Plantar Fasciitis

Is heel pain making those first few steps in the morning something you've started to dread?

Perhaps you've noticed a sharp, stabbing pain underneath your heel when getting out of bed, or an uncomfortable pulling sensation through the arch of your foot after sitting for a while. You might find that the discomfort gradually improves once you start walking, only to return after spending longer periods on your feet. Even everyday activities like shopping, walking the dog, gardening or wearing your favourite shoes can become frustrating when your feet aren't feeling as comfortable as they should.

If you've been diagnosed with plantar fasciitis, you'll understand just how disruptive this condition can become. After all, it's difficult to give your foot the rest it needs when almost everything you do involves standing or walking. The good news is that many cases improve without surgery, and understanding what's causing the irritation, which activities may be making it worse and how to manage the strain on your foot can help you take the right steps towards recovery.

In this article, we'll explore the causes and symptoms of plantar fasciitis, the treatment options available and how OSMO Patch may offer a drug-free, non-invasive option for helping manage swelling and associated pain.

What Is Plantar Fasciitis?

Your plantar fascia is a strong band of connective tissue that runs along the underside of your foot, connecting your heel bone to the base of your toes. It plays an important role in supporting your foot's arch, absorbing some of the forces generated during walking and helping your foot push off the ground with each step.

When the plantar fascia is subjected to excessive or repetitive strain, the tissue can become irritated and painful. This condition is commonly known as plantar fasciitis, one of the most frequent causes of pain underneath the heel. Although the name suggests inflammation, longer-standing plantar fasciitis may involve changes within the tissue rather than inflammation alone. For this reason, healthcare professionals sometimes use the term plantar fasciopathy to describe persistent plantar fascia problems. [1][2]

Most commonly, the pain develops around the inside of the heel where the plantar fascia attaches to the heel bone, although discomfort can also extend along the arch of your foot. For more information about other conditions that may cause discomfort through the arch, visit our Foot Arch Pain Information article.

What Are the Symptoms of Plantar Fasciitis?

One of the most recognisable symptoms of plantar fasciitis is pain underneath the heel when taking your first few steps after getting out of bed. You may find yourself walking carefully until the foot begins to loosen up, or notice the same discomfort when standing after sitting for an extended period.

Common symptoms include:

• Sharp pain underneath the heel: Often concentrated around the inner underside of the heel bone.

• Pain during the first steps in the morning: Particularly after sleeping or resting for several hours.

• Discomfort through the foot arch: An aching or pulling sensation along the sole of the foot.

• Pain after prolonged standing: Especially when working or walking on hard surfaces.

• Tenderness beneath the heel: The affected area may be sensitive when pressed.

• Pain after exercise: Discomfort may become more noticeable after a long walk, run or other physical activity.

• Stiffness or tightness: Particularly through the arch, calf or underside of the foot.

A frustrating feature of plantar fasciitis is that the pain may improve temporarily as you begin moving, creating the impression that the problem is getting better. However, if the plantar fascia continues to experience excessive strain, the discomfort may return later in the day or become more noticeable the following morning.

Why Does Plantar Fasciitis Hurt More in the Morning?

If you've been experiencing plantar fasciitis, you may have wondered why your heel can feel reasonably comfortable while resting, yet become so painful the moment you stand up.

During sleep, your foot generally remains in a relaxed position for several hours. When you get out of bed and place weight on it again, the plantar fascia is suddenly stretched and loaded. If the tissue is already irritated, this can produce the familiar sharp pain beneath the heel.

As you begin walking, the stiffness may gradually ease and movement can become more comfortable. However, feeling less pain after warming up doesn't necessarily mean the underlying condition has recovered. This is why someone with plantar fasciitis may experience relatively little discomfort during part of the day, only to find their heel becomes painful again after prolonged standing or walking. [1][3]

What Causes Plantar Fasciitis?

Plantar fasciitis generally develops when the plantar fascia is exposed to more strain than it's comfortably able to tolerate. Sometimes the cause is relatively straightforward, such as a sudden increase in exercise or wearing footwear that provides inadequate support. In other cases, several factors may contribute.

1. Tight Calf Muscles and Reduced Ankle Flexibility

Your calf muscles and Achilles tendon work together with the structures underneath your foot. When these muscles are unusually tight or ankle movement is restricted, additional strain may be placed on the plantar fascia during walking. This is one reason why calf flexibility is often considered as part of plantar fasciitis rehabilitation.

2. Flat Feet, High Arches and Foot Mechanics

The shape of your feet can influence how pressure is distributed when you walk or stand. People with flat feet may experience additional strain through certain supporting tissues, while those with high arches may distribute pressure differently across the heel and forefoot. However, having flat feet or high arches doesn't automatically mean you'll develop plantar fasciitis.

For a broader explanation of these conditions, including how changes in your foot's arch can contribute to discomfort, read our Foot Arch Pain Information article.

