Does your heel hurt when you first get out of bed? Have you been told you have plantar fasciitis? Are you looking for treatment options before considering injections?
If so, you’re not alone.
Plantar fasciitis is one of the most common causes of heel pain, particularly among active adults over 50. Research suggests that most cases respond well to conservative treatment, often making injections or surgery unnecessary1.
At Kriz Physical Therapy, we help active adults throughout Bonita Springs, Naples, Estero, and Fort Myers identify the root cause of heel pain and develop a personalized plan to stay active.
The goal is not simply reducing pain. The goal is helping you continue walking, golfing, traveling, exercising, and enjoying life.
What Is Plantar Fasciitis?
Why Does Plantar Fasciitis Cause Heel Pain?
The plantar fascia is a thick band of connective tissue that runs along the bottom of the foot from the heel to the toes. Its primary roles include supporting the arch, absorbing shock, and assisting with force transfer during walking and other activities2.
When excessive stress is placed on the plantar fascia, irritation and degeneration can develop over time.
Common symptoms include:
✓ Sharp heel pain in the morning
✓ Pain after sitting
✓ Pain during walking
✓ Arch discomfort
✓ Foot stiffness3
Why Does My Heel Hurt When I First Get Out of Bed?
While you sleep, the plantar fascia shortens slightly. When you stand and take your first steps, the tissue is suddenly stretched and loaded. This often produces the classic sharp heel pain associated with plantar fasciitis.
Expert Takeaway: Plantar fasciitis is often influenced by mobility, strength, footwear, balance, and walking mechanics — not simply inflammation in the foot. Current clinical practice guidelines emphasize evaluating the entire lower extremity rather than focusing only on the painful heel.
Do I Need an Injection for Plantar Fasciitis?
Not necessarily. Many individuals improve significantly without injections.
While cortisone injections may temporarily reduce symptoms, they do not always address the factors contributing to the problem. Current evidence supports exercise, stretching, manual therapy, and other conservative treatments as first-line interventions for plantar heel pain1.
For long-term success, it’s often important to identify why excessive stress is being placed on the plantar fascia in the first place.
1. Improve Calf Flexibility
Can Tight Calf Muscles Cause Plantar Fasciitis?
Yes. Tight calf muscles are one of the most common contributors to heel pain. Limited calf flexibility can reduce ankle mobility and increase strain on the plantar fascia during walking and other activities. Stretching programs are strongly supported within current clinical practice guidelines for plantar heel pain1.
When calf mobility decreases, additional stress may be placed on:
- The plantar fascia
- The Achilles tendon
- The ankle joint
Daily stretching often helps improve mobility and reduce tension on the foot.
2. Improve Ankle Mobility
How Does Ankle Mobility Affect Plantar Fasciitis?
The ankle plays a critical role in walking mechanics. When ankle mobility becomes restricted, the foot often compensates. Over time, this may increase stress on the plantar fascia and other tissues throughout the lower extremity. Clinical guidelines support interventions that improve joint mobility and movement mechanics1.
Improving ankle mobility can help:
✓ Improve walking mechanics
✓ Reduce foot stress
✓ Improve overall movement efficiency
3. Strengthen the Foot Muscles
Does Foot Weakness Contribute to Plantar Fasciitis?
Absolutely. The muscles inside the foot help support the arch and absorb shock during movement. Emerging evidence suggests that strengthening intrinsic foot muscles may improve foot function and reduce stress on the plantar fascia1.
Helpful exercises often include:
- Toe spreading
- Short-foot exercises
- Towel scrunches
- Balance drills
Strong feet provide a stronger foundation for movement.
4. Improve Hip Strength
What Do My Hips Have to Do With Heel Pain?
More than most people realize. The hips help control leg alignment during walking. Weakness in the gluteal muscles may alter movement patterns and increase stress throughout the lower body, including the foot and ankle. Addressing proximal strength deficits is often an important component of comprehensive rehabilitation1.
Improving hip strength often improves overall movement quality.
5. Wear Appropriate Footwear
What Are the Best Shoes for Plantar Fasciitis?
There is no single best shoe for everyone. However, supportive footwear and, when appropriate, foot orthoses may help reduce stress on irritated tissues and improve comfort during walking. Clinical guidelines support individualized footwear recommendations based on foot structure, symptoms, and activity demands1.
Look for shoes that provide:
- Appropriate support
- Proper fit
- Adequate cushioning
- Stability during walking
The best shoe depends on your foot type, activity level, and movement patterns.
6. Consider Radial Shockwave Therapy
Can Shockwave Therapy Help Plantar Fasciitis?
In many cases, yes. Extracorporeal Shockwave Therapy (ESWT), including radial shockwave therapy, has been studied extensively as a non-invasive treatment option for chronic plantar fasciitis. Multiple systematic reviews and meta-analyses have reported improvements in pain and function, particularly in individuals with persistent symptoms that have not responded to traditional treatment approaches4,5.
