“I have been experiencing pain in my heel when I first wake up in the morning. The pain lasts for the first few steps in the morning and by the time I make it to the kitchen it's gone. I also noticed that when I start moving after a period of prolonged sitting the pain comes back. What is happening, and why does my heel hurt after not doing anything?”
Plantar fascial pain and plantar fasciitis (otherwise known as heel spurs) is an overuse injury causing pain in the rearfoot (heel pain) that commonly affects runners and the older adult but can affect younger non-runners as well. The plantar fascia spans the entire length of your foot from your calcaneus (heel bone) to your toes and plays an important role in normal foot biomechanics, and shock absorption. An abnormally tight plantar fascia can result in an altered walking pattern and pain.
Plantar fasciitis pain is typically felt in the inside of the heel and progresses gradually. Pain is usually at its worse in the morning, improves with exercise at first but feels achy after activity. Periods of inactivity during the day are generally followed by an increase in pain as activity is recommenced. As the condition becomes more severe, the pain may be present when weight-bearing or standing and worsens with activity. Common causes for plantar fasciitis include:
- Limited ankle, and great toe range of motion
- Pes planus (low arches or flat feet) or pes cavus (high arches)
- An elevated BMI
- A sudden increase in training load (typically running and dancing)
- Poor footwear
- Work requiring long hours of standing
- Tight calf, hamstrings, and glutes
It is important to gain a correct diagnosis of plantar fasciitis as it can be mistaken for stress fractures in the calcaneus, a bruised fat pad in the heel or referred pain from other conditions such as tarsal tunnel syndrome. Through several diagnostic tests, including a biomechanical assessment, your local physiotherapist can identify the correct management plan for you.