Plantar Fasciitis: Effective Treatment Options and the Role of Hyaluronic Acid Injections
- Daniel Taylor
- May 11
- 5 min read
Updated: Jul 6
Plantar fasciitis is a common condition characterised by pain in the heel which can sometimes radiate into the arch of the foot. Some people also know this as policeman's heel. The pain can vary significantly from person to person. Many people describe sharp pain with their first few steps in the morning or after long periods of rest. Symptoms are often aggravated by prolonged walking, running or standing for long periods. In severe cases patients often describe "plantar fasciitis so bad I can't walk"
In mild cases, symptoms will often resolve with simple conservative measures such as stretching exercises, icing, anti-inflammatory gels and supportive insoles. Activity modification and appropriate footwear can also play an important role in reducing symptoms and improving recovery.
Footwear for Plantar Fasciitis
Footwear can play a very important role in the management of plantar fasciitis. Wearing supportive shoes and appropriate orthotic insoles can help reduce strain through the plantar fascia and improve the overall mechanics of the foot during walking and standing.
I often recommend using insoles designed to provide additional arch support and improved pressure distribution across the sole of the foot. These insoles also contain additional cushioning around the heel region, which helps offload pressure from the painful area and can make day-to-day activities more comfortable.
Below are two insoles that I commonly recommend for patients suffering with plantar fasciitis:
Exercises
Exercises for plantar fasciitis (sometimes referred to as “policeman’s heel”) are primarily focused on stretching the calf muscles and the plantar fascia itself. Tightness within the calf complex can increase tension through the plantar fascia and contribute to ongoing heel pain.
Commonly recommended exercises include calf stretches against the wall, towel stretches for the sole of the foot and gentle plantar fascia stretching exercises. In addition, light calf raises can help maintain strength within the foot and lower leg, which may help improve load tolerance and reduce irritation over time.
Research has shown that stretching programmes targeting both the plantar fascia and calf muscles can help improve pain and function in patients with plantar fasciitis. Strengthening exercises are also increasingly recommended as part of modern rehabilitation programmes.
Icing and Pain Relief
We recommend icing the foot daily to help settle pain and irritation. This can be performed using an ice pack, cooling gel or by placing a bottle of water in the freezer and gently rolling it underneath the foot for approximately 5–10 minutes per day.
This technique may help reduce inflammation, calm sensitivity around the surrounding soft tissues and provide short-term pain relief. Ice massage and frozen bottle rolling are commonly used conservative treatments for plantar fasciitis and are widely recommended alongside stretching exercises.
Self-Massage and Soft Tissue Care
Self-massage techniques can also be beneficial in managing plantar fascia pain. We often recommend using heat gels, ice gels or anti-inflammatory gels and massaging these into the heel and arch of the foot approximately 2–3 times per day for around 3–5 minutes at a time.
Soft tissue massage may help improve circulation, reduce local sensitivity and ease tightness within the plantar fascia and surrounding muscles. Combining massage techniques with stretching and appropriate footwear often provides the best results for long-term symptom management.
At Elite Joint Solutions, we take a comprehensive approach to treating plantar fasciitis. Rather than simply treating the painful heel, we aim to identify why the condition has developed and address the underlying causes.
Biomechanical Assessment
Every patient undergoes a detailed biomechanical assessment. This includes analysing the way you stand, walk and move, as well as assessing the mechanics of your foot, ankle, knee and lower limb.
We commonly assess:
Foot posture and arch height
Excessive pronation or supination
Ankle flexibility and movement
Walking and gait mechanics
Identifying these contributing factors allows us to tailor treatment specifically to your needs rather than providing a "one-size-fits-all" programme.
Bespoke Insoles
One of the treatments we frequently use is the prescription and modification of supportive orthotic insoles.
Unlike purchasing an insole straight from the shelf, we will often modify and adapt the orthosis to better match your foot shape and biomechanics. This enables us to provide improved support to the medial arch, redistribute pressure away from the painful heel and plantar fascia, and improve the overall alignment of the foot during walking.
Many patients notice that appropriately fitted orthotics reduce pain during standing and walking whilst allowing them to remain more active throughout their recovery.
Hands-On Manual Therapy
Our physiotherapy treatment also includes hands-on manual therapy where appropriate.
This may include:
Soft tissue massage to the plantar fascia and calf muscles
Deep friction massage to areas of persistent tissue thickening and tenderness
Trigger point release techniques
Myofascial release
Joint mobilisation techniques to improve movement within the ankle, subtalar and midfoot joints
These techniques aim to improve tissue mobility, reduce pain, restore normal joint movement and make stretching and strengthening exercises more comfortable and effective.
Individualised Rehabilitation
Once pain begins to settle, we gradually progress your rehabilitation programme.
This may include:
Progressive calf strengthening
Foot intrinsic muscle exercises
Balance and proprioception training
Walking and running advice
Return-to-sport programmes where appropriate
Our goal is not simply to reduce your pain but to address the factors that contributed to the condition and reduce the risk of it returning.
Our Unique Combined Approach
One aspect that makes Elite Joint Solutions different from many clinics is our combined treatment approach.
Rather than relying on exercises alone, we combine:
✔️ Advanced biomechanical assessment
✔️ Bespoke orthotic prescription and modification
✔️ Hands-on physiotherapy
✔️ Joint mobilisation techniques
✔️ Exercise rehabilitation
✔️ Acupuncture where appropriate
✔️ Hyaluronic acid injections for persistent cases
This allows us to tailor treatment to each individual patient and often helps people recover more quickly than using a single treatment approach alone.
However, in more severe or persistent cases, more advanced treatments may need to be considered. Historically, clinicians have been cautious with injection therapy around the plantar fascia because the most commonly used injection — corticosteroid (steroid) injections — can carry risks, particularly damage to the surrounding soft tissues and weakening of the fascia itself. Therefore, this type of injection is not seen as a 1st line of treatment.
Over recent years, alternative injection therapies have been developed. At Elite Joint Solutions, we offer hyaluronic acid injections for plantar fasciitis. This type of injection is considered a safer alternative as it does not carry the same risk of soft tissue damage associated with steroid injections.
For this reason, we commonly use hyaluronic acid injections as a first-line injection treatment for plantar fasciitis. This can often be more cost-effective and time-efficient compared to multiple sessions of physiotherapy or shockwave therapy, as only one appointment is usually required to perform the procedure. Current evidence suggests that symptoms often begin to improve within 4–6 weeks following the injection.
If you would like to discuss this treatment in more detail, please contact us via our website: Elite Joint Solutions | Physiotherapy, Injections & Pain Management in Bristol
References
Martin RL, Davenport TE, Reischl SF, et al. Heel Pain—Plantar Fasciitis Revision 2023 Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy. 2023.
National Institute for Health and Care Excellence. Plantar heel pain and musculoskeletal conditions guidance.
American Physical Therapy Association. Heel Pain—Plantar Fasciitis.
Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses for plantar fasciitis: systematic reviews and randomised controlled trials.
Rasenberg N, et al. Effectiveness of foot orthoses for plantar heel pain: systematic review and meta-analysis. British Journal of Sports Medicine. 2018.
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