Heel pain that is worst on the first steps of the morning. It is common and stubborn. It can usually be treated without surgery.
What is plantar fasciitis?
The plantar fascia is a thick band running along the sole of the foot. Repeated loading causes degeneration (the tissue breaking down) where it attaches to the heel.
It is also worth ruling out a trapped nerve (nerve entrapment). If there is numbness, also rule out a peripheral neuropathy.
What does plantar fasciitis feel like?
- Sharp heel pain on the first steps out of bed.
- Eases after a few minutes of walking, returns after sitting.
- Sore to press at the inside front of the heel.
- Worse after long periods of standing.
How is plantar fasciitis treated?
- An exam that tells fascia pain apart from nerve entrapment.
- Ultrasound-guided injection when conservative (non-surgical) care fails.
- Physical therapy. Specific loading programs work well here.
- Advice on shoes and shoe inserts (orthotics).
To get checked, call us or request an appointment.
What usually gets missed
Heel spurs are the classic red herring. They show up in many feet with no pain. Whether an X-ray shows one or not has almost nothing to do with treatment.
The key other diagnosis is nerve entrapment of Baxter’s nerve. It looks similar, but the pain burns instead of being sharp, and there is often numbness. When feeling in the foot has changed, a peripheral neuropathy also needs to be ruled out.
How long does plantar fasciitis take to heal?
The large majority of cases clear up within a year with rehab built on loading the tissue. Specific calf and plantar fascia loading programs beat passive treatment.
It is truly slow, and that is the hardest part for patients. Corticosteroid injection gives short-term relief. It also carries a small risk of tearing the fascia. So we use it only in select cases, not as routine.
When this becomes urgent
Heel pain with fever, redness or swelling needs urgent assessment. A sudden pop with instant severe pain and being unable to push off suggests fascial or Achilles rupture. That needs a prompt check. Numbness or burning in the foot points to a nerve problem rather than the fascia.
Why it happens
The plantar fascia is a thick band running from the heel to the toes. In most chronic cases the problem is degenerative (tissue breaking down) rather than inflammatory. The tissue has failed to rebuild under repeated load. The classic story is pain in the first few steps in the morning. It eases after several minutes and returns after long standing. That happens because the fascia tightens overnight and is then loaded suddenly.
What gets mistaken for plantar fasciitis?
Heel spurs often get blamed, but they are usually a side finding. Many people with spurs have no pain, and many with pain have no spur. If heel pain comes with numbness or burning, think about nerve entrapment instead. If it is worse at rest rather than on the first steps, a stress fracture should be ruled out.
Working with your other clinicians
If you already have a primary doctor, surgeon or therapist, our aim is to add a diagnosis, not a competing plan. Our findings and reasoning go back to whoever referred you or manages your care. If the answer is that no procedure is needed, we say that just as clearly.
Common questions
Is the heel spur causing this?
Usually not. Spurs are common in people with no heel pain at all. Treatment targets the fascia and the loading, not the spur.
Why is it worst first thing in the morning?
The fascia shortens overnight and gets loaded all at once when you stand. That pattern is distinct enough to make the diagnosis.
How can I get rid of plantar fasciitis?
Most people get rid of it without surgery. The core of treatment is a specific loading program for the calf and the plantar fascia. It does better than passive treatment. Add advice on shoes and orthotics. It is slow, and the large majority settle within a year. An ultrasound-guided injection is used only in select cases when conservative care fails, because steroid carries a small risk of fascial rupture.
What causes plantar fasciitis to flare up?
Load is the trigger. Pain flares on the first steps out of bed, after sitting, and after long periods of standing, because the fascia tightens at rest and is then loaded suddenly. Heel pain that is worse at rest rather than on the first steps does not fit this pattern. A stress fracture should be ruled out.
Is walking good for plantar fasciitis?
Walking is not the enemy. The pain usually eases after a few minutes of walking and returns after sitting or long standing. Recovery comes from loading the tissue on purpose. Specific calf and plantar fascia loading programs beat passive treatment. Physical therapy sets that program, and footwear advice keeps daily standing from undoing it.
Related: a deep ache in the front of the ankle after standing, rather than pain under the heel, points to ankle arthritis.
Sources
- Morrissey D et al. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British journal of sports medicine, 2021. PubMed 33785535
- Huffer D et al. Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 2017. PubMed 27692740
- Charles R et al. The effectiveness of shockwave therapy on patellar tendinopathy, Achilles tendinopathy, and plantar fasciitis: a systematic review and meta-analysis. Frontiers in immunology, 2023. PubMed 37662911
- Noriega DC et al. Plantar Fasciitis in Soccer Players-A Systemic Review. International journal of environmental research and public health, 2022. PubMed 36361304
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