Heel Pain That Will Not Go Away? Here Is When to Get Help
Plantar Fasciitis: When Is It Time to See a Physio?
That sharp stab under your heel the moment your foot hits the floor in the morning is one of the most miserable ways to start the day. Some plantar fasciitis settles with a few weeks of self management. A lot of it does not, and the longer it drags on, the harder it is to fix. Here is exactly when to book in with our physio team at PHYZFIT Bexley North and Marrickville.
Short Answer
Try 4 to 6 weeks of proper self management first: calf and foot stretching, load modification, supportive footwear and gradual return to activity. Book a physio if your heel pain has lasted more than 6 weeks with no improvement, if it is affecting your walking or running, if the first step morning pain is getting worse, or if you already have known risk factors like flat feet, high arches or a job that keeps you on your feet all day. Early physio treatment typically settles plantar fasciitis in 6 to 12 weeks; chronic cases can take 6 to 12 months.
Below we walk you through what plantar fasciitis actually is, what to try first, and the clear signals it is time to book in with a physio.
What is plantar fasciitis?
The plantar fascia is a thick band of connective tissue that runs along the underside of your foot from the heel bone to the base of your toes. It supports the arch and stores elastic energy every step you take.
Contrary to the name, most plantar fasciitis is not primarily inflammatory. It is more accurately described as a plantar fasciopathy, where the fascia undergoes degenerative changes from repeated overload. It is one of the most common causes of heel pain in adults, affecting around 10 percent of people at some point in their life.
The classic story is sharp pain under the heel with the first steps out of bed in the morning, which eases after a few minutes of walking but returns after long standing, walking or exercise.
What does plantar fasciitis feel like?
- Sharp, stabbing pain under the inside of the heel, sometimes spreading into the arch
- First step morning pain that is often severe for the first few steps, then eases
- Pain returning after sitting for a while, then taking the first steps again
- Worse after long walks, standing, running or jumping
- Sometimes tender to press right on the inside of the heel bone
- Rarely swollen or red (if it is red and hot, think other causes)
What to try first at home
If your heel pain is mild and has only been around a few days or a couple of weeks, start with these steps. Give the program at least 4 to 6 weeks before deciding it is not working:
- Calf stretching. Straight knee and bent knee calf stretch on a step or against a wall. 3 x 30 second holds, 3 times a day.
- Plantar fascia specific stretching. Cross the affected foot over the other knee. Pull the toes back gently. Hold 20 seconds. 10 reps, 3 times a day. Do this before your first steps in the morning.
- Roll a frozen water bottle under your arch for 5 to 10 minutes after activity or at the end of the day.
- Supportive footwear. Wear supportive shoes as much as possible, including around the house. Avoid barefoot walking on hard floors while it is sore.
- Reduce load. Cut running mileage by 30 to 50 percent. Add cycling or swimming for cardio.
- Progressive calf raises. Start with double leg heel raises. Progress to single leg. 3 sets of 10 to 12, every second day.
- Off the shelf heel cups or arch supports can help take the load off the fascia while it settles.
When is it time to see a physio?
These are the clear signals it is time to book in:
Pain lasting over 6 weeks
You have followed a proper self management routine for 4 to 6 weeks and the heel pain has not meaningfully improved. Early treatment prevents chronic plantar fasciopathy that takes many months to fix.
Getting worse, not better
Pain is escalating despite reducing load and stretching. This often means the fascia is not tolerating even reduced load and needs a proper rehab plan.
Affecting your walking or running
You are limping, altering your gait, avoiding stairs or unable to run. Waiting it out often creates secondary knee, hip or back issues from the compensation.
Morning pain not easing
The first step morning pain used to settle after 5 to 10 minutes and now lasts most of the day. That is a sign the fascia is significantly irritated.
Both feet affected
Bilateral heel pain often points to systemic contributors (footwear, gait, load, sometimes inflammatory conditions) that need proper assessment.
Symptoms over 3 months
Anything past 3 months is chronic plantar fasciopathy. It responds much slower and often needs shockwave, targeted loading and gait retraining.
Known risk factors
If you have flat feet, high arches, a job that keeps you on your feet, recent significant weight change or you run high mileage, an early physio assessment is worth it even in the first few weeks.
