Plantar Fasciitis

What plantar fasciitis actually is

The plantar fascia is a thick band of connective tissue running along the sole of the foot from the heel bone to the base of the toes. It works like a tie rod, holding the arch together and storing energy as you push off.

Plantar fasciitis is pain where that band attaches at the heel. The name says inflammation, but tissue samples from long-standing cases tend to show degenerative change rather than active inflammation, which is why some clinicians prefer plantar fasciopathy. That is not pedantry. It changes what helps. If the problem were purely inflammatory, rest and anti-inflammatories would fix it. Because it is a tissue capacity problem, the thing that actually works is graded loading.

The classic presentation is distinctive enough to be close to diagnostic: sharp heel pain for the first few steps in the morning, easing within five or ten minutes of walking, returning after a long day on your feet.

Why it shows up here

The Okanagan pattern is seasonal and predictable.

Spring is the big one. A winter of relatively low walking volume meets the first stretch of good weather, and people go from modest daily steps to long hikes at Kal Park or the BX trails inside a couple of weeks. The fascia adapts to load slowly. Step count does not.

Summer footwear is the second driver. Months in flat sandals, with no structure and no heel counter, is a meaningful change in what the foot is being asked to do, particularly for people walking on hard surfaces.

The third is work. Long shifts standing on concrete, in trades, healthcare, retail and hospitality, produce a steadier version of the same overload with no obvious starting event.

And the local favourite: starting a running programme in March. Nothing wrong with it, but the jump in load is usually bigger than it feels.

How we assess and treat it

The assessment separates true plantar fascia pain from the things that imitate it, because the treatments differ. Fat pad irritation sits in the middle of the heel rather than the inside edge. Nerve entrapment produces burning and tingling rather than sharp localised pain. A calcaneal stress fracture hurts when you squeeze the heel from both sides, and it needs imaging, not hands-on work.

We also look above the foot. Ankle dorsiflexion, calf strength and endurance, hip control and your actual gait all feed into how much load the fascia is absorbing.

Treatment runs on two tracks at once:

• Settle the tissue. Active Release Technique and Graston Technique through the plantar fascia and the calf complex, supported by massage therapy where the whole posterior chain is involved.
• Build capacity. This is usually the part that turns it around. Exercise rehabilitation progressing calf and foot loading, typically slow heavy calf raises with the toes extended, advanced over weeks rather than days.

Footwear gets an honest conversation, because it is often the cheapest fix available. Custom orthotics come into it where there is a clear biomechanical driver or where loading work and footwear changes have not been enough on their own. We are deliberately cautious about prescribing them first.

Red flags that need a doctor

Most heel pain is straightforward. Get medical assessment rather than booking with us if you have:

• Heel pain following a specific traumatic injury, such as a fall or a landing from height
• Pain when the heel is squeezed from both sides, which can indicate a stress fracture
• Numbness, burning or pins and needles through the sole, suggesting nerve involvement
• Redness, swelling, heat or fever, which can point to infection
• Night pain that wakes you, or heel pain alongside unexplained weight loss
• Pain in both heels in a younger person, which occasionally signals inflammatory arthritis

When to book

Book when morning heel pain has been going for more than two or three weeks, when it is changing how you walk, or when a season of hiking or running is coming up and you would rather not lose it. Early cases genuinely do resolve faster. The ones that take six months are almost always the ones that were ignored for the first three.