Tight calves — specifically the soleus — are almost always part of the picture.

Weak foot intrinsics. The small muscles in the foot that support the arch can become deconditioned, especially in people who wear supportive shoes all day. When these muscles aren't doing their job, the fascia takes on more mechanical stress than it's designed for.

Training errors. A sudden increase in walking or running volume, switching to minimalist shoes too quickly, or starting a standing job after years of sitting. The fascia can tolerate load, but it needs time to adapt to changes.

Hip and pelvic mechanics. A weak gluteus medius causes the knee to collapse inward during walking and running, which increases pronation at the foot and loads the medial arch and fascia. This is why plantar fasciitis sometimes comes back even after local treatment — the root cause is upstream.

How we approach it

I treat the whole chain. OMM addresses restrictions in the foot, ankle, tibia, and pelvis that are altering how load is distributed during gait. Restoring ankle dorsiflexion and normalizing foot mechanics often produces immediate relief.

Shockwave therapy is one of our most effective tools for chronic plantar fasciitis — the kind that's been hanging on for months despite stretching, ice, and orthotics. Extracorporeal shockwave therapy stimulates blood flow, breaks down disorganized tissue, and triggers the healing response. Multiple randomized controlled trials support its use, and most patients notice significant improvement within 3 to 4 sessions.

For acute flares, ultrasound-guided corticosteroid injections targeted to the plantar fascia insertion can provide relief. We use ultrasound guidance to ensure accuracy and avoid the fat pad, which can thin with repeated steroid exposure.

What about orthotics?

Orthotics can help, especially in the short term. They reduce strain on the fascia by supporting the arch. But they're a crutch, not a cure. The goal is to get your foot strong enough and your ankle mobile enough that you don't depend on them indefinitely.

When to seek care

If your heel pain has lasted more than two to three weeks, if it's getting worse rather than better, or if it's changing the way you walk, don't wait it out. The longer plantar fasciitis goes on, the more the tissue degenerates, and the harder it becomes to reverse.

What you can do right now

Stretch your calves — but do it right. Straight-knee calf stretches hit the gastrocnemius; bent-knee stretches hit the soleus. You need both. Hold each stretch for 30 seconds, three times, twice a day.

Roll a frozen water bottle under your foot. This gives you ice and soft tissue mobilization at the same time.

Strengthen the foot intrinsics. Towel scrunches, marble pickups, and short-foot exercises (lifting your arch without curling your toes) rebuild the muscles that support the fascia from below.

Avoid walking barefoot on hard floors, especially first thing in the morning. That first unprotected step on a cold tile floor is often the most painful part of the day.