Plantar Fasciitis

Almost certainly the fascia, not the spur. Heel spurs (bony prominences at the fascia's attachment point) are present in about 50% of people with plantar fasciitis, but they're also found in roughly 15% of people with no heel pain at all. The spur is a response to chronic tensile stress at the bone, not the primary pain generator. Treating the spur surgically doesn't consistently resolve pain; treating the fascial load and Achilles-calf complex does.

During sleep and rest, the plantar fascia shortens and tightens. Your first steps rapidly apply full body weight, forcefully stretching already-contracted tissue — the micro-trauma at the attachment site creates that characteristic stabbing pain. As you walk around, the fascia warms up, stretches out, and pain eases. Later in the day, after prolonged standing or walking, fatigue and cumulative load bring the pain back. This warm-up-and-return pattern is nearly pathognomonic for plantar fasciitis.

For most people, a quality over-the-counter semi-rigid insole with good arch support and heel cushioning works as well as a custom orthotic in the short and medium term. A 2003 Cochrane review and subsequent trials found no significant difference in outcomes between prefabricated and custom orthotics for plantar heel pain. Custom orthotics may add value in cases of significant structural foot deformity or when simpler interventions have failed, but they're not the automatic first choice and the research supports trying OTC options first.

Often yes, with modifications. The goal is keeping load below the threshold that provokes or worsens pain. Switching to lower-impact activities (cycling, swimming, elliptical) temporarily reduces fascial stress while maintaining fitness. If you continue running, cushioned shoes, a softer surface, and reducing mileage by 30 to 50% are practical starting points. Wearing supportive footwear immediately on waking — rather than walking barefoot on hard floors first thing in the morning — is one of the most consistently helpful modifications patients report.

Extracorporeal shockwave therapy delivers acoustic pressure waves to the affected tissue, which appears to stimulate neovascularization (new blood vessel formation) and restart a healing response in degenerative tissue that has stalled. It's FDA-cleared for plantar fasciitis and has consistent support across multiple randomized trials — typically showing meaningful pain reduction in 60 to 80% of chronic cases that haven't responded to 3 to 6 months of conservative care. It's not a first-line treatment, but for cases that have plateaued, it's one of the more evidence-backed options available.