Plantar Fasciitis and Heel Spur: Pain With the First Steps
Strain where the plantar fascia attaches to the heel, causing sharp pain with the first morning steps.
A strong band of tissue (the plantar fascia) runs along the sole from the heel to the toes. Pain arising from repeated strain where it attaches to the heel is called plantar fasciitis. The 'heel spur' seen on X-rays is usually a consequence rather than the cause; many people with a spur have no pain at all.
Symptoms and Risk Factors
- Sharp heel pain with the first steps after getting out of bed
- Pain easing after a few minutes of walking, returning after prolonged standing
- Tenderness on pressing the inner-lower part of the heel
- Recurrence of pain on standing after prolonged sitting
Risk factors include prolonged standing at work, hard walking surfaces, excess weight, tight calf muscles and limited ankle dorsiflexion, flat or high-arched feet, unsupportive or worn shoes, and abrupt increases in running distance.
Treatment
Diagnosis is largely clinical; X-rays are usually requested to exclude other conditions. Most patients improve with non-surgical treatment, although the process requires patience:
- Stretching: calf and plantar fascia stretches, several times a day
- Stretching the sole before the first steps in the morning
- A heel cushion or appropriate insole
- Supportive footwear with a cushioned sole; avoiding barefoot walking on hard floors
- Weight management and activity modification
- A night splint and appropriate pain management
Additional treatments and, rarely, surgery are considered in cases that do not respond over a long period.
If heel pain with the first morning steps has lasted weeks or limits how long you can stand, arrange an assessment.
Frequently Asked Questions
Should the heel spur be removed surgically?
In most patients this is unnecessary. The source of pain is usually strain at the fascial attachment rather than the spur itself, and treatment is directed accordingly.
How long does it take to settle?
With regular stretching and load management, symptoms usually decrease within weeks; in some patients the process takes months.
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