Heel pain on your first steps in the morning: plantar fasciitis
Sharp heel pain with the first steps after getting out of bed in the morning is most often due to plantar fasciitis. In most people it settles with exercise and by adjusting the load on the foot.
The plantar fascia is a thick band of connective tissue that runs from the heel bone to the toes and supports the arch of the foot. Pain that develops where this tissue attaches to the heel is called plantar fasciitis. It is one of the most common causes of heel pain.
Typical symptoms
- Sharp, stabbing pain on the inner underside of the heel with the first steps after getting out of bed in the morning or after sitting for a long time
- Pain that eases after walking for a few minutes and increases again at the end of the day or after standing for a long time
- Tenderness when pressing on the inner underside of the heel
Who gets it more often?
It is more common in people who work on their feet for long periods, those who do sports that put repeated load on the feet such as running, people who are overweight and those with tight calf muscles. It can appear when load increases suddenly, for example when starting a new job or an intensive training period.
Is it a heel spur?
A heel spur (a bony projection) seen on an X-ray is also present in many people who have no pain. This is why the cause of the pain is often not the spur itself but overloading of the fascia; the diagnosis, too, is made largely through examination.
Treatment
In most people, symptoms decrease markedly within a few months without the need for surgery. Approaches with strong evidence include:
- Regular stretching exercises for the plantar fascia and calf muscles
- Exercises that strengthen the foot and ankle muscles
- Manual therapy delivered by a physiotherapist
- Dry needling of trigger points in the calf and sole muscles
- Taping to reduce pain in the short term
- A night splint for 1–3 months if morning pain is marked
- Suitable insoles used together with other treatments
- Temporarily adjusting load: moving at a level that does not increase pain, rather than resting completely
If symptoms do not settle despite a few months of regular treatment, options such as shockwave therapy (ESWT) or an injection can be considered together with the doctor.
When should you be seen straight away?
If the pain started after an injury, if there is marked swelling, redness or warmth in the heel, if it is accompanied by numbness or tingling in the foot, or if the pain continues at night while you are resting, get examined without delay.
Treatments at our clinic: ESWT · Shockwave therapy · Dry needling
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