Patient information · Physiotherapy and orthopaedics
Plantar fasciitis
the first-step pain, and what actually shifts it
Sharp pain under the heel on the first steps out of bed, easing as you walk and returning after sitting, is the signature of plantar fasciitis. It is stubborn and slow, and it does resolve — but the timescale is months rather than weeks, and knowing that at the start prevents a lot of frustration.
Arrange assessment rather than assuming plantar fasciitis if you have
- heel pain following a sudden pop or tearing sensation, with bruising
- numbness, tingling or burning spreading into the sole or toes
- pain that is constant, present at rest and at night
- a hot, red, swollen heel, or fever
- heel pain in a child or teenager, which is usually a different condition
- pain with back stiffness, eye inflammation or a rash, which may indicate inflammatory arthritis
Sudden pain with a pop may be a plantar fascia rupture or an Achilles problem. Bilateral heel pain in a younger adult, particularly with morning back stiffness, warrants investigation for inflammatory disease rather than months of insoles.
Why the first steps hurt most
The plantar fascia is a thick band running from the heel to the toes. Overnight the foot rests in a pointed position and the tissue shortens; the first steps stretch it abruptly. The same thing happens after any prolonged sitting. Pain that eases after ten minutes of walking then worsens later in the day is the classic pattern.
What helps
- Stretch before your first step. Before getting out of bed, pull your toes back towards you and hold for 30 seconds, three times. This alone changes the morning considerably.
- Calf stretches, both with the knee straight and bent, three times each, twice a day. Tight calves are strongly associated with plantar fasciitis.
- Plantar fascia specific stretch — sitting, cross the affected leg over the other knee, pull the toes back with one hand and massage along the arch with the other. Ten repetitions, three times daily.
- Progress to loading. Heel raises with a rolled towel under the toes, done slowly, three sets of twelve every other day. This has better evidence than stretching alone.
- Roll the arch over a frozen bottle or a ball for a few minutes in the evening.
Footwear and support
Helps
- Cushioned, supportive shoes with a slight heel, worn indoors as well
- Off-the-shelf arch supports or heel cups — as effective as custom for most people
- Replacing worn-out trainers
- Reducing standing time on hard floors where you can
- Losing weight if you are carrying extra — this genuinely matters here
Makes it worse
- Barefoot on hard floors, especially first thing
- Flat, unsupportive shoes, flip-flops and ballet pumps
- Sudden increases in running distance or walking
- Standing all day without a break or a change of shoes
- Complete rest, which does not resolve it
When self-management is not enough
- A night splint holds the foot at a right angle overnight, preventing the tissue shortening. Uncomfortable at first, but effective for morning pain.
- Shockwave therapy has good evidence for plantar fasciitis that has not responded to three months of exercise and is a reasonable next step before injections.
- Steroid injection gives short-term relief but carries a risk of fascia rupture and fat pad atrophy, both of which can leave you worse off. It is not a first-line option.
- Custom orthotics where foot mechanics are clearly contributing.
- Imaging is not usually needed but can exclude a stress fracture or other cause where the picture is atypical.
Heel spurs are usually irrelevant
A bony spur is often seen on X-ray and is frequently blamed for the pain. Spurs are found just as commonly in people with no heel pain at all, they are a consequence rather than a cause, and removing them is not the treatment. If you have been told you have a spur, it does not change the management.
Book an appointment if heel pain has lasted more than six weeks, is limiting your work or exercise, or has not responded to stretching. Our physiotherapy team can assess foot mechanics and calf flexibility, set up a loading programme, and we offer shockwave therapy on site.
Shockwave therapy and physiotherapy on site
Same-day appointments most days, seven days a week, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.