Plantar Fasciitis
Plantar fasciitis is a common and often frustrating condition of the foot, caused by irritation and breakdown of the plantar fascia which is the thick band of tissue that runs along the bottom of the foot. This connects the heel to the toes and supporting your arch. It's one of the most frequent causes of heel pain we see, especially in runners and anyone involved in rigorous training or athletic activity, though it also shows up frequently in people who spend long hours standing or walking on hard surfaces.
What Causes Plantar Fasciitis?
The plantar fascia absorbs a lot of stress with every step. When that stress builds up faster than the tissue can recover, small tears and degenerative changes develop at the point where the fascia attaches to the heel bone. Common contributors include:
- A sudden increase in running mileage, standing time, or training intensity
- Tight calf muscles or a tight Achilles tendon, which increase strain on the fascia
- Flat feet, high arches, or an abnormal walking pattern (overpronation)
- Worn-out, unsupportive, or poorly fitted footwear
- Being on your feet for long stretches on hard flooring
- Carrying extra body weight, which increases load on the fascia with every step
Symptoms
- Sharp, stabbing heel pain, most noticeable with your first steps in the morning or after sitting for a while
- Pain that often eases somewhat once you're up and moving, then can return after long periods of standing or at the end of the day
- Tenderness at the bottom of the heel, often reproduced by pulling the toes upward while pressing on the area
- Pain that has built up gradually over weeks, rather than from a single injury
How We Diagnose It
Plantar fasciitis is primarily a clinical diagnosis, meaning we can usually confirm it through your history and a hands-on exam, without needing imaging. We'll check for tenderness at the heel's attachment point, assess your calf and ankle flexibility, and look at your foot mechanics and footwear. One important point: X-rays sometimes show a small heel spur, but a heel spur is not a reliable sign of plantar fasciitis. Many people with a spur have no heel pain at all, and many people with plantar fasciitis have no spur.
Treatment for Plantar Fasciitis
The good news is that the large majority of people improve with conservative, non-surgical care. Depending on your evaluation, your plan may include:
- Targeted stretching for the calf muscles, Achilles tendon, and plantar fascia itself
- Soft tissue and manual therapy to address tight, restricted tissue in the calf and foot
- Chiropractic adjustments to the foot and ankle when joint mechanics are contributing to how stress is distributed across the fascia
- Footwear changes or custom orthotics to better support your arch and foot type
- Night splints or taping to keep the fascia gently stretched and reduce that classic first-step-in-the-morning pain
- Activity modification to reduce repetitive load while the tissue heals
Most people see meaningful improvement within several weeks to a few months of consistent conservative treatment, and roughly 9 in 10 people recover without ever needing more invasive care. Steroid injections and surgery are reserved for a small number of longer-standing cases that haven't responded to a genuine course of conservative treatment.
Frequently Asked Questions
Why does my heel hurt most with my first steps in the morning? Overnight, the plantar fascia tightens back up while at rest. That first stretch when you stand and start walking is what typically produces the sharp pain, a hallmark sign of plantar fasciitis.
Do I have a heel spur, and does it matter? You might, but a heel spur on X-ray doesn't reliably predict pain, plenty of people have a spur with no symptoms at all. Treatment focuses on the fascia itself, not the spur.
Can a chiropractor help with plantar fasciitis? Yes, particularly by combining stretching and soft tissue work with hands-on adjustments to the foot and ankle, alongside footwear or orthotic guidance to reduce ongoing strain on the fascia.
Will I need surgery? Very rarely. About 90% of people recover with conservative treatment, and surgery is reserved for select cases that don't respond after a genuine trial of non-surgical care.
We will get you quickly back on your feet so you can enjoy all your activities free from pain. If heel pain is holding you back, our Midtown Manhattan team can help. Call us today or request an appointment online.