For the most common pattern, sharp pain under the heel with the first steps in the morning, a physical therapist is a sensible first visit: stretching, strengthening, footwear and load advice are the core of guideline care, and in Indiana you can start without a referral. See a podiatrist first if you have diabetes or poor circulation, a wound or numbness in the foot, swelling after a fall, or you are already months into treatment and weighing injections, custom orthotics or surgery. Many people end up seeing both.
Last reviewed By the Monon Therapy Collective editorial team
What is the difference between a podiatrist and a physical therapist?
A podiatrist is a doctor of podiatric medicine (DPM) who diagnoses and treats the foot and ankle medically and surgically: ordering imaging, injecting, prescribing medication, casting custom orthotics and operating. A physical therapist is a movement specialist who treats with exercise, manual therapy, load management and education, and does not inject, prescribe or operate.
Both can examine your heel and both can tell plantar fasciitis from the conditions that mimic it. The difference is the toolbox. Heel pain that comes from how much and how fast you load the foot responds mostly to the therapist’s tools; heel pain with a medical driver, such as a stress fracture, an infection or diabetic foot changes, needs the podiatrist’s.
Which heel pain is a good fit for physical therapy first?
Pain under the front of the heel that is worst with the first steps after sleep or sitting, eases as you walk, and returns after long days on your feet is the classic plantar heel pain pattern, and it is a good fit for therapy first. The American Academy of Orthopaedic Surgeons notes that more than 90 percent of people with plantar fasciitis improve within 10 months of simple treatment.
A therapist works on calf and plantar fascia flexibility, progressive strengthening of the foot and calf, and the training error behind it, which for many Carmel runners is a sudden jump in Monon Trail mileage before the Carmel Marathon in April. Pain at the back of the heel is a different problem, usually the Achilles insertion; see Achilles tendinitis physical therapy for that pattern.
APTA’s ChoosePT guide to plantar fasciitis lists what a therapist typically uses: a program to improve the flexibility of the ankle and plantar fascia, strengthening for the muscles that support the arch, taping of the foot for pain relief, advice on orthotics and supportive footwear, a night splint where morning pain dominates, and an assessment of how you walk. The Academy of Orthopaedic Physical Therapy revised its heel pain practice guideline in 2023 along the same lines. Expect a short series of visits and a home routine you do most days, rather than a long block of passive treatment.
When should a podiatrist see your heel before anyone else?
See a podiatrist or physician first when the foot has a medical complication that exercise cannot address, or when the pain pattern does not look mechanical. Diabetes in particular changes the risk: reduced sensation means small injuries and pressure points can go unnoticed, so foot problems in people with diabetes deserve medical eyes early.
- Diabetes, peripheral artery disease or numbness in the foot
- An open sore, redness and warmth, or fever with foot pain
- Heel pain after a fall or jump, with swelling and pain on squeezing the heel bone
- Pain at rest and at night that does not change with activity
- Burning, tingling or shooting pain into the arch, which can point to tarsal tunnel syndrome
Do I need custom orthotics or will store-bought inserts do?
Most people with plantar heel pain do well with prefabricated arch supports or heel cups, which are cheaper and quicker than custom orthotics; custom devices are usually reserved for people who have not improved or who have a marked structural foot difference. Orthotics are a support while the tissue settles, not the treatment on their own.
This is a common point where the two professions overlap. A podiatrist can cast and prescribe custom orthotics; a physical therapist can recommend off-the-shelf options and taping to test whether support helps before you spend more. The answer page on orthotics for plantar fasciitis goes further.
How do a podiatrist and a physical therapist work together on stubborn heel pain?
When heel pain lingers past a few months, the two often share the case: the podiatrist confirms the diagnosis, may image the foot and considers options such as a night splint, a walking boot or an injection, while the therapist keeps loading and strengthening the foot so it can tolerate daily life. AAOS describes surgery as generally saved for people who have not improved after 12 months of nonsurgical treatment.
Indiana law lists podiatrists among the providers who can refer to physical therapy, which matters if your care runs past the 42-day direct access window. If you want to start with the therapist side, the plantar fasciitis physical therapy page explains the first visit, and the two-minute questionnaire starts the match.
Related questions
Is a heel spur the cause of my heel pain?
Often not. AAOS notes that most people with heel spurs on an X-ray have no heel pain, and plantar fasciitis can be treated without removing a spur.
Can a physical therapist give a cortisone shot for heel pain?
No. Injections are given by physicians and podiatrists. A therapist can tell you whether your progress suggests that conversation is worth having.
How many physical therapy visits does plantar fasciitis usually take?
It varies, but many plans use a handful of visits spread over several weeks, with most of the work done at home between them. Your therapist sets the frequency after the evaluation.
Can I keep running with heel pain while I wait to be seen?
Often yes, at a reduced distance and on softer routes, if the pain stays mild during the run and settles by the next morning. Stop if you are limping or the morning pain is getting worse.
Do I need an X-ray before seeing anyone for heel pain?
Not usually for the typical morning-pain pattern, which is diagnosed by history and examination. Imaging becomes more useful after a fall, with suspected stress fracture, or when months of treatment have not helped.
Keep reading
- How long does plantar fasciitis last?
- Do I need orthotics for plantar fasciitis?
- When should I see a physical therapist?
- Plantar fasciitis physical therapy in Carmel
- Heel pain in the morning: likely causes
- Running injury physical therapy
Sources
This page is general education, not medical advice. A physical therapist can only advise on your situation after an examination.
