It’s Not Just Running: Why Standing and Walking Matter in Plantar Heel Pain

Plantar heel pain is one of the most common and frustrating injuries we see in runners.

A common pattern looks like this:

You reduce or stop running…but your symptoms don’t improve.

That’s often where confusion sets in.

Because if running is the problem, shouldn’t removing it fix things?

Not necessarily.

Plantar Heel Pain Is a Load-Driven Condition

The key concept to understand is this:

👉 Plantar heel pain is driven by load, not just running

The plantar fascia is a load-bearing structure. It responds to the total amount of stress placed on it over time. That includes running, but also everything else you do on your feet.

This is reflected in the current clinical guidelines and broader tendon research:

• Load management is central to treatment (Koc 2023)

• Symptoms relate to cumulative mechanical stress

So if we only focus on running, we’re missing a big part of the picture.

The Hidden Load: Standing and Walking

When runners stop running, they often unintentionally increase load elsewhere.

More time on your feet at work

More walking during the day

More standing, less sitting

From a tissue perspective, this still counts.

👉 The plantar fascia doesn’t differentiate between running and standing

It just experiences load

Research has consistently identified time on feet and occupational standing as key contributors:

• Prolonged standing is a recognised risk factor (Riddle 2003)

• Activity exposure is associated with symptom persistence (Irving 2006; Beeson 2014)

So while running might be reduced, total daily load often isn’t.

Why Symptoms Persist

This is where many runners get stuck.

They remove running (a high-load activity), but:

• Maintain or increase step count

• Spend long hours standing

• Don’t modify daily habits

The result?

👉 The net load on the plantar fascia stays high

And when load doesn’t reduce, symptoms often don’t settle.

This isn’t a failure of rehab.

It’s a mismatch between load and capacity

A Better Way to Think About It: Total Load

Instead of asking:

“Am I running too much?”

A better question is:

👉 “What is my total daily load?”

This includes:

• Running volume and intensity

• Step count

• Time spent standing

• Changes in routine (work, travel, lifestyle)

Because all of these contribute to what the plantar fascia has to tolerate.

What Should You Do?

If you’re dealing with plantar heel pain, the goal isn’t just to stop running.

It’s to manage load more intelligently across the entire day.

Here are some practical starting points:

1. Track Your Daily Load

• Monitor step count

• Be aware of spikes in activity

• Look at patterns across the week

2. Modify Time on Feet

• Reduce prolonged standing where possible

• Use sitting breaks strategically

• Consider alternating tasks at work

3. Break Up Continuous Load

• Avoid long, uninterrupted periods on your feet

• Short breaks can reduce cumulative stress

4. Progress Gradually

• Whether it’s walking or running

• Avoid sudden increases in total load

The Key Takeaway

👉 Your foot doesn’t care where the load comes from

Running, walking, standing

It all contributes to the total stress placed on the plantar fascia

If that total load exceeds what the tissue can tolerate, symptoms persist.

If you manage it well, symptoms improve.

Want to Go Deeper?

I recently covered this in more detail on the podcast:

🎧 The Rehab Runway – Episode 9: Plantar Heel Pain Explained: Load, Foot Strength & the Truth About Heel Spurshttps://www.healthhp.com.au/the-rehab-runway/episode-9-plantar-heel-pain

References

• Beeson, P. (2014). "Plantar fasciopathy: Revisiting the risk factors." Foot and Ankle Surgery 20(3): 160-165.

• Irving, D. B., et al. (2006). "Factors associated with chronic plantar heel pain: a systematic review." Journal of Science and Medicine in Sport 9(1): 11-22.

• Koc, T. A., et al. (2023). "Heel Pain – Plantar Fasciitis: Revision 2023." Journal of Orthopaedic & Sports Physical Therapy 53(12): CPG1-CPG39. doi:10.2519/jospt.2023.0303

• Riddle, D. L., et al. (2003). "Risk Factors for Plantar Fasciitis: A Matched Case-Control Study." JBJS 85(5): 872-877.