By William Huang, Registered Physiotherapist
Plantar fasciitis can flare up in the fall as walking and training demands increase and footwear changes from summer sandals to closed-toe shoes. The best way to prevent flare-ups is to gradually increase activity levels while maintaining calf flexibility and foot strength. If heel pain persists for more than a week or two, consider seeing a physiotherapist to identify the cause and develop a plan to get you back to comfortable movement.
How Plantar Fasciitis Starts
Plantar fasciitis is irritation of the plantar fascia, the thick band along the sole of your foot from the heel bone to the toes. It often develops when the fascia is loaded faster than it can adapt, though the specific cause is not always clear.
With each step, your plantar fascia stretches as your arch flattens and recoils as you push off. A sudden increase in walking distance, hill training, or time spent standing on hard surfaces can place extra strain on the tissue, leading to pain around the inner heel where the fascia attaches to the heel bone.
Tight calf muscles can add to this strain. When calf flexibility is limited, it can affect how your foot moves and increase the load on the plantar fascia. This is why your physiotherapist will assess your calf flexibility and ankle mobility, along with your heel pain, to better understand what may be contributing to your symptoms.
Early Signs of Heel Pain
The earliest sign of plantar fasciitis is heel pain with your first steps after rest, and seeking treatment at that point can support a faster recovery. These are the signs to look for:
- First-step pain: Sharp pain at the inner heel when you get out of bed or stand after a long sit. It eases after a few minutes of walking.
- Pain after activity: An ache that builds in the evening after a long walk or run, even if the run itself felt fine.
- Tenderness at the heel: Pressing on the bottom of the heel, just in front of the heel bone on the inner side, is sore.
- Tight arch: The sole feels stiff or pulled when you pull your toes up toward your shin.
Pain at the back of the heel is more often the Achilles tendon, covered in our guide to preventing Achilles tendonitis.
Why Heel Pain Flares in Fall
Fall heel pain comes from a change in what your feet are doing, and several changes tend to arrive in the same few weeks:
- Footwear: Sandals, flip-flops and barefoot time, which give little arch support, are replaced by closed shoes.
- Distance: Longer walks to work and school drop-offs on pavement are back.
- Sport: Race training, rec-league hockey and pickleball start up again.
- Ground: Wet pavement leads to a shorter, more guarded stride, which is one more thing for the foot to adapt to.
- New shoes: Pairs bought for the season add to the change if their cushioning differs from your old pair.
When several of these happen in the same month, the foot has less time to adapt. A runner who adds a fourth weekly run and switches from soft trails to sidewalks, for example, changes three things at once.
Prevention Strategies
Prevention comes down to controlling how fast the load rises and giving the fascia the support and strength it needs. These are the points that matter most:
- Add load gradually: Raise weekly distance or time in small steps, and change only one thing at a time, such as distance, hills or surface. Keep a rest day between harder sessions.
- Use cushioned, supportive shoes while the heel is irritated: Choose shoes that bend at the ball of the foot but resist twisting through the middle, as this provides better arch support than a flat, flexible sole. Extra cushioning can also help ease heel discomfort, so replace your running shoes when the cushioning breaks down or the tread shows uneven wear. The same principle applies at home: during a flare-up, wearing supportive slippers or sandals on hard floors can help reduce strain on your feet and keep you more comfortable throughout the day.
- Bring in minimalist footwear gradually: Supportive shoes are not the long-term answer for every foot. Minimalist footwear has been shown to help build foot strength over time, but the benefit is not immediate, so introduce it slowly once the heel has settled rather than during a flare-up.
- Keep your calves flexible: A tight calf adds pull on the fascia, so regular calf stretching is part of prevention.
- Build foot and calf strength: Strong calf and foot muscles share the work with the fascia, and your physiotherapist can pick exercises that match your sport.
Research suggests that stretching the calf and the plantar fascia can reduce heel pain in people who already have it. Evidence for preventing it is less certain, so treat these steps as a sensible routine.
