The plantar fascia is a band of fibrous tissue running from the heel to the base of the toes, supporting the arch of the foot as you load it. When it is overloaded it becomes irritated where it attaches to the heel, and that produces the characteristic pain: the first steps out of bed hurt a great deal, it eases after walking for a while, and it returns on standing up after sitting.
It rarely has a single cause. Usually several things add up: a recent increase in activity, footwear with no support or badly worn, a change of surface, extra weight, or a way of loading the foot that makes the fascia work harder than it should. That is why the approach starts by working out which of those is pulling on the heel in your case, rather than treating the heel on its own.
What is examined and what is done
- The exact location of the pain and the times of day it appears.
- Examination of the fascia, the Achilles tendon and ankle mobility.
- Assessment of loading and walking, to see what is overloading the fascia.
- Review of footwear and of activity over recent weeks.
- Offloading measures and, where appropriate, insoles to redistribute the tension.
Does your heel hurt when you first put your foot on the floor in the morning?
Book an appointmentFrequently asked questions
- Why does the first step in the morning hurt most?
- Because while you sleep the foot is at rest and the fascia shortens and stays still. Overnight the tissue tries to repair itself in that shortened position, and when you get up the first step stretches it abruptly: that is what hurts. After a few steps the tissue regains elasticity and the discomfort eases, which is why it improves once you have been walking a while. The same happens when you stand up after sitting for a good stretch. That the pain follows this pattern is useful information, not a detail: it is what most guides the diagnosis, so notice when it appears and mention it at the appointment.
- Do I have to stop exercising?
- Almost never completely, and stopping dead is usually not the best idea either: the tissue needs load to recover — what it does not tolerate is the load that is irritating it. So the usual approach is to adjust rather than suspend: reduce volume or intensity, temporarily change the surface or swap to an activity that loads the heel less, and offload the area while the cause is addressed. What is worth avoiding is training through pain and compensating by changing how you land, because a second problem then appears somewhere else. The decision is made at the appointment with your details: what you do, how much, and what changed just before.
- Do the stretches and ball massages you see online help?
- They can help, and they can also change nothing: it depends on what is pulling on your heel. If what is tight is the Achilles tendon and the calf muscles, working there usually shows; if the problem is how load is distributed when you step, stretching the sole will not solve it however often you repeat it. So the first thing is to know what is tight and what is not, which is a five-minute examination. And one specific warning: rolling hard over a point that is already irritated can make it worse, especially daily and through pain. If something hurts while you are doing it, that does not mean you are not doing enough of it.
