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Plantar fasciitis – what is it and how can I fix it?

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If, when you take your first few steps in the morning, you feel a sharp pain in the bottom of your foot, at the front or centre of the heel bone, you are probably suffering from plantar fasciitis.

Plantar fasciitis, commonly just called ‘heel pain’ or ‘Policeman’s Heel’, occurs when the ligament under your arch – the plantar fascia – becomes inflamed.

The plantar fascia supports the arch of your foot and also acts as a shock-absorber. Since it is hard to rest your foot, the symptoms may persist and it can become very painful indeed.

The pain is usually at its worst when you take your first step after a period of inactivity, dissipating a few steps later. However, it often deteriorates again after standing, walking or running for a long period of time – sometimes making running or even daily life feel impossible.

What causes plantar fasciitis?

The plantar fascia is constantly subject to strains and sprains. Many people get “some niggle” that settles quite quickly. Others struggle to recover.

Perhaps you’ve taken up a new form of exercise or increased the intensity of your exercise, without allowing your body to adjust. Even something as ‘trivial’ as wearing worn-out shoes, with weak arch supports and thin soles, can prove enough for the tissue to flare-up. It might develop from a change of lifestyle or training. For example, you now spend a lot of time on your feet or do lots of walking, having previously had a more sedentary lifestyle.

Why has mine lasted so long?

Only in certain circumstances does the problem persist.

Being overweight does increase your chances of getting plantar fasciitis, since just walking is causing excessive weight to go through the heel. This also makes recovery more difficult.

Persisting problems could also be the result of anatomical variations, such as having flat feet or an unusually high arch. A tight Achilles tendon is a common finding with long-term sufferers of heel pain.

Stubbornly refusing to rest from that marathon training schedule is another common cause for the problem persisting.

How can plantar fasciitis be treated?

A foot and ankle specialist will first question you on your lifestyle and medical history to try and decipher the source of your heel pain. A thorough examination helps to see whether your pain is from the plantar fascia – and if so, from which part. A biomechanical assessment looks specifically for calf muscle tightness. If the problem is unusual or long-standing then X-rays or a scan may be helpful.

You will probably be advised to stop any exercise that is making your pain worse. Rest is a key part of the recovery from plantar fasciitis. This can be facilitated with various pads and shoe inserts to cushion the heel and support the arch of your foot.

Wearing the right footwear is crucial to overcoming heel pain, particularly when running and exercising, where the force going through your heel increases.

Regularly stretching your calf muscles and plantar fascia, in order to elongate the heel cord, proves effective in up to 90% of sufferers.

However, in about one in 10-20 cases, the usual treatments don’t prove enough. Further treatments that are advised include steroid injections, to reduce inflammation. It is rare for this to cure the problem, and there are potentially serious side effects. For these reasons, it is not something we routinely recommend.

Extracorporeal shock wave therapy (Shock Wave) is considered very useful if the patient’s symptoms have persisted for more than six months. It uses a high intensity ultrasound to stimulate healing of the plantar fascia. It is successful in eight out of ten patients.

Many patients with stubborn heel pain are stuck because their calf muscle is naturally tight. If stretches and physio don’t solve this, then a small operation under local anaesthetic and sedation stretches the calf and allows the foot pain to recover.

Treating plantar fasciitis with surgery to the foot is seen as a very last resort. A plantar fascia release involves freeing a portion of the plantar fascia from the heel bone. It can be done “keyhole” in selected cases. Happily, because the easier treatments outlined above are so successful, this is only very rarely required.

How can plantar fasciitis be prevented?

Regardless of whether you’ve had plantar fasciitis before, efforts should be made to prevent it from developing. An estimated one in ten people will have at least one episode of heel pain at some point in their life. If stretching has helped, then don’t stop once the pain has gone. Keep up some gentle stretches as “preventative maintenance”.

If you’re overweight, try to combine regular exercise with a healthy, balanced diet. Losing excess weight will do more than just help your feet, of course.

Wearing shoes with good cushioning in the heels and good arch support is crucial to preventing plantar fasciitis, as is regularly changing training shoes used for running or walking. Incorporate some stretching of the plantar fascia and Achilles tendon into your training regime.

Also, take care not to increase the intensity of your training too quickly and try to avoid exercising on hard surfaces.

Remember, your feet are constantly being worked, so be good to them.

Free phone consultation

If you think you may have Plantar fasciitis – or any other foot or ankle injury – call Wimbledon Clinics for advice and specialist treatment.

We’ll take a look at your injury, make a specialist assessment and put together a clear strategy for your treatment and recovery. Our goal is to help you to get back to your best as soon as possible.

For a free phone consultation or to book an appointment, call Wimbledon Clinics now on 020 8629 1889 or visit www.wimbledonclinics.co.uk