Plantar fasciitis

The plantar fascia is the thick band of tissue running along the sole, supporting the arch and absorbing load with each step. Plantar fasciitis develops when repeated strain causes small areas of irritation and degeneration where the fascia attaches to the heel. Despite the name, it is now understood to be more of a wear-related change than true inflammation.

Several factors make it more likely:

• Sudden increases in activity, long periods standing, or a change in surface or footwear
• Tight calf muscles or Achilles tendon, and flat or high-arched feet
• Carrying extra weight, which raises the load through the heel

It is most common in middle age. Occasionally heel pain forms part of a wider inflammatory picture, which is one reason confirming the cause matters.

Plantar fasciitis has a fairly typical pattern. Features may include:

• Pain under the heel, often sharp with the first steps in the morning or after sitting
• Pain that eases as you get moving but can return after long periods on your feet
• Tenderness when pressing the underside of the heel

Plantar fasciitis can usually be recognised from the history and examination. It is worth confirming the diagnosis, as other conditions can also cause heel pain and are managed differently.

Ultrasound can help by showing thickening or changes in the plantar fascia and excluding other causes. Dr Borukhson uses point-of-care ultrasound during the consultation, so the heel can often be assessed in the same visit. You can read more on the ultrasound clinic page.

Treatment usually begins with simple measures such as stretching, supportive footwear, and reducing the activities that aggravate it, alongside pain relief. These help most people. Where symptoms persist, an ultrasound-guided injection may be considered, with ultrasound guidance allowing accurate placement. The plan is agreed with you.

Alongside any treatment plan, a few day-to-day habits make a real difference, though heel pain can take several months to settle, so consistency matters more than quick fixes.

• Stretch the calf and the sole of the foot regularly, and especially before the first steps of the day, when the fascia is at its tightest
• Choose cushioned, supportive shoes with a slight heel, and avoid going barefoot on hard floors
• A gel heel pad or off-the-shelf insole can ease pressure under the heel
• If high-impact exercise aggravates it, switch to swimming or cycling for a while, then build back gradually

If extra weight is a factor, gentle weight loss reduces the load through the heel. The outlook is good, and most people return to normal activity.

Plantar fasciitis is rarely dangerous, but certain features point to a different problem and deserve prompt attention.

Arrange an urgent review if you notice:

• Numbness, tingling or pins and needles spreading into the foot, which can suggest a trapped nerve rather than the fascia
• A sudden snap or severe pain during activity, or being unable to put weight on the foot, which may indicate a tear or fracture
• A red, hot, swollen heel with fever or feeling unwell, which needs same-day assessment

Seek routine review if heel pain affects both feet, comes with stiffness, swelling or pain in other joints, or wakes you at night, as this can reflect an inflammatory cause such as enthesitis. Pain that has not improved after a few months of self-care is also worth assessing.

Heel pain that is not settling is worth assessing to confirm the cause and put in place an effective plan, rather than letting it become long-standing. If you have persistent heel pain, a specialist review, with ultrasound where helpful, can clarify it.

Will plantar fasciitis go away on its own?

For many people heel pain from plantar fasciitis does settle over time, especially with simple measures such as stretching, supportive footwear and easing off the activities that aggravate it. It can be slow to improve and sometimes persists, which is why a clear plan helps rather than simply waiting. If the pain is not settling, a specialist review can confirm the cause and put effective treatment in place before it becomes long-standing.

How is plantar fasciitis diagnosed?

Plantar fasciitis can usually be recognised from your history and an examination of the heel, without the need for scans in most cases. Where it is helpful, ultrasound can show thickening or changes in the plantar fascia and rule out other causes of heel pain. Dr Borukhson uses point-of-care ultrasound during the consultation, so the heel can often be assessed in the same visit.

Why does my heel hurt most with the first steps in the morning?

This first-step pain is one of the most typical features of plantar fasciitis. The plantar fascia tightens while you rest, so the first steps after waking or after sitting can feel sharp before easing as you get moving. Pain that follows this pattern is a useful clue, though it is still worth confirming the diagnosis, as other conditions can cause heel pain and are managed differently.

Do I need surgery for plantar fasciitis?

Surgery is rarely needed for plantar fasciitis. Most people improve with simple measures such as stretching, supportive footwear, activity changes and pain relief, and where symptoms persist an ultrasound-guided injection may be considered, with the ultrasound allowing accurate placement. The right plan is agreed with you, and a specialist assessment helps match the treatment to your particular case.