What is plantar fasciitis?

Plantar fasciitis is one of the most common causes of heel pain. It occurs when the plantar fascia – a thick band of connective tissue running along the sole of the foot from the heel bone to the toes, becomes overloaded and painful.

Despite the name, plantar fasciitis is not always an inflammatory condition. In many people, particularly when symptoms have been present for several months, it represents a degenerative or overload-related condition of the plantar fascia, sometimes referred to as plantar fasciopathy.

The plantar fascia plays a key role in supporting the arch of the foot and absorbing forces during walking, running and standing. Repetitive strain or excessive load can lead to micro-damage within the tissue, resulting in pain and stiffness.

Who gets plantar fasciitis?

Plantar fasciitis can affect people of all ages and activity levels.

It is commonly seen in:

• Runners and individuals involved in high-impact sports
• People who spend long periods standing or walking, particularly on hard surfaces
• Middle-aged adults
• Individuals who have recently increased their activity levels
• Those with certain foot biomechanics or footwear issues

It may affect one or both feet, although symptoms are more commonly felt on one side.

Predisposing and risk factors

A number of factors can increase the risk of developing plantar fasciitis. These include foot structure, activity patterns and lifestyle factors.

Common predisposing factors include:

• Reduced ankle flexibility or tight calf muscles
• Flat feet or high arches
• Poor foot biomechanics or altered gait
• Sudden increase in training volume or intensity
• Prolonged standing or walking at work
• Running on hard surfaces
• Inappropriate or worn footwear with inadequate support
• Excess body weight, which increases load through the plantar fascia

Often, plantar fasciitis develops as a result of a combination of factors rather than a single cause.

Symptoms of plantar fasciitis

The hallmark symptom of plantar fasciitis is heel pain, usually felt on the underside of the heel, slightly towards the inner side.

Typical symptoms include:

• Sharp or aching pain under the heel
• Pain that is worse with the first steps in the morning or after rest
• Stiffness in the sole of the foot
• Pain that improves slightly with movement but worsens again after prolonged activity

In some cases, pain may radiate along the arch of the foot.

Assessment at London Bridge Orthopaedics

At London Bridge Orthopaedics, assessment begins with a detailed clinical consultation. Your specialist will take a thorough history, including symptom onset, activity levels, footwear and occupational demands.

Clinical examination typically focuses on:

• Localised tenderness over the plantar fascia insertion
• Foot posture and biomechanics
• Ankle and calf flexibility
• Gait and functional movement patterns

This comprehensive assessment helps identify contributing factors and guides an individualised treatment plan.

Diagnosis of Plantar Fasciitis

Plantar fasciitis is usually diagnosed clinically based on your history and examination findings.

Imaging is not always required but may be recommended in certain cases, particularly if symptoms are persistent or atypical. Investigations may include:

• Ultrasound scanning, which can show thickening or changes within the plantar fascia
• MRI scanning, used if there is diagnostic uncertainty or to exclude other causes of heel pain

Imaging can also help guide treatment decisions in more complex or long-standing cases.

Differential diagnosis

Several other conditions can cause heel pain and may need to be considered during assessment. These include:

• Plantar fascia tear
• Fat pad irritation or atrophy
• Stress fracture of the calcaneus (heel bone)
• Tarsal tunnel syndrome (nerve compression)
• Inflammatory arthropathies, such as rheumatoid arthritis

Accurate diagnosis is essential to ensure appropriate treatment.

Expert Plantar Fasciitis Treatment at London Bridge Orthopaedics

Treatment for plantar fasciitis is usually successful, but it often requires patience and a structured approach. Most people improve with conservative management.

Conservative treatment

First-line treatment focuses on reducing load through the plantar fascia and addressing contributing factors. This may include:

• Activity modification and load management
• Stretching programmes targeting the calf muscles and plantar fascia
• Strengthening exercises for the foot and lower limb
• Footwear advice and activity-specific shoe modifications
• Insoles or orthoses to support the arch and improve biomechanics
• Physiotherapy-led rehabilitation

Conservative treatment is effective for the majority of patients, particularly when followed consistently.

Medical treatments

If symptoms persist despite appropriate conservative care, additional medical treatments may be considered.

These may include:

• Corticosteroid injections, used selectively to reduce pain and inflammation, often performed under ultrasound guidance for accuracy
• Shockwave therapy, which can stimulate tissue healing in chronic cases

Your specialist will discuss the potential benefits and risks of these options in detail.

Surgical treatment

Surgery for plantar fasciitis is rarely required and is only considered when symptoms have failed to improve after prolonged, comprehensive non-surgical treatment.

Surgical options may involve partial release of the plantar fascia. This is carefully considered and only recommended in selected cases, as most patients improve without surgery.

Outcomes and recovery

The outlook for plantar fasciitis is generally very good. With appropriate treatment, most people experience significant improvement over time.

Recovery can take several months, particularly in long-standing cases, and symptoms may fluctuate during rehabilitation. Early assessment, accurate diagnosis and a tailored treatment plan can help optimise recovery and reduce the risk of recurrence.

At London Bridge Orthopaedics, our multidisciplinary team works closely with you to ensure a safe, effective and evidence-based approach to managing plantar fasciitis and supporting your return to normal activities.