By: Devin Blessing, PT, DPT, OCS
Plantar heel pain is a common complaint among runners, often sidelining even the most dedicated athletes. While plantar fasciitis is the most frequently diagnosed cause, several other conditions can mimic its symptoms. Fortunately, physical therapy offers a highly effective, evidence-based approach to resolving plantar heel pain and preventing its recurrence.
What is Plantar Heel Pain?
Plantar heel pain refers to discomfort located at the bottom of the heel, most noticeable during the first few steps in the morning or after prolonged rest. In runners, this pain is usually due to overuse and biomechanical stress.
Common Causes of Heel Pain in Runners
The most common cause is plantar fasciitis, an inflammation or degeneration of the plantar fascia—a thick band of connective tissue that supports the arch of your foot. However, other potential causes (differential diagnoses) include:
- Heel fat pad syndrome – Pain due to thinning or displacement of the fat pad beneath the heel.
- Tarsal tunnel syndrome – Nerve entrapment causing radiating pain or numbness.
- Calcaneal stress fracture – A hairline fracture in the heel bone from repetitive impact.
- Achilles tendinopathy – Though slightly higher up the heel, it can mimic plantar pain.
- Baxter’s nerve entrapment – A less common but underdiagnosed cause of chronic heel pain.
A skilled physical therapist will perform a detailed assessment to differentiate between these conditions and tailor a treatment plan accordingly.
Physical Therapy Treatment for Plantar Fasciitis and Heel Pain
Physical therapy for plantar heel pain goes far beyond rest and ice. A comprehensive rehab plan will address pain relief, improve mobility, and correct faulty mechanics that contribute to symptoms.
1. Manual Therapy
Hands-on techniques to mobilize the plantar fascia, calf muscles, and surrounding tissues can improve flexibility and reduce pain. Joint mobilization of the ankle or subtalar joint may also enhance foot biomechanics.
2. Stretching and Strengthening
Targeted stretches for the plantar fascia, gastrocnemius, and soleus muscles are essential. Strengthening exercises focus on intrinsic foot muscles, posterior chain, and core stability, all of which contribute to proper foot mechanics during running.
Gastrocnemius Stretch:
Toe Yoga:
Single Leg Calf Raise:
Single Leg RDL:
3. Gait and Running Analysis
A video gait analysis can reveal underlying issues such as overpronation, poor cadence, or heel striking, allowing therapists to provide personalized feedback and correction strategies.
4. Taping and Orthotics
Low-dye taping or custom orthotics may be used to offload stress on the plantar fascia during recovery, especially for those with flat feet or high arches.
Prevention Strategies for Runners
Once symptoms subside, prevention becomes the priority. Key strategies include:
- Gradually increasing mileage
- Rotating running shoes regularly
- Incorporating cross-training and strength work
- Running on varied surfaces to reduce repetitive strain
When to See a Physical Therapist
If you’re experiencing persistent heel pain that doesn’t improve with rest, a visit to a physical therapist can fast-track your recovery. Early intervention not only speeds healing but also minimizes the risk of chronic pain or compensatory injuries.
In conclusion, plantar heel pain, including plantar fasciitis, doesn’t have to keep runners on the sidelines. With a focused physical therapy program tailored to your needs and biomechanics, you can return to the road feeling stronger and pain-free. Don’t ignore your heels—treat them right, and they’ll carry you many more miles. Request an appointment with one of our running specialist physical therapists today to get started!
