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Plantar Fasciitis: Why Your Heel Hurts (And How We Fix It)

You know that first step out of bed in the morning?​

The one that feels like you've stood on a stone that isn't there? That's the classic sign of plantar fasciitis, and it's one of the most common problems I see in clinic. The good news: it's very treatable. The less good news: it rarely disappears just because you rested for a week and bought softer slippers. On this page I'll walk you through what plantar fasciitis actually is, why it happens, and exactly how I treat it, so you know what a proper recovery plan looks like before you book anything.

Paul the podiatrist assessing the heel of a patient
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The Telltale Symptoms

  • Sharp pain under the heel with your first steps in the morning

  • Pain that eases as you warm up, then returns after a long day on your feet

  • Tenderness when you press the inside edge of your heel

  • Stiffness through the arch, often with tight calves

  • A flare-up the day after doing more than usual

How I Treat It

  • Custom foot orthotics

  • Taping

  • Exercise and mobility work

  • Prescribed strength and conditioning

  • VALD strength testing

  • Shockwave therapy

  • Manual therapy

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What Is Plantar Fasciitis?

  • Your plantar fascia is a thick band of tissue running from your heel to the base of your toes. Think of it as the bowstring under your arch: every time you stand, walk or run, it tensions and releases to support your arch and spring you forward.

  • Plantar fasciitis happens when the load going through that tissue is more than it can cope with. Small amounts of damage build up faster than the tissue can repair, usually right where the fascia attaches to your heel bone. That is why the pain sits under your heel.

  • Despite the name, it often is not purely an inflammation problem. In longer-standing cases the tissue starts to weaken and degenerate, which is why anti-inflammatories and rest alone often disappoint. The fix is not just calming the tissue down. It is building it back up.

What Actually Causes It?

  • Think of it as a maths problem: load going in versus what your tissue can handle. When the first number beats the second for long enough, your heel lets you know. Things that push the load up:

  • A sudden jump in activity, like a new running plan, a hiking holiday, or a new job on your feet

  • Long hours standing or walking on hard floors, which is most of Singapore

  • Footwear that does not suit your foot or your activity, including worn-out trainers and flat, unsupportive sandals

  • Carrying more body weight than your tissues are conditioned for

  • Foot mechanics, like a flatter foot that overloads the fascia, or a stiff high arch that does not absorb shock well

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Is It Definitely Plantar Fasciitis?

  • Not all heel pain is plantar fasciitis, and plenty of people waste months treating the wrong thing. Conditions commonly mistaken for it include:

  • Heel fat pad irritation, which sits more centrally under the heel and feels like bruising

  • Nerve-related pain such as Baxter's nerve entrapment or tarsal tunnel syndrome, which often burns or tingles

  • A calcaneal stress fracture, which hurts with almost every step and does not ease as you warm up

  • Achilles problems, which sit at the back of the heel rather than underneath

  • Inflammatory conditions like gout or reactive arthritis, especially if the heel is hot or swollen

  • And no, a heel spur on your X-ray usually is not the villain. Plenty of pain-free feet have spurs. Getting the diagnosis right is the single most valuable part of an assessment.

How I Assess Your Heel Pain

  • Your story: when it started, what changed beforehand, what makes it better or worse, and what you need your feet to do

  • Hands-on examination: confirming it really is the plantar fascia, and ruling out the imposters

  • Gait and biomechanics: how your foot loads when you walk and run, and where the strain is coming from

  • Footwear review: bring your everyday shoes and your trainers. Shoes are often a bigger piece of the puzzle than people expect

  • VALD strength testing: objective force plate and dynamometry testing to measure exactly how strong your calves and feet are. Numbers, not guesswork

  • From there, you get a plan that is specific to you

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What Pulls Your Capacity Down

  • Weak calves and foot muscles, which means the fascia takes more of the strain

  • Tight calves and limited ankle mobility

  • Age, since tissue tolerance drops as we get older, particularly from our 40s onwards

  • Long gaps between activity, because tissues that are not loaded lose their resilience

  • Notice something? Almost everything on this list and the last one is fixable. That is exactly what good treatment targets.

How We Treat It: The Toolbox (1-4)

  • Custom foot orthotics: reduce the strain going through the fascia by changing how your foot loads with every step. Not everyone needs them, and some people only need them temporarily while we rebuild strength

  • Taping: low-dye taping supports your arch and offloads the fascia immediately. Simple, cheap, and it works fast. If taping gives you relief, that tells us something useful about what your foot needs

  • Exercise: targeted stretching and mobility work for the fascia, calves and ankle eases morning stiffness. This is your daily homework, and the people who do it get better faster

  • Prescribed strength and conditioning: the part most heel pain plans miss. A progressive loading programme for your calves, foot muscles and fascia that builds week by week. This is what turns a fragile, cranky fascia back into the strong spring it is meant to be

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How We Treat It: The Toolbox (5-7)

  • VALD testing: how do you know the strength work is working? You measure it. I use VALD force plates and dynamometry, the same technology used by professional sports teams, to test your calf and foot strength at the start and retest as we go. Watching your own numbers climb is great motivation

  • Shockwave therapy: for stubborn cases that have been grumbling for months, ESWT delivers targeted acoustic waves to kickstart the healing response. It works best alongside a loading programme rather than instead of one. Shockwave wakes the tissue up. Strength work teaches it to cope

  • Manual therapy: hands-on treatment through the calf and fascia, plus joint mobilisation through the foot and ankle. A supporting act rather than the headline, but it makes everything else work better

How Long Does Recovery Take?

  • Honest answer: it depends how long you have had it and how consistently you follow the plan

  • Caught early, many people feel meaningful improvement within 4 to 6 weeks

  • If it has been grumbling for six months or more, think in terms of a few months of structured rehab rather than a few weeks

  • That might not be what you want to hear, but it beats the alternative: studies show untreated plantar fasciitis can drag on well past a year, and limping around on it has a habit of stirring up knees, hips and backs too

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Five Things You Can Do Today

  • Stop walking barefoot on hard floors. Wear a supportive sandal or cushioned shoe at home. Your tiles are not your friend right now

  • Audit your shoes. If your daily trainers are old, flat or dead in the midsole, that is the first fix. A cushioned shoe with a slightly higher heel-to-toe drop takes real strain off the fascia

  • Trim the spike, not the activity. Cut the things that flare it most, like hills, speed work and marathon shopping days, but keep moving. Complete rest weakens the tissue further

  • Stretch your calves daily. Gentle, consistent calf and fascia stretches, especially before your first steps in the morning

  • Roll a frozen bottle under your arch for a few minutes after long days. If your heel pain has hung around for more than two or three weeks, that is your cue to get it properly assessed

Frequently Asked Questions

  • Will it go away on its own? Sometimes, eventually. But without addressing why it started, it can take a year or more, and it loves a comeback tour

  • Do I need a scan? Usually not. Plantar fasciitis is diagnosed from your story and a physical examination

  • Can I keep running? Often yes, with adjustments. If pain stays mild and does not flare the next morning, we can usually keep you running while we rehab

  • What are the best shoes? There is no single best shoe, but there is a best shoe for your foot. Generally: good cushioning, a supportive midsole and a bit of heel-to-toe drop while symptoms settle

  • Is it caused by a heel spur? Almost never. Spurs show up on plenty of pain-free feet

  • Do I need injections or surgery? The vast majority of people never need either. Cortisone carries risks to the fascia and fat pad, and surgery is a genuine last resort

  • Will I need orthotics forever? Not necessarily. For some people they are a short-term offloading tool while we rebuild strength. Your foot, your mechanics and your goals decide

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