Plantar Fasciitis and Flat Feet: Understanding the Connection and Treatment Options

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre 

Heel pain is one of the most common foot complaints among active adults. A frequent cause is plantar fasciitis, a condition involving irritation of the plantar fascia (a thick band of connective tissue that runs along the bottom of the foot). People with flat feet (pes planus) may be at increased risk because changes in foot mechanics can place additional stress on the plantar fascia (Morrissey et al., 2021). 

Plantar Fasciitis Symptoms 

Pain is often most noticeable during the first few steps in the morning or after periods of inactivity (Morrissey et al., 2021). 

• Sharp pain on the bottom of the heel 

• Pain with the first steps in the morning 

• Discomfort after prolonged standing or walking 

• Heel pain during or after running and exercise 

• Tightness in the calf or arch of the foot 

  
  

What Are Flat Feet? 

Flat feet occur when the arches of the feet are lower than usual or collapse during standing and walking. Some people are born with flat feet, while others develop them over time. Altered foot mechanics can contribute to stress on structures of the foot and lower extremity (Aiyer et al., 2019).  This is due to less effective force absorption through your feet and makes people more prone to running/jumping injuries.  

Causes and Risk Factors 

Several factors can contribute to plantar fasciitis, including: 

• Flat feet or excessive foot pronation 

• Tight calf muscles or Achilles tendons 

• Running and jumping sports 

• Sudden increases in activity levels 

• Prolonged standing occupations 

• Inadequate footwear 

• Higher body mass index (BMI) 

• Reduced foot and ankle strength (Morrissey et al., 2021; Thomas et al., 2023) 

  
  

A Team-Based Approach to Heel Pain 

At Waterloo Sports Medicine Centre, patients benefit from a collaborative approach that may include physiotherapists, pedorthists, custom orthotic assessments, and shockwave therapy when appropriate. By addressing both symptoms and the underlying causes of plantar heel pain, we help patients return to walking, running, work, and sport with greater confidence and comfort. 

How Long Does Recovery Take? 

Recovery timelines vary from person to person. Many individuals experience improvement within several weeks to a few months when treatment begins early and rehabilitation exercises are performed consistently. Persistent cases may take longer, particularly if symptoms have been present for several months before treatment begins. Continuing aggravating activities without addressing contributing factors can prolong recovery (Morrissey et al., 2021). 

How Can Physiotherapy Help? 

Physiotherapy is considered an important part of conservative treatment for plantar fasciitis and foot-related pain. 

Following a thorough assessment on mobility and strength, treatment may include: 

• Stretching exercises for the plantar fascia and calf muscles 

• Foot and ankle strengthening exercises 

• Activity modification and load management 

• Manual therapy when appropriate 

• Gait (running biomechanics) and movement assessment 

• Footwear education 

• Home treatment recommendations (E.g. rolling a frozen plastic water bottle under your foot) 

• Recommendations regarding orthotics or arch supports when indicated (Morrissey et al., 2021; Thomas et al., 2023) 

  
  

Custom Orthotics and Pedorthic Services 

For some individuals, abnormal foot mechanics, excessive pronation, or flat feet may contribute to ongoing stress on the plantar fascia. In these cases, custom foot orthotics may help reduce strain on the tissues and improve comfort during walking, standing, work, and exercise. 

At Waterloo Sports Medicine Centre, our team works closely with certified pedorthists who specialize in assessing lower-limb biomechanics, footwear, and foot function. Following a comprehensive assessment, custom orthotics may be recommended to help support the foot, improve alignment, and reduce stress on painful structures. 

Shockwave Therapy for Plantar Fasciitis 

Shockwave therapy uses acoustic waves to stimulate healing within injured tissues and has been shown to help reduce pain and improve function in individuals with chronic plantar fasciitis (Morrissey et al., 2021). 

The treatment is non-surgical, does not require injections, and is often used alongside physiotherapy and exercise-based rehabilitation. Many patients are able to continue their normal daily activities throughout treatment.