Episode 4 | Ask the Expert | Guest: Maddie Tait BSc, MSc – Sports MSK Podiatrist, LBSM
Plantar fasciitis [Video] is one of those diagnoses people often arrive at via Dr Google before they’ve seen a clinician. The heel is sore, it hurts most in the morning, and a quick search confirms the culprit. Sometimes that self-diagnosis is right. Sometimes it isn’t – and that distinction matters more than most people realise.
In this episode of the London Bridge Sports Medicine podcast, Dr Ajai Seth is joined by Maddie Tait, LBSM’s Sports MSK Podiatrist, for a focused conversation on plantar fasciitis – what it is, why it happens, and what the right approach to treatment actually looks like.
What is plantar fasciitis?
The plantar fascia is a band of strong connective tissue that runs from the inside of the heel bone all the way forward to the base of the toes. Its job is to support the arch of the foot during standing, walking, and running – absorbing load and providing stability with every step.
Plantar fasciitis [Article] is the term for when this band becomes strained, irritated, or inflamed – most commonly at its attachment point at the heel, which is where the pain tends to be felt. The characteristic symptom pattern is pain that is worst first thing in the morning, or after a period of rest, and that eases somewhat once the foot has warmed up and started moving – only to worsen again after prolonged activity.
Maddie is quick to note that not all heel pain is plantar fasciitis. The Achilles tendon inserts close by, and the heel bone itself can become stressed or inflamed. “It’s important to always make sure we’ve got the diagnosis right in the first place,” she says. Getting the right label matters because the management is not identical across these conditions.
Why does it happen?
The most common thread Maddie sees across her caseload is a change in loading – something has shifted, even if the patient can’t immediately identify what. Common triggers include:
- Increased training load – a spike in running volume or intensity, or more time on the feet at work
- Footwear change – a particularly common trigger at the start of summer, when people switch from supportive winter shoes or trainers to flatter sandals. “You’re requiring more of your foot,” says Maddie, “and that can irritate it.” (it can also be a ski boot syndrome)
- Worn footwear – running shoes that have been in use too long lose their cushioning and support without the wearer necessarily noticing
- Biomechanical factors – the way the foot functions and moves can predispose certain people to plantar fascia strain
- Compensation from another injury – an injury on the opposite leg or foot can shift load patterns, loading one heel more than usual
- Increased body weight – any increase in the load the foot is carrying has a direct effect on plantar fascia stress
- Underlying systemic conditions – autoimmune or inflammatory conditions can contribute to plantar fascia irritation, and are worth considering when the cause is not obvious
A patient who says nothing in their life has changed often, on closer questioning, identifies a small but meaningful shift: an extra walk built into the commute, a new job that involves more standing, a change in the floor surface at work. These things matter.
Getting the basics right: what to do
Calf flexibility and ankle mobility
Maddie’s first port of call in assessment is almost always calf flexibility and ankle movement. The calf muscles attach via the Achilles into the heel bone, and when they are tight, they increase the strain on the plantar fascia. Regular calf stretching – performed properly and consistently – is often one of the most impactful things a patient can do.
Keep the foot moving during rest periods
The classic pattern of morning pain, or pain after sitting, happens because the plantar fascia tightens during periods of rest and is then suddenly stretched on weight bearing. Maddie’s practical advice: before getting out of bed or standing up from a chair, spend a minute moving the foot. Flex and point the toes, draw ankle circles, bring the foot towards the body. This keeps the fascia from tightening fully before it needs to work.
Avoid being barefoot indoors
Walking around the house barefoot – particularly on hard floors – places more strain on the plantar fascia than wearing a shoe with a slight heel. During a flare-up, wearing a supportive trainer indoors is a simple change that can make a meaningful difference to day-to-day comfort.
Ice and relative rest
For acute pain and inflammation, icing the heel and reducing the loading activities that aggravate it can help settle things down in the short term. This is about creating a window for recovery, not about stopping movement entirely.
Address the underlying cause
Identifying and modifying the trigger is essential. If the cause was a spike in running mileage, that needs addressing. If it was footwear, the footwear needs to change. If it is biomechanical – relating to the way the foot functions – a proper assessment with a podiatrist or physiotherapist will identify what is driving the problem and what can be done about it.
What about medical treatments?
Shockwave therapy and steroid injections both have a role in plantar fasciitis management – but both Dr Seth and Maddie are consistent on this point: they work best as an addition to getting the basics right, not as a substitute for it.
“If you’re not actually addressing the main features – the inflexibility, the weakness, the mechanics – then likelihood is that you’re going to go and increase your running volume again and it’s going to come back six months later,” says Maddie.
Medical intervention can temporarily reduce pain and inflammation, but without the underlying drivers being addressed, it is only buying time. The two approaches – conservative management and, where appropriate, medical therapies – work best together.
The bottom line
Plantar fasciitis is common, often straightforward to manage, and highly responsive to the right approach. The key steps are getting an accurate diagnosis, identifying the trigger, addressing calf tightness and foot mechanics, modifying load, and giving the foot the right support during recovery.
If symptoms have been present for more than a few weeks, are not responding to self-management, or are significantly limiting activity, a proper clinical assessment is the logical next step. Heel pain is not something to simply push through.
Maddie Tait (BSc, MSc) is LBSM’s Sports MSK Podiatrist, specialising in gait analysis, biomechanical assessment, and lower limb injury management. She sees patients across LBSM’s London clinic sites.
To book an appointment with Maddie or another member of the LBSM team, visit lbsm.co.uk/booking
Listen to the full episode below ↓
