That first step out of bed in the morning.

Before you have hopped in the shower.

Before you have even had your first sip of coffee.


If you have plantar fasciopathy (PF) you will know exactly what I am talking about.

In the physio circles we call it ‘first step’ sign (original I know).

Where, the moment you take your first in the morning you get a sharp unpleasant pain in the bottom of the heel.

4-8% of the population will experience it and generally speaking there are two pockets of people that we see at Instant Physio with it:

  • Runners (it accounts for 8% of injuries in runners)
  • People over 45

One of my patients said that body has a design floor and that we should carry on evolving so other human beings don’t have to suffer with it anymore.

This reflects how irritated he was by the problems that his PF had caused.

PF has it’s own set of highly annoying characteristics:

  • You feel it when you first wake up (which is the worst way to start the day)
  • Weight bearing activities provoke it (which can mean you stop exercising and put on weight or become generally more unhealthy)
  • It has a habit of lasting for aaages (sometimes 1-3 years)
  • Lots of health practitioners aren’t very good at treating it
  • It can be very painful due to the foot being highly sensitive which can lead fear-avoidance behaviours

So what is Plantar Fasciopathy first of all?

Plantar fasciitis (what is was previously known as) isn’t the best representation of what is happening when someone is experiencing PF.

This is because there are lots of studies that show a lack of inflammation.

So the ‘itis’ part (which means inflamed) isn’t always accurate.

Hence the new terminology which is plantar fasciopathy.

The truth is…

We don’t know why it is painful.

There I said it!

But that is the truth.

Researchers ask:

Why does it hurt when there is no inflammation?

Why do people see a reduction in pain after sharing the problem with a healthcare professional?

How is that there are some people who can have signs of plantar PF on an MRI scan but also not have any pain?

These are all questions that may never be answered.

But these are the things that are definitely true about some of the things that we see when we scan the heel of someone who has p PF:

  1. Subjects with PF can have increased plantar fascia thickness
  2. Inflammation can be present in people with PF
  3. Heel spurs (pointy bony bits that dig into the plantar fascia) can feature in subjects with PF but are not thought to be the cause

What else causes heel pain?

This article focuses on PF but there are some other possible cause of pain in that area:

  1. Fracture of the calcaneum – either a stress fracture from overuse or from a trauma
  2. Fat pad contusion (bruising) – normally after landing on the heel from a jump
  3. Calcaneal bursitis
  4. Plantar fat pad atrophy

These are all treated relatively differently to PF.

So how do we get rid of the problem once and for all?

There is no shortage of “quick win’s” when it comes to PF.

Freezing a coke can and rolling that on your foot is a nice example of that…

But sadly these ‘hacks’ don’t get people back to being able to do what they like doing e.g. walking for long periods or running.

Below are 5 gold standard treatments we use at Instant Physio to achieve results that are evidence based:

  1. Rehabilitation: This is a proven method that helps to improve PF. It works in a number of ways. One way is that it can provide pain relief. The second way is that a progressive rehabilitation programme stresses the area in small amounts. The plantar fascia then slowly adapts in response to that stress and gets stronger as a result. And slowly over time the plantar fascia gets better and better at tolerating periods of weight bearing like walking or standing for long periods.
  2. Orthotics: There is good evidence to demonstrate the effectiveness of custom orthotics when it comes to treating PF. This helps by making the rest of the foot take more of the stress during weight bearing activities to allow the plantar fascia to settle.
  3. Shockwave therapy: This has a good body of clinical research to show it’s effectiveness in the treatment of PF. Similar to rehabilitation, shockwave treatment causes a small amount of stress to the PF which forces it to remodel and become more and more tolerant to weight bearing in response to this stress. It is particularly good at treating very stubborn PF that has not responded to previous interventions like rehabilitation.
  4. Taping: Taping and strapping is an evidence backed treatment that is proven to help with PF. We like it at Instant Physio because it offers very quick results and is easily provided.
  5. Education: This a really key part of treatment for us at Instant Physio. An example of this would be where a patient may be what we call an ‘avoidant coper’. This is someone who is so sick and tired of being in pain during weight bearing activities that they stop doing everything. This then has a knock on effect which is that the foot and ankle can become stiff and weak as a result which can cause further problems. Part of the treatment for this particular person would need to be around educating them on what is a safe amount of discomfort for them to tolerate. And also it would be about giving them some alternatives to exercising which doesn’t involve aggravating their pain.

How can Instant Physio help you?

  1. Diagnosis
  2. Explaining the underlying causes of your problem
  3. Design a treatment plan for you based on your specific goals
  4. Use scientifically backed treatments for proven results
  5. All of our team are great to work with and we have passion for helping people

At Instant Physio we are very results focussed.

We had a patient who came to see us last year with an 8 month history of heel pain.

He had stopped doing all kinds of exercise and had given up leaving the house apart from once per week to go into the office.

He wasn’t walking for more than 40 minutes per week.

Initially he didn’t respond to rehabilitation and other forms of treatment.

We started using shockwave treatment with him which made him turn a corner.

He was tolerating small amounts of running at 8 weeks after his initial consultation with us.

At 12 weeks after his initial consultation he was running for 25 minutes and had seen a significant reduction in his pain.

If you are struggling with heel pain, I would strongly advise you get in touch and we can start helping you get rid of that “first step” yelp!

Inquire about cost and availability