What Is Plantar Fasciitis?
Plantar fasciitis is the most common cause of heel pain, affecting approximately 2 million Americans per year. It is caused by degeneration and micro-tearing of the plantar fascia — a thick band of connective tissue that runs along the bottom of the foot from the heel bone (calcaneus) to the base of the toes, forming the arch of the foot. When this tissue becomes overloaded, it develops the degenerative changes of tendinopathy: disorganized collagen, ingrown blood vessels, and chronic pain.
Like epicondylitis, plantar fasciitis is actually better described as plantar fasciopathy — a degenerative rather than inflammatory process — which explains why anti-inflammatory medications and rest provide only temporary relief without addressing the tissue pathology.
The Classic Morning Pain Pattern
The hallmark symptom of plantar fasciitis is severe heel pain with the first steps in the morning, or after any period of prolonged rest. This is caused by the plantar fascia shortening during rest and then being rapidly stretched with weight-bearing. After walking a few minutes, the pain typically decreases — but returns with prolonged standing or walking later in the day.
Other characteristic features include:
- Sharp, stabbing pain at the medial (inner) heel and arch
- Pain that worsens at the beginning of activity and often improves with continued movement
- Tenderness when pressing at the front and inner edge of the heel
- Pain after (not necessarily during) high-impact activity like running
Why Does Plantar Fasciitis Develop?
Plantar fasciitis results from excessive tensile load on the plantar fascia that exceeds its capacity to recover. Contributing factors include:
- Tight calf muscles and Achilles tendon — limits ankle dorsiflexion, forcing the plantar fascia to absorb more force
- Foot pronation (flat feet) — increases the tensile strain on the plantar fascia
- High arched foot — reduces shock absorption, concentrating load at the heel
- Sudden training load increases — too much mileage or standing time too fast
- Body weight increase — directly increases plantar fascia load
- Poor footwear — inadequate arch support or cushioning
Heel spurs are not the cause: Many patients are told their plantar fasciitis is caused by a heel spur (calcaneal osteophyte). In reality, heel spurs are present in many people without plantar fasciitis and absent in many with it. The spur is a consequence of chronic fascial pull, not a cause of pain.
Treatment at Pittsburgh Physical Medicine
Shockwave Therapy — The Gold Standard
Extracorporeal shockwave therapy (ESWT) is the most evidence-supported treatment for plantar fasciitis, with multiple randomized controlled trials showing 70–85% success rates — including in chronic cases that have failed every other conservative treatment. ESWT delivers acoustic pressure waves to the plantar fascia insertion, stimulating the body's healing response, promoting neovascularization, and breaking down degenerative tissue. It is the treatment of choice for plantar fasciitis lasting longer than 3 months at Pittsburgh Physical Medicine.
Graston Technique
IASTM applied to the plantar fascia, calf, and Achilles tendon complex addresses adhesions, promotes tissue remodeling, and reduces pain quickly. It is typically combined with eccentric calf loading.
Chiropractic Foot and Ankle Assessment
Restricted subtalar, talocrural, and midfoot joint mobility contributes to abnormal plantar fascia loading. Joint manipulation of the foot and ankle restores normal biomechanics and reduces fascial strain.
Stretching and Loading Protocol
The Alfredson eccentric calf loading protocol and plantar fascia-specific stretching are the most evidence-based self-management strategies. Dr. Crockatt teaches proper technique and progression to patients from the first visit.
Suffering from Plantar Fasciitis?
Our team at Pittsburgh Physical Medicine treats this condition with chiropractic care, physical therapy, and soft tissue techniques — under one roof in East Liberty, Pittsburgh.
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