Most heel pain responds well to simple treatments.
Jeffrey R. King, DPM, podiatrist at Mt. Ascutney Hospital and Health Center.When you get out of bed in the morning, you might feel a sudden, stabbing pain in your heel, almost like stepping on a Lego.
Those first few uncomfortable steps are a classic sign of plantar fasciitis, the most common cause of heel pain.
“People often describe the feeling as a burning or sharp pain,” says Frances D. Faro, MD, an orthopaedic surgeon at Dartmouth Hitchcock Medical Center.
Even though plantar fasciitis is often thought of as a runner’s injury, it can affect almost anyone.
Spending long hours on your feet, changing your activity level, having tight calf muscles, or the way your foot moves can all put extra stress on the plantar fascia.
Here’s what doctors suggest for recognizing and treating plantar fasciitis.
When do you feel pain?
The word 'plantar' refers to the sole of your foot. The fascia is a thick band that runs along the bottom of your foot, connecting your heel to your toes and supporting your arch.
“When that band gets stressed or overloaded, that’s when you can start to have pain,” Faro explains.
You might feel the worst pain in the morning. The pain often gets a bit better as you move around, but it can come back later in the day, Faro says. You might also feel discomfort when you stand up after sitting for a while.
What are risk factors?
There usually isn’t just one cause of plantar fasciitis. It often happens because of repeated or increased stress on your foot. Common causes include:
- A sudden increase in activity (like walking or running more, hiking, or intense workouts)
- Long periods of standing or walking on hard surfaces
- Repetitive-impact activities, such as running
- Tight calf muscles or Achilles tendon, which limit ankle movement
- Foot mechanics, like very high or low arches, or differences in walking style
- Hiking on hills or uneven ground
- Unsupportive or ill-fitting footwear
How do you know it’s plantar fasciitis?
You’re typically diagnosed with plantar fasciitis based on your symptoms and a physical exam.
Your doctor will typically look for characteristic signs, including:
Where it hurts: Pain is usually on the bottom of the heel, often near the inside edge where the plantar fascia attaches to the heel bone.
When it hurts: First-step pain is a major clue. This presents as pain with the first few steps in the morning or after sitting for a while that may improve as you move.
Tenderness: Pressing on the plantar fascia near its attachment to the heel often reproduces the pain.
Pain when the fascia is stretched: Pulling the toes upward can tighten the plantar fascia and sometimes reproduce symptoms.
Foot and ankle movement: The clinician may check calf tightness, ankle flexibility, arch shape, gait, and other factors that could be contributing.
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What about treatment?
“Most people, if they can get on top of it quickly, can get rid of the pain without any significant intervention,” Faro says.
With self-care and some patience, you can get better, but experts say it may take several weeks or even months to fully recover.
“If you’re experiencing persistent foot pain, don’t wait months hoping it will go away. Early intervention and the right treatment can make recovery much easier and prevent chronic problems,” says Jeffrey R. King, DPM, a podiatrist at Mt. Ascutney Hospital and Health Center, a member of Dartmouth Health.
Treatment can include:
- Calf stretching
- Wearing night splints, which are braces worn on the foot and lower leg while sleeping
- Supportive footwear
- Physical therapy
If your heel pain doesn’t get better after a few weeks of home care, it’s a good idea to see your primary care doctor.
More aggressive treatments include corticosteroid injections and walking boots.
Research shows that corticosteroid injections can provide short-term pain relief, but the benefit tends to diminish over time. Repeated injections can weaken your plantar fascia, and the thinning of the heel's protective fat pad is a risk.
Experts say about 80% of patients improve within 12 months without surgery.
Surgical procedures are reserved for severe cases that haven’t improved after a year of consistent therapy.
“Most heel pain responds well to simple treatments. With the right care and a little patience, almost everyone gets better,” King says. “Surgery is often a last resort.”
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