This is mistakenly considered the most common cause of heel pain, when, in actuality, based on a review of approximately 50,000 heel pain cases presenting to the office, it represents less than 10 percent of the cases. When it occurs, it is marked by increased bottom heel pain primarily after the patient has been on his/her foot for an increased amount of time as the day progresses. It is easily fixed by any kind of increased support to the foot. Over-the-counter foot supports may work, but severe unresponsive cases to home therapy may require custom Root Functional Orthoses, developed after a podiatrist performs a bio mechanical exam, to determine the inherited cause by measurement of the patient's abnormal foot structure. Oral pain medication or injection therapy is rarely necessary. It is generally just a question of support.

The cause is increased strain to the plantar fascia, a thick fibrous band of tissue connecting the heel to the forefoot, which serves several functional as well as protective purposes.

Sometimes, from increased physical activity or trauma, the fibrous band can develop tears, and may require more aggressive therapy. These are the rarest cases.