Conditions · Foot
Heel pain that
bites in the morning.
The signature of plantar fasciitis is the first few steps out of bed: a sharp, stabbing pain under the heel that eases as you get moving, then returns after you have been sitting. It is one of the more recognisable presentations in musculoskeletal practice, and one of the most persistent.
It is also one where being straight with you matters. This responds to load management, footwear and time more than it responds to anything done in a treatment room — so what I offer is short-term management alongside those things, not instead of them.
01 · The differential
Heel pain isn't always the fascia.
The first job is establishing whether this is actually plantar fasciitis, because several things produce heel pain and they don't all want the same handling.
The plantar fascia
Worst on the first steps of the morning and after sitting, eases with movement, tender at a specific point under the front of the heel bone. The classic pattern.
The heel's fat pad
More of a deep bruise under the middle of the heel, worse on hard surfaces and barefoot walking, without the pronounced first-step-of-the-morning signature. Commoner with age and after a lot of running on hard ground.
Nerve-related heel pain
Burning, tingling or numbness rather than a sharp point of tenderness, sometimes worse at night. It points somewhere different and is worth identifying rather than treating as fascia that isn't responding.
Referred from further up
How the ankle, knee and hip are working changes what the foot has to absorb. A foot that keeps flaring despite sensible local management is a reason to look up the chain rather than to try harder at the heel.
02 · The honest answer
Chiropractor or podiatrist?
Another question people want answered and few sites will. Podiatrists specialise in the foot, assess gait and footwear in detail, and prescribe orthotics. I do not. If your problem is primarily about foot structure, footwear or an orthotic, they are the right call and I will say so.
What I bring is extremity assessment — foot and ankle joint mechanics, the soft tissue around them, dry needling where it is indicated, and a look at whether the knee and hip above are contributing. As a Certified Chiropractic Extremity Practitioner that is postgraduate training in exactly these joints rather than an extension of spinal work.
The two approaches are not in competition, and plenty of people do best with both.
03 · The management
What I actually do, and what you do.
In clinic, I assess the foot and ankle joints and how they move, work the soft tissue through the fascia and calf, use dry needling where indicated, and treat anything at the knee or hip that is loading the foot badly.
Outside clinic, which honestly matters more: managing how much load goes through it, footwear, and a progressive calf and foot loading programme. This is a condition where the exercises do the heavy lifting and the treatment room makes them tolerable — I would rather you heard that at the start than after six appointments.
It typically takes months rather than weeks. I will give you a realistic picture at the first visit rather than an optimistic one.
04 · The limits
When a podiatrist or doctor leads.
Some heel and foot pain belongs elsewhere, and the sooner that is established the better.
Urgent assessment
Sudden severe pain at the back of the heel with a sense of something giving way, an inability to push off or stand on tiptoe, or heel pain with redness, heat and fever.
Where a podiatrist or specialist leads
Where the problem is primarily footwear, foot structure or orthotic need; where there is a stress fracture in the picture; or where a diabetic foot is involved, which needs specialist oversight rather than manual therapy.
Often connected
Where to see me
Two London clinics, same practitioner at both. A new patient appointment is 45 minutes and includes your first treatment where that’s appropriate.