Numbness, tingling or spreading pain
These are not typical plantar fasciitis features. They could indicate a nerve entrapment (tarsal tunnel) or referred pain from the spine and need proper diagnosis.
Not sure if it is time to book?
Give us a call and our reception team can guide you.
What does a physio actually do for plantar fasciitis?
Our physio team (Julian De Rosa, Ari Moushis and Sam Nunan) uses a structured evidence based approach:
- Accurate diagnosis. Ruling out other causes of heel pain like calcaneal stress fracture, fat pad contusion, tarsal tunnel syndrome, referred pain from the lumbar spine or inflammatory conditions.
- Loading program. A specific high load strengthening program (Rathleff protocol style heel raises with a towel under the toes) that outperforms stretching alone.
- Hands on treatment. Soft tissue release of the calf, foot and plantar fascia to unload the tissue.
- Dry needling for calf and foot trigger points contributing to the load.
- Shockwave therapy for stubborn chronic cases that have not responded to loading.
- Footwear and orthotic assessment. Recommendations on shoes, off the shelf orthotics, or referral for custom orthotics if needed.
- Gait retraining for runners with contributing biomechanics.
- Load management planning so you can return to running, walking or your sport without flaring up.
Red flags to seek urgent review for heel pain
⚠ See your GP or an Emergency Department if you have
- Heel pain following a fall or specific injury with sudden severe pain and inability to weight bear (possible calcaneal fracture)
- Redness, heat and swelling of the heel or foot with fever (possible infection)
- Sudden numbness, spreading pins and needles or foot weakness
- Bilateral heel pain in a young adult with morning stiffness lasting hours (possible inflammatory arthropathy)
- Heel pain in a runner that has escalated rapidly over days (possible calcaneal stress fracture)
How long does plantar fasciitis take to settle?
- Early stage (under 6 weeks): 4 to 8 weeks of self management often enough
- Moderate (6 weeks to 3 months): 8 to 12 weeks of structured rehab
- Chronic (over 3 months): 3 to 12 months, often needing shockwave and structured loading
- Very chronic (over 12 months): longer, sometimes with specialist review or extracorporeal shockwave
The earlier you address it, the faster and easier it fixes. That is the whole point of knowing when to book in.
We support patients across Bexley, Kingsgrove, Beverly Hills, Bardwell Park, Earlwood, Rockdale, Kogarah and Hurstville from Bexley North, and Marrickville, Newtown, Enmore, Dulwich Hill and Petersham from Marrickville.
Frequently asked questions about plantar fasciitis
Not usually. Plantar fasciitis is diagnosed clinically. Imaging is considered if there is suspicion of a stress fracture, if the presentation is unusual, or if pain has not responded to 3 months of quality rehab.
Usually you can keep running at reduced volume as long as pain stays under 3 out of 10 and morning stiffness is not worsening. Cutting volume by 30 to 50 percent and building strength usually works better than full rest.
Not always. Off the shelf heel cups and arch supports work well for many patients. Custom orthotics are considered if there is a specific foot alignment issue or if simpler options have not helped.
They can help short term but come with risks including fat pad atrophy and (rarely) plantar fascia rupture. Generally used only in severe cases that have not responded to conservative care.
Yes, for chronic plantar fasciopathy (over 3 months) that has not responded to loading. Best combined with continued loading and load management, not as a standalone.
Yes. Medicare covers 5 sessions per year under a Chronic Disease Management plan. Private health Extras rebates through HICAPS on the day. Workers Compensation, CTP and NDIS (plan managed and self managed only) are all accepted.
Ready for Us to Help You With Your Pain?
If your heel pain is dragging on, book a physiotherapy assessment at PHYZFIT Bexley North or Marrickville with Ari Moushis, Sam Nunan or Julian De Rosa. The earlier we assess it, the faster it settles.
📍 20 Shaw Street, Bexley North 2207
📍 4 Carrington Road, Marrickville 2204 (inside World Gym)
✉ admin@phyzfit.com.au
PHYZFIT Health and Rehab | Bexley North and Marrickville, Sydney | Helping you rebuild trust in your body and live a life without limits.