The goal is to stimulate healing within irritated tissues and support the body’s natural recovery processes.
At Kriz Physical Therapy, shockwave therapy is often combined with:
- Mobility training
- Strengthening exercises
- Movement correction
- Activity modification
This comprehensive approach addresses both symptoms and contributing factors.
7. Address the Root Cause
Why Does My Plantar Fasciitis Keep Coming Back?
Many people focus only on the painful heel. However, persistent symptoms often involve multiple factors, including:
- Calf tightness
- Ankle stiffness
- Foot weakness
- Hip weakness
- Balance deficits
- Walking mechanics
- Footwear choices
Current best-practice recommendations emphasize identifying and addressing contributing impairments throughout the entire kinetic chain rather than focusing solely on symptom reduction1.
Treating the symptom alone may provide temporary relief. Identifying the root cause often leads to better long-term outcomes.
Can Physical Therapy Help Plantar Fasciitis?
Yes. Physical therapy can help identify factors contributing to:
- Heel pain
- Plantar fasciitis
- Achilles tendonitis
- Foot weakness
- Balance deficits
- Walking dysfunction
The 2023 Heel Pain Clinical Practice Guidelines support individualized treatment plans that may include stretching, strengthening, manual therapy, patient education, taping, and progressive loading strategies1.
A comprehensive evaluation allows treatment to be tailored to your specific needs.
Frequently Asked Questions About Plantar Fasciitis
Can plantar fasciitis go away without injections?
Yes. Many cases improve with conservative treatment that addresses mobility, strength, footwear, and movement patterns.
Are cortisone injections necessary for plantar fasciitis?
Not always. Many individuals achieve meaningful improvements without injections when contributing factors are properly addressed.
How long does plantar fasciitis take to heal?
Recovery varies depending on symptom duration, severity, activity level, and contributing factors. Consistent treatment often leads to gradual improvement.
Is walking good for plantar fasciitis?
In many cases, yes. Appropriate activity modification and progressive loading are often recommended rather than complete rest.
Can shockwave therapy help plantar fasciitis?
Research suggests shockwave therapy may help improve pain and function in chronic plantar fasciitis4,5.
Why does my heel hurt more in the morning?
The plantar fascia tightens overnight and is suddenly stretched when you take your first steps.
Can physical therapy help plantar fasciitis?
Absolutely. Physical therapy can help identify and address mobility restrictions, weakness, balance deficits, and movement patterns that contribute to symptoms.
Expert Takeaways
✓ Most cases of plantar fasciitis improve without surgery.
✓ Injections are not always necessary.
✓ Tight calves and limited ankle mobility frequently contribute to heel pain.
✓ Foot and hip strength play important roles in recovery.
✓ Shockwave therapy may be helpful for chronic cases.
✓ Persistent plantar fasciitis often involves more than just the foot.
✓ The goal is not simply reducing pain — it’s helping you stay active for life.
Stay Active for Life
At Kriz Physical Therapy, we help active adults improve mobility, reduce pain, and maintain independence.
Whether your goal is walking comfortably, golfing, playing pickleball, traveling, or exercising, we’re here to help.
Our mission is simple:
Move Better. Live Better. Stay Active for Life.
Ready to Find the Root Cause of Your Heel Pain?
If plantar fasciitis or heel pain is limiting your ability to stay active, a comprehensive evaluation may help identify what’s contributing to your symptoms.
Schedule a Complimentary Discovery Visit and learn:
✓ Why your heel hurts
✓ What may be contributing to the problem
✓ Whether physical therapy may help
✓ What treatment options may be available
Serving active adults throughout Bonita Springs, Naples, Estero, Fort Myers, and Southwest Florida.
Move Better. Live Better. Stay Active for Life.
References
1. Koc TA Jr, Bise CG, Neville C, Carreira D, Martin RL, McDonough CM. Heel pain–plantar fasciitis: Revision 2023. Journal of Orthopaedic & Sports Physical Therapy. 2023;53(12):CPG1-CPG39.
2. Mayo Clinic. (2023). Plantar fasciitis: Symptoms and causes. Mayo Foundation for Medical Education and Research.
3. Cleveland Clinic. (2022). Plantar fasciitis: Symptoms, causes & treatment options.
4. Cortés-Pérez I, Moreno-Montilla L, Ibáñez-Vera AJ, Díaz-Fernández Á, Obrero-Gaitán E, Lomas-Vega R. Efficacy of extracorporeal shockwave therapy, compared to corticosteroid injections, on pain, plantar fascia thickness and foot function in patients with plantar fasciitis: A systematic review and meta-analysis. Clinical Rehabilitation. 2024;38(8):1023-1043.
5. Lippi L, Folli A, Moalli S, Turco A, Ammendolia A, de Sire A, Invernizzi M. Efficacy and tolerability of extracorporeal shock wave therapy in patients with plantar fasciopathy: A systematic review with meta-analysis and meta-regression. European Journal of Physical and Rehabilitation Medicine. 2024;60(5):832-846.