What You Can Do at Home
Two stretches and a couple of daily habits are a safe place to start for mild heel soreness. Before you try them, stop or limit any exercise that causes sharp pain or pain that gets worse as you go, and keep in mind that a mild pulling sensation in the calf or arch is expected. If your heel pain is severe, started suddenly, came after an injury or hard landing, you cannot put weight on the foot, or the foot is swollen, bruised or looks out of shape, get assessed before you try these.
- Standing calf stretch: Stand facing a wall with the sore leg behind you and the heel flat on the floor. Lean forward until you feel a mild pull in the calf, hold it, and repeat a few times through the day.
- Seated arch stretch: Sit with the sore foot across your other knee. Pull the toes back toward your shin until you feel a mild pull along the arch, hold it, and repeat. Do this before your first steps in the morning.
- Roll the arch: Roll the sole over a water bottle or a firm ball with light pressure. Keep it comfortable and stop if it feels sharp.
- Shoes on early: While the heel is sore, put on supportive shoes before you stand up in the morning instead of walking barefoot to the kitchen.
If the pain gets worse from day to day instead of easing gradually, stop and book an assessment, since home stretches suit mild, early pain and do not replace a diagnosis.
Orthotics for Heel Pain
Custom foot orthotics are inserts made from an impression of your foot to support the arch and spread load across the sole. They are one option when shoe changes and stretching have not settled the pain, or when your arch shape, work boots or sport put repeated stress on the fascia.
Whether orthotics suit you depends on your foot and how it moves, so a physiotherapist decides this at an assessment before anything is ordered. Our custom foot orthotics page explains the assessment and ordering process.
Orthotics support the foot while you build strength and flexibility, so your plan still includes the stretches and strength exercises above.
Shockwave Therapy at Joyce
Research suggests that shockwave therapy may benefit some people with persistent plantar fasciitis, although results can vary. Your physiotherapist may combine shockwave therapy with activity modifications and targeted exercises to address the underlying causes of irritation. Some discomfort during treatment is normal, but let your physiotherapist know if you experience sharp pain.
We offer shockwave therapy at our Joyce clinic only.
What Physiotherapy Adds
A physiotherapist confirms that your pain is coming from the plantar fascia and builds a plan around what is driving it. A first visit usually covers your history, how you stand and walk, and tests of your calf, ankle and foot.
Treatment can then include hands-on work on the calf and foot, a graded exercise program that builds calf and foot strength, advice on shoes and training, and the options above where they suit you.
Some heel pain is not plantar fasciitis. Nerve irritation in the foot, a bone injury or a problem in the lower back can feel similar, so if the assessment points that way, your physiotherapist refers you for imaging or to a physician. Our physiotherapy service covers the assessment and treatment of heel pain.
Booking an Assessment
Book a physiotherapy assessment at our Kingsway or Joyce clinic if heel pain has lasted more than a week or two or keeps coming back each fall. You can book online through our booking page.
This is general information, not a diagnosis. See a clinician for advice specific to you.
Frequently Asked Questions
Is a heel spur the same as plantar fasciitis?
No. A heel spur is a small bony growth on the heel bone that can show up on an X-ray, and it is also seen in people with no heel pain. Plantar fasciitis is irritation of the tissue along the sole, and the two can exist separately.
Can I keep running with heel pain?
Mild soreness that settles by the next morning may allow reduced running on softer surfaces. If pain sharpens as you run or lingers into the next day, cut back and have it assessed.
Why is the first step in the morning the worst?
Overnight the fascia rests in a shortened position, so the first steps stretch it suddenly. Walking warms it up, which is why the pain fades within minutes and then returns after another long sit.
Do I need an X-ray before seeing a physiotherapist?
No. A physiotherapist can assess heel pain from your history and a hands-on exam. If the findings point to something else, they refer you for imaging or to a physician.
Does ice or heat work better for a sore heel?
Either can ease soreness for a while, but neither fixes the cause, so pick whichever feels better on your foot and keep working on the load, footwear and strength steps above.
Will I need shockwave therapy?
Shockwave therapy may be used alongside other treatments or considered if pain persists despite trying other approaches. Your physiotherapist can recommend it based on your symptoms, treatment history, and individual needs.
