That stabbing heel pain when you take your first steps in the morning. The ache that returns after sitting at your desk and getting up. The pain that makes you favour one foot without even realising it. Plantar fasciitis is one of the most common — and most frustrating — foot conditions we treat at Burwood Physio. Here’s what’s actually happening in your heel, why it’s so stubborn, and why shockwave therapy has changed the treatment landscape.
What Is the Plantar Fascia?
The plantar fascia is a thick band of connective tissue — similar in structure to a tendon — that runs along the sole of your foot from the heel bone (calcaneus) to the base of your toes. It plays a vital role in supporting the arch and acting as a shock absorber during walking and running. Every step you take loads the plantar fascia. Over a typical day, it endures thousands of loading cycles.
What Happens in Plantar Fasciitis?
Plantar fasciitis develops when the plantar fascia is subjected to more load than it can handle. This triggers micro-tears at the attachment point on the heel bone, inflammation, and a degenerative process within the fascial tissue.
Research in recent years has shifted our understanding: while the “-itis” suffix suggests pure inflammation, plantar fasciitis is now understood to be more of a tendinopathy — a degenerative condition of the fascial tissue rather than primarily an inflammatory one. This matters enormously for treatment.
If the condition were purely inflammatory, anti-inflammatories and ice would be the answer. But because degeneration is the primary process, the tissue needs to be loaded and stimulated to heal — not simply rested.
Why Does It Hurt Worst in the Morning?
The classic morning pain is caused by something called the “windlass mechanism.” During sleep, the foot is in a relaxed, plantarflexed position (toes pointing down). The plantar fascia contracts and shortens slightly overnight. When you take your first steps and the foot dorsiflexes (toes come up), the fascia is suddenly stretched — and those degenerative, micro-damaged fibres are pulled under tension, producing sharp pain.
After 10–15 minutes of walking, the fascia warms up and temporarily becomes more extensible, which is why morning pain often eases after a few minutes of walking. Similarly, after prolonged sitting, the fascia shortens again and produces pain on rising — the “post-static dyskinesia” pattern that is characteristic of plantar fasciitis.
What Causes Plantar Fasciitis?
Plantar fasciitis doesn’t appear out of nowhere. There is almost always a combination of contributing factors:
- Sudden load increase: Starting a running programme, significantly increasing weekly mileage, or spending much more time on your feet (e.g. a new job requiring prolonged standing)
- Calf tightness: Tight gastrocnemius and soleus muscles increase tension through the Achilles and plantar fascia during the push-off phase of gait
- Foot structure: Both flatfoot (excessive pronation) and high arches increase strain on the plantar fascia through different mechanisms
- Worn or unsupportive footwear: Shoes with insufficient heel cushioning or arch support fail to attenuate the forces transmitted to the fascia
- Body weight: Higher BMI increases the load through the heel with every step
- Occupational factors: Prolonged standing on hard surfaces (concrete, tiles) is a major contributor
Why Is Plantar Fasciitis So Stubborn?
Tendons and fascial tissue have a relatively poor blood supply compared to muscle. This means healing is slower. Additionally, the plantar fascia is under load with virtually every waking step — unlike an injured shoulder, which can be rested during most daily activities. True rest of the plantar fascia is almost impossible without a moon boot or crutches.
Many patients also fall into a “loading trap”: they rest until the pain improves, then return to normal activity, which reloads the degenerated tissue before it has adequately healed — restarting the injury cycle. Without addressing the underlying tissue degeneration, plantar fasciitis can persist for 12–18 months or longer.
How We Treat Plantar Fasciitis at Burwood Physio
Shockwave Therapy
Shockwave therapy has transformed the treatment of chronic plantar fasciitis and is now the most evidence-supported intervention for cases that haven’t responded adequately to stretching and exercise alone.
Extracorporeal shockwave therapy (ESWT) works by delivering high-energy acoustic waves to the plantar fascia attachment. These waves:
- Stimulate cellular repair processes (neovascularisation and growth factor release)
- Break down calcific deposits that sometimes form at the heel attachment
- Disrupt the pain cycle by temporarily reducing pain signal transmission
- Promote collagen remodelling in degenerated fascial tissue
Clinical trials consistently show 70–80% success rates for shockwave therapy in chronic plantar fasciitis (symptoms >3 months). Most patients require 3–5 sessions spaced one week apart. Results often continue to improve for 8–12 weeks after the final session as tissue remodelling progresses.
At Burwood Physio, we use clinic-grade shockwave equipment. Learn more about our Shockwave Therapy service.
High-Load Strength Training
Heavy slow resistance (HSR) exercises — particularly eccentric and isometric calf raises — are one of the most powerful tools for treating plantar fasciitis. Loading the calf-Achilles-plantar fascia chain under high, slow loads stimulates collagen remodelling and strengthens the tissue. Research shows that HSR produces results equivalent to or better than surgery in some tendinopathy studies.
Plantar Fascia and Calf Stretching
The plantar fascia-specific stretch (pulling the toes back before the first step out of bed) has strong evidence for reducing morning pain. Combined with calf stretching (both straight and bent knee to target gastrocnemius and soleus separately), regular stretching is essential to the programme.
Taping and Orthotics
Low-dye taping supports the arch and reduces strain on the plantar fascia — particularly useful in the acute phase or when load management alone isn’t sufficient. For patients with significant biomechanical contributors (flat feet, excessive pronation), custom or prefabricated orthotics may be recommended.
How Long Does Recovery Take?
With appropriate treatment, most patients see significant improvement within 6–8 weeks. Shockwave therapy significantly accelerates recovery in chronic cases. Without treatment, plantar fasciitis can persist for well over a year.
Book Plantar Fasciitis Treatment in Burwood
Don’t let heel pain limit your life. Burwood Physio offers shockwave therapy, stretching programmes, and comprehensive plantar fasciitis management at Shop 2, 36-38 Victoria St E, Burwood NSW 2134.
Open Mon–Fri 7AM–7PM, Sat 7AM–2PM. HICAPS on-site, all health funds. Call 02 8322 9022 or read more on our Plantar Fasciitis Treatment page.
Reviewed by the Burwood Physio Clinical Team
BPhty (Hons) | AHPRA Registered Physiotherapists | Member, Australian Physiotherapy Association
Our clinical team has over 20 years of combined experience in musculoskeletal physiotherapy, sports rehabilitation, and pain management. All content is reviewed for clinical accuracy and updated in line with current evidence-based practice guidelines. Meet our team →
