1. Introduction / Plain Theory

Plantar fasciitis is one of the most common causes of heel and foot pain.
It involves irritation or microtearing of the plantar fascia — a strong band of connective tissue running from the heel (calcaneus) to the toes, supporting the foot’s arch and aiding shock absorption during walking and running.

Despite the name, the condition is not primarily inflammatory, but rather a degenerative and mechanical overload disorder of the fascia and its attachment.
Many people are mistakenly told they have a “heel spur.” In reality, heel spurs are usually an incidental finding on X-rays and are not the cause of pain in most cases.

Prevalence is high — affecting up to 10% of the population — especially in those who stand for long periods, runners, or individuals with altered foot mechanics.

2. Typical Symptoms and Functional Impact

• Sharp or stabbing pain under the heel, especially with first steps in the morning.

• Pain after long periods of standing or after exercise.

• Tenderness at the inside of the heel bone (medial calcaneal region).

• Tightness along the sole of the foot or calf.

• Reduced foot flexibility and altered gait.

Functional impact:
Pain may limit walking, sports participation, or even daily tasks such as getting out of bed or climbing stairs.
Left untreated, compensatory patterns often develop in the ankle, knee, hip, and lower back.

Red flags:
Severe swelling, numbness, or pain unrelated to movement may indicate other causes such as nerve entrapment or systemic inflammatory disease — requiring medical evaluation.

3. Contributing Factors / Underlying Causes

Plantar fasciitis often develops due to a combination of mechanical overload and tissue adaptation failure.

Common contributors include:

• Foot mechanics: excessive pronation or flat feet increasing tension on the fascia.

• Tight calf muscles (gastrocnemius–soleus complex): limiting ankle dorsiflexion.

• Reduced hip or pelvic stability: causing altered gait mechanics.

• Overuse: running, walking on hard surfaces, or prolonged standing.

• Improper footwear: poor arch support or thin soles.

• Obesity or sudden weight gain: increasing load on the foot.

• Fascial and myofascial restrictions: throughout the kinetic chain, from lower limb to pelvis.

An osteopathic perspective views plantar fasciitis not as an isolated “foot problem,” but as a whole-body adaptation issue, often involving postural asymmetry, fascial tension, and load transfer through the lower kinetic chain.

4. Osteopathic Approach

Osteopathic management focuses on reducing local tension, improving circulation, and restoring balanced mechanics throughout the lower limb and pelvis.

An osteopathic assessment may include:

• Detailed evaluation of foot alignment, gait, and load distribution.

• Examination of ankle, knee, hip, and pelvic motion to identify contributing restrictions.

• Gentle soft tissue, myofascial, and articulatory techniques to relieve tension in the fascia, calf, and posterior chain.

• Mobilisation of the ankle and subtalar joints to improve movement and shock absorption.

• Functional techniques addressing compensations in the lumbar spine and pelvis.

• Advice on footwear, activity modification, and stretching as adjuncts (if appropriate).

The goal is to restore dynamic balance through the lower limb, support tissue healing, and reduce strain on the plantar fascia — rather than merely treating the heel itself.

5. Scientific Evidence & References

Research supports manual therapy and exercise as first-line interventions for plantar fasciitis, often providing faster recovery than passive or pharmacological methods alone.
Evidence shows that addressing lower-limb biomechanics and fascial tension improves outcomes more effectively than focusing only on the heel.

Osteopathic and physiotherapy-based interventions show significant benefit for pain relief, gait correction, and long-term function.

References

1. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004;25(5):303–310. Link

2. Buchbinder R. Plantar fasciitis. N Engl J Med. 2004;350(21):2159–2166. Link

3. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234–237. Link

4. DiGiovanni BF, Nawoczenski DA, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. J Bone Joint Surg Am. 2003;85(7):1270–1277. Link

5. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265. Link

6. Rathleff MS, et al. High-load strength training improves outcome in patients with plantar fasciitis: randomized controlled trial. Scand J Med Sci Sports. 2015;25(3):e292–e300. Link

7. Fraser JJ, et al. Manual therapy and exercise for plantar heel pain: systematic review and meta-analysis. J Orthop Sports Phys Ther. 2018;48(6):439–447. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for plantar heel pain: network meta-analysis. Front Pain Res. 2024;15:1507329. Link