Many people first notice pain in the heel or sole of the foot, especially when getting out of bed in the morning or when standing up after prolonged sitting.
As the pain worsens, they attend a general clinic and are told they have plantar fasciitis.In the age of the internet, countless “pain‑relief tips” are available online.Many patients try to self‑manage or visit non‑medical pain centres that advertise “advanced devices”. Unfortunately, many end up spending considerable time and money without achieving the relief they expected.
It is easy to assume that pain in the sole simply means the plantar fascia is “overused.” People then follow online suggestions to stretch the calf and foot, alternate ice and heat, or try devices promoted by non‑medical pain clinics.
In reality, the structure under the sole is far from a simple sheet of tissue. The plantar fascia is a very tough, dense fibrous connective tissue (an aponeurosis) lying deep to the fat pad of the sole and directly covering the intrinsic foot muscles. It originates from a prominent bony projection on the underside of the heel and fans forward towards the forefoot, forming multiple bands. These bands have superficial, intermediate and deep layers that attach to the joints of all the toes.
The central portion is the thickest and strongest, whereas the medial and lateral portions are thinner.
Taken together, the plantar fascia behaves like a strong “bowstring” stretched beneath the foot arch. From a biomechanical perspective, it is not merely a passive strap. It helps maintain the shape of the arch, stores elastic energy, elevates the arch, and acts like a spring that loads and releases energy.
More importantly, it forms the starting point of the body’s posterior kinetic chain, influencing the biomechanics and muscular function of the calf, knee and even the lower back, and can therefore contribute to symptoms in other regions.
In clinical physical therapy, treatment should therefore be guided by the anatomy of the plantar fascia and its biomechanical role.
Most non‑medical pain centres focus only on numbing the painful area, teach patients to roll a small ball under the foot as a “massage,” then prescribe a few stretching exercises. At best, they may add an insole for temporary comfort.
At Omnicare Pain Centre, my physical therapy approach is more comprehensive and grounded in this anatomical and biomechanical understanding. Using professional physical therapy techniques – including manual therapy – I do not simply chase the painful spot.
Instead, I treat the entire foot, applying specific manual techniques to each foot joint and the surrounding soft tissues. By using a combination of physiological and non‑physiological joint mobilisations, the painful areas can be relieved in a more thorough way.
I then assess the patient’s posture and movement, and guide targeted training of the trunk muscles and all relevant muscles along the posterior kinetic chain.
This helps provide longer‑term pain reduction and, importantly, improves overall quality of life and work performance.
Physiotherapist
Li Lai Shan
