Your heel hurts first thing in the morning, or after a run, or from standing around at work all day. So you stop running, stop walking the dog as far, maybe cut activity out entirely and hope it settles.
Plantar heel pain, plantar fasciitis being the most common version, is one of the most common things we see. Most people deal with it at some point. It’s stubborn and can hang around for up to a year even with good management.
Most importantly- this is a self-limiting condition. This means that it generally safe to stay active on, even while it’s sore, and actually if you let it stop you from doing everything and you protect it too much it makes the condition worse.
The myth: rest it until it stops hurting
Makes sense on the surface. Pain settles when you’re off your feet, so surely staying off your feet is the fix.
The truth: rest doesn’t build tolerance, so the pain comes right back
Pain settles with rest because you’ve removed the load, not because the tissue got stronger or happier. Load tolerance doesn’t improve just because you stopped loading it. The moment you go back to walking, running, or standing, the pain shows back up, usually just as bad as before.
The goal is staying active with pain that’s controlled, not chasing zero pain. Load management is the foundation of getting better here, not avoidance.
Use these three rules as your check:
- Keep pain tolerable during activity. Movements should stay controlled, not painful enough to change your gait.
- After stopping, pain should be low and settle within 30 to 60 minutes.
- The next morning shouldn’t be worse than the day before.
Failing one of those means dial the load back, not stop. Practical ways to do that: cut your daily step count by about 25%, shorten your runs instead of skipping them, play pickleball every other day instead of daily, take a golf cart instead of walking 18 holes.
On treatment: footwear matters, but orthotics aren’t automatically necessary for everyone. Heel taping is often more effective than an orthotic and worth trying first. Stretching the plantar fascia and calf is a good idea and supported by most experts. Strengthening the calf and foot is important too, progressing heel raises from two-legged, to single-leg, to single-leg off a step edge with added weight.
For temporary relief, dry needling, acupuncture, and massage can help short term. Ultrasound and TENS generally show limited evidence of meaningful benefit. Laser therapy can help but needs near-daily dosing, which is hard to get right in private practice. Shockwave therapy is worth considering after about 3 months of quality conservative care that hasn’t started to improve, but it is not for everyone.
What to do about it
Start with the three rules above this week. If your pain fits inside them, keep doing what you’re doing, just smarter about the load. If it doesn’t, or you’ve been stuck for months without a clear plan, that’s a mechanical issue worth getting looked at properly.
If you’re in Collingwood and heel pain has been dragging on longer than it should, come see us at The Physio Hub for a detailed physio assessment and to tailor these treatments to your lifestyle. We’ll figure out what’s actually driving it instead of guessing.