Plantar Fasciitis: Why Your Heel Pain Keeps Coming Back
If you've ever taken your first few steps out of bed in the morning and felt a sharp pain in your heel, you're not alone.
In fact, that's one of the classic signs of plantar fasciitis.
I see this condition all the time at Modern Movement Physical Therapy in Scottsdale. Runners, hikers, golfers, pickleball players, gym-goers, and even people who simply spend a lot of time on their feet can develop it.
The frustrating part is that plantar fasciitis often seems to improve... and then come right back.
Many people try stretching, buying new shoes, rolling their foot on a frozen water bottle, or wearing a night splint. Sometimes those things help. Sometimes they don't.
The reason plantar fasciitis can be so stubborn is that many people are treating the symptoms without addressing why the tissue became irritated in the first place.
What is plantar fasciitis?
The plantar fascia is a thick band of connective tissue that runs along the bottom of your foot from your heel toward your toes.
Its job is to help support the arch of the foot and absorb forces during walking, running, and jumping.
When the plantar fascia is exposed to more stress than it can tolerate, it becomes irritated and painful.
The most common symptom is pain at the bottom of the heel, especially during those first few steps in the morning or after sitting for a long period of time.
As the tissue warms up, many people actually feel a little better.
Then later in the day, the pain comes back.
Sound familiar?
Why does plantar fasciitis happen?
There usually isn't one single cause.
More often, it's the result of multiple factors gradually building up over time.
Some of the most common contributors I see include:
Limited ankle mobility
Calf tightness
Weak foot and ankle muscles
Sudden increases in activity
Running volume increases
Standing for long periods
Poor load management
For active adults here in Scottsdale and Phoenix, pickleball is becoming an increasingly common contributor simply because people are playing more frequently than ever.
The foot is being asked to tolerate more load than it's prepared for.
Eventually it lets you know.
What does the research say?
Research has evolved quite a bit over the years.
For a long time, plantar fasciitis was thought to be primarily inflammatory.
More recent research suggests many chronic cases are actually degenerative in nature, meaning the tissue has undergone structural changes similar to other tendinopathies.
A systematic review published in The British Journal of Sports Medicine found that exercise-based treatment programs, particularly progressive loading strategies, play an important role in recovery.
In other words, simply resting and stretching forever usually isn't enough.
The tissue ultimately needs to become stronger.
How I treat plantar fasciitis
One of the first things I evaluate is the entire kinetic chain.
Because the foot is rarely working in isolation.
How is the ankle moving?
How strong are the calves?
What are the hips doing?
How much activity is the patient performing?
Once we identify the contributing factors, treatment becomes much more targeted.
Depending on the individual, treatment may include:
Shockwave therapy
Dry needling
Calf mobility work
Ankle joint mobilization
Foot strengthening
Progressive loading exercises
Activity modification when necessary
Shockwave therapy has become one of my favorite treatments for chronic plantar fasciitis because the research supporting it is quite strong.
Several studies have demonstrated improvements in pain and function, particularly in stubborn cases that haven't responded to other treatments.
When combined with strengthening and mobility work, the results can be impressive.
Why new shoes aren't always the answer
One of the first things many people do is buy a new pair of shoes.
Sometimes that's appropriate.
But shoes alone rarely solve the problem.
Think about it this way:
If your shoulder hurts, you wouldn't expect a new shirt to fix it.
The same principle applies here.
Footwear can help manage symptoms, but if strength deficits, mobility restrictions, and loading issues remain unchanged, the pain often returns.
The goal is not just making the foot more comfortable.
The goal is making it more capable.
The bottom line
Plantar fasciitis can be incredibly frustrating, especially when it starts affecting your ability to walk, exercise, or stay active.
The good news is that most cases respond very well to the right treatment plan.
At Modern Movement Physical Therapy in Scottsdale, I focus on identifying why the plantar fascia became overloaded and then building a plan that improves mobility, restores strength, and increases the tissue's capacity.
Because the goal isn't just getting rid of heel pain.
The goal is keeping it from coming back.
Take good care of your body, it's the only one you have.
Yours in health,
Dr. Michael Price