Morning heel pain is a common symptom of plantar fasciitis.

During sleep or rest, the plantar fascia and calf can become less mobile. Your first few steps suddenly place pressure through the area again, which can produce sharp or aching pain.

Similar discomfort may occur when standing after sitting for an extended period.

Plantar fasciitis most commonly causes pain:

• Underneath the heel
• Toward the inside of the heel
• Near the beginning of the arch
• During the first steps after resting
• After prolonged standing, walking or exercise

Pain directly behind the heel may be associated with the Achilles tendon, while pain in the centre of the heel can sometimes involve the protective heel pad.

No.

Heel pain may also be related to:

• Achilles tendon problems
• Heel-pad irritation
• Nerve irritation
• Arthritis
• Stress injuries
• A recent injury
• Sever’s disease in growing children
• Referred pain from another area

Burning, tingling, numbness, significant swelling or pain following an injury may suggest a different cause.

Plantar fasciitis usually develops from a combination of factors rather than one single problem.

Common contributors include increased activity, prolonged standing, tight calf muscles, reduced ankle movement, unsuitable footwear and changes in the way pressure moves through the foot.

Both active people and those who stand for long periods at work can develop heel pain.

Flat feet do not automatically cause plantar fasciitis.

People with high arches can also develop heel pain.

Foot posture is only one part of the assessment. Ankle movement, muscle strength, walking pattern, footwear, activity levels and working conditions may be equally important.

Treatment should be based on your symptoms and overall foot function rather than the appearance of the arch alone.

Not necessarily.

A heel spur is a small bony growth that may be visible on an X-ray. Some people have heel spurs without experiencing any pain.

Other people may have significant plantar heel pain without a prominent heel spur.

Treatment usually focuses on reducing pressure through the painful tissue and addressing contributing factors rather than treating the spur itself.

Some cases gradually improve, but recovery times vary.

Symptoms may continue if the same activities, footwear or loading patterns keep aggravating the area.

Early management may include footwear changes, activity modification, stretching, strengthening and reducing unnecessary pressure through the heel.

Persistent symptoms may require a more detailed assessment and treatment plan.

Complete rest is not always necessary, but repeatedly pushing through significant pain may delay improvement.

You may need to temporarily reduce activities that aggravate the heel, including long walks, running, jumping or prolonged standing.

Activity can then be gradually increased as your symptoms and capacity improve.

The right amount of activity will depend on the severity and cause of your pain.

There is no single shoe that is suitable for everyone.

A suitable shoe should feel comfortable and match your foot shape, activity and work requirements.

Helpful features may include:

• A secure fit around the heel
• Adequate width
• Comfortable cushioning
• A stable sole
• Appropriate support
• Enough space for an orthotic when required

Very worn, flat or poorly fitting footwear may increase discomfort.

Bring your regular work and exercise shoes to your podiatry appointment so they can be assessed.

Walking barefoot on hard floors can aggravate heel pain for some people, particularly during the first few steps in the morning.

Wearing a comfortable and supportive shoe inside the house may reduce discomfort.

However, footwear advice should be based on your symptoms, daily activities and individual foot function.

Calf and plantar fascia stretches can help some patients, particularly when calf tightness or reduced ankle movement is contributing to the problem.

Stretching should be gentle and consistent. It should not create sharp or worsening pain.

Stretching is usually more effective when combined with other treatments such as footwear changes, strengthening, taping and activity management.

Orthotics may help selected patients by changing how pressure and load are distributed underneath the foot.

Not everyone with heel pain requires custom orthotics.

Depending on the assessment, treatment options may include:

• Footwear changes
• Temporary padding
• Taping
• Prefabricated insoles
• Custom orthotics

Orthotics generally work best when used as part of a broader treatment plan rather than as the only treatment.

Shockwave therapy may be considered for persistent plantar heel pain that has not adequately improved with initial treatment.

It uses controlled pressure waves directed toward the painful area.

Shockwave therapy is usually combined with exercise, footwear advice, activity management and other appropriate treatments.

It is not required or suitable for every patient. Your symptoms, diagnosis and medical history should be reviewed before treatment begins.

A heel pain consultation may include an assessment of:

• The exact location of the pain
• How and when the symptoms started
• Foot and ankle movement
• Calf flexibility
• Lower-limb strength
• Walking pattern
• Foot posture and function
• Work and exercise demands
• Regular footwear
• Previous treatments

Depending on the findings, treatment may include:

• Footwear recommendations
• Taping
• Stretching
• Strengthening exercises
• Activity modification
• Biomechanical assessment
• Custom orthotics
• Shockwave therapy

Not every patient requires every treatment. Your management plan should be based on the cause of your symptoms and your individual needs.