Plantar Fasciitis
Heel and arch pain — especially with the first steps in the morning.
Plantar fasciitis — more accurately plantar fasciopathy — is the most common cause of heel pain, affecting roughly 10% of adults at some point in life (Riddle & Schappert, Foot Ankle Int 2004). The plantar fascia is a thick band of connective tissue that supports the arch of the foot. Despite the '-itis' suffix, biopsy studies show the underlying pathology is collagen degeneration with little to no inflammation, making it more accurately a tendinopathy of the fascia.
The hallmark symptom is sharp, stabbing pain at the bottom of the heel — most intense with the first steps in the morning or after prolonged sitting, easing slightly after a few minutes of walking, then worsening again with prolonged standing or activity. Some patients report arch tightness or a feeling of bruising under the heel.
Most common in adults aged 40–60, runners (particularly with sudden mileage increases or hill work), individuals who spend long hours on hard surfaces (nurses, teachers, retail, restaurant workers), people with elevated BMI, and those with reduced ankle dorsiflexion or tight calves.
A combined, root-cause approach.
A 2017 randomized trial in the British Journal of Sports Medicine demonstrated that high-load progressive strength training combined with manual therapy produced superior outcomes to plantar-specific stretching alone at 3 months. We release the gastrocnemius, soleus, and plantar fascia with ART and instrument-assisted work, dry needle persistent trigger points, mobilize the ankle and rearfoot, and prescribe progressive heel-raise and intrinsic foot strengthening to remodel the fascia.
- ART and Graston for calf and plantar fascia
- Dry needling
- Foot and ankle mobilization
- Foot strengthening rehab