Plantar Fasciitis
That first step out of bed in the morning. The sharp, stabbing pain in the heel that hits before you've even reached the bathroom.
For some people it eases once they've been moving for a while; for others it builds through the day or flares up again after sitting for any length of time. If that sounds like your mornings, there's a good chance you're dealing with plantar fasciitis.
It's one of the more common conditions we see at the clinic, and it responds well to the right treatment.
What's actually happening
The plantar fascia is a thick band of connective tissue that runs along the sole of your foot, connecting your heel bone to the base of your toes. Its job is to support the arch and absorb load with every step you take. Plantar fasciitis is what happens when that tissue becomes irritated and inflamed, usually at or near the point where it attaches to the heel bone. The pain tends to be sharpest first thing in the morning, or after a period of rest, because the fascia tightens up when it isn't bearing weight. The classic pattern is that it eases after a few minutes of walking as the tissue warms up, though it can return after prolonged activity or at the end of a long day on your feet.
Plantar fasciitis isn't a single thing, and the location of your pain can tell us something about what's going on: Insertional plantar fasciitis affects the point where the fascia meets the heel bone. This is the area where a heel spur can sometimes develop. A heel spur is a small bony growth that forms in response to repeated stress at the attachment site. It's worth knowing that heel spurs don't always cause pain on their own; they're often found on scans in people with no symptoms at all. What matters is the inflammation and tension in the surrounding tissue, not the spur itself. Mid-plantar fasciitis affects a portion further along the sole of the foot, away from the heel. The underlying process is the same, but the pain sits in a different part of the arch.
Why it happens
Plantar fasciitis usually develops when the tissue is exposed to more load than it can comfortably absorb over time. That might be a sudden increase in activity, taking up running, switching to harder floors at work, or standing for longer hours than usual. But it can also creep up without any obvious trigger. Tightness in the calf and Achilles tendon is a frequent contributor, because it alters the way load travels through the heel during walking. Foot mechanics matter too, particularly how the arch behaves under weight. Changes in footwear, hard surfaces, and shifts in body weight can all add to the picture. It's not just a runner's problem. We see it in people who are on their feet all day, in people who've recently returned to exercise after a long gap, and in people who can't point to anything specific that changed. The causes vary, which is one of the reasons a proper assessment is worth having.
How we approach it at BTC
The right starting point is an osteopathic assessment. Your osteopath will look at the foot, the ankle, the calf, and the way load travels through the whole lower limb, building a clear picture of what's driving the problem in your case. From there, they'll determine whether standard osteopathic treatment or shockwave therapy is the better route for you, based on the severity and duration of the condition.
For many people, hands-on osteopathic work on the surrounding soft tissue, the ankle joint, and the calf, combined with practical advice on load management and footwear, is enough to bring things back under control. For more persistent or established cases, shockwave therapy is a well-evidenced option that can be highly effective at stimulating the healing response in chronically irritated tissue. All of our shockwave practitioners are GOsC-registered osteopaths who have received additional specialist training in its use. If they recommend it, it will be because they've assessed it as the right approach for your specific presentation.
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You don't need a diagnosis to come in
A lot of people arrive at the clinic not entirely sure whether what they have is plantar fasciitis, Achilles tendinopathy, a heel spur, or something else. Heel and arch pain can have several different causes, and they don't always announce themselves clearly. You don't need a label before you book. If the bottom of your foot hurts and it's getting in the way of your day, that's enough reason to come and see us. Our osteopaths will assess what's going on and work out the best way forward from there.
Questions people ask us
Will I need shockwave therapy?
Not necessarily, and you won't know until you've had an assessment. Shockwave is a particularly good option for plantar fasciitis that has been going on for a while and hasn't responded to other measures, but it isn't the right approach for every presentation. Your osteopath will assess the condition first and recommend the most appropriate course of treatment based on what they find.
Should I stop exercising while I wait for my appointment?
That depends on what you're doing and how much it's aggravating things. Complete rest isn't usually the answer. Keeping mobile and maintaining some load through the foot tends to be better than stopping entirely, though certain activities may need to be dialled back temporarily. Your osteopath will give you specific guidance once they've assessed the foot.
I've had this for over a year. Is it too late for treatment to help?
No. Long-standing plantar fasciitis can take more time to resolve than a recent episode, but it does respond to treatment. Chronic presentations are often where shockwave therapy comes into its own, because it can stimulate a healing response in tissue that has essentially stopped recovering on its own. Your osteopath will assess what's still driving the problem and put together a plan from there.
Can I come in if I've already had it seen elsewhere?
Absolutely. If you've had imaging, orthotics, physiotherapy, or any other previous treatment, that information is useful context and your osteopath will take it into account. It doesn't matter where you're starting from. What matters is working out the best way forward from here.
Related Conditions
Achilles tendinopathy: Achilles tendinopathy and plantar fasciitis both affect the heel and the structures around it, and tightness in the Achilles tendon is a common contributing factor in both. Some people have elements of both presenting at the same time.
Still Not Sure?
If you're in pain and wondering whether we can help, that's exactly why we're here. You don't need to know what the problem is. You don't need a referral. You just need to take the first step. Book online today or call 020 7733 9944 to speak to us.