3. Unsuitable Footwear

Shoes that provide inadequate cushioning or support may contribute to discomfort, particularly if you spend considerable time standing or walking on hard surfaces. You may notice that your heel becomes increasingly painful when wearing very flat shoes, thin-soled footwear or shoes that have lost their original cushioning. Similarly, a sudden change in footwear can sometimes place additional demands on the tissues of your foot.

4. Sudden Increases in Physical Activity

Perhaps you've recently started walking longer distances, returned to running after a break or decided to become more active. Although regular exercise is important, increasing the duration or intensity too quickly can overload the plantar fascia before it has had sufficient time to adapt.

5. Prolonged Standing and Additional Weight

Activities that involve standing for extended periods, particularly on hard surfaces, can increase the strain placed on your feet. Additional body weight can also increase the forces passing through the heel and plantar fascia during everyday movement.

6. Age-Related Changes

Plantar fasciitis is particularly common among middle-aged adults, although it can affect people of different ages and activity levels. Changes in muscle strength, flexibility and tissue tolerance may contribute, especially when combined with prolonged standing or sudden increases in exercise. [1]

Plantar Fasciitis vs Other Causes of Heel Pain

Although plantar fasciitis is a common cause of pain underneath the heel, not all heel pain is caused by this condition. Several other problems can produce discomfort around the heel and ankle, although the location of the pain may help distinguish them.

Plantar Fasciitis: Usually produces pain underneath the heel, often towards its inner edge, with discomfort particularly noticeable during the first steps after resting.

Achilles Tendonitis: Generally causes pain at the back of the heel or along the Achilles tendon rather than directly underneath the foot. You can learn more about the symptoms and treatment options in our Achilles Tendonitis Information article.

Heel Bursitis: Involves inflammation of one of the small cushioning sacs around the heel, often producing localised tenderness or swelling near the Achilles tendon. For more information about this condition, including the different types of heel bursitis, visit our Achilles Bursitis Information article.

Foot Arch Strain: May cause aching or discomfort through the middle or inner underside of the foot, particularly following increased activity.

Stress Fractures: Can produce localised heel or foot pain that progressively worsens with weight-bearing activity and may require imaging to identify.

Because these conditions can produce overlapping symptoms, obtaining an accurate diagnosis is important before deciding on treatment. If you're unsure what's causing your discomfort, our Foot Pain Information guide provides a broader overview of common foot conditions and their symptoms.

How Is Plantar Fasciitis Diagnosed?

If you're experiencing persistent pain underneath your heel, a healthcare professional will generally begin by discussing your symptoms, medical history and the activities that aggravate the discomfort. They may examine your foot to identify areas of tenderness, assess the movement of your ankle and check the flexibility and strength of your calf muscles.

In many cases, plantar fasciitis can be diagnosed through your symptoms and a physical examination. However, additional investigations may sometimes be recommended.

Ultrasound: May help assess the thickness and appearance of the plantar fascia or investigate other soft-tissue conditions.

X-rays: Can help rule out certain bone-related problems, although a heel spur doesn't necessarily mean plantar fasciitis is responsible for the pain.

MRI Scan: May be considered when the diagnosis remains uncertain or another injury, such as a stress fracture, is suspected.

Not everyone with plantar fasciitis requires imaging, particularly when their symptoms are typical of the condition.

What Are the Treatment Options for Plantar Fasciitis?

If plantar fasciitis is making walking, working or enjoying your usual activities uncomfortable, your first priority is understandably to find some relief. Fortunately, many cases can be managed without surgery, although recovery often requires patience and a combination of treatments rather than relying on one approach alone.

The main aim is to reduce excessive strain on the plantar fascia while gradually improving the strength, flexibility and function of the surrounding tissues.

1. Rest and Activity Modification

Temporarily reducing activities that aggravate your heel is often an important first step. You may need to limit running, longer walks, jumping or standing for extended periods, particularly when these activities consistently increase your discomfort.

However, prolonged complete inactivity isn't generally necessary. Gentle movement and appropriately selected exercise may be beneficial, provided they don't significantly aggravate your symptoms. The aim is to reduce excessive strain while gradually restoring the foot's ability to tolerate normal activity.

2. Supportive Footwear and Orthotics

The shoes you wear can make a considerable difference to how comfortably your foot tolerates everyday activities. Footwear with adequate heel cushioning and appropriate arch support may help reduce unnecessary strain on the plantar fascia, while avoiding barefoot walking on hard surfaces may also be beneficial during a painful flare-up.

In some cases, a podiatrist may recommend heel cushions, supportive insoles or orthotics to help distribute pressure more comfortably. However, orthotics are generally most useful as part of a broader treatment program rather than relying on them alone. [2]

3. Cold and Heat Therapy

During the first 48–72 hours following a new injury or acute flare-up, cold therapy may help manage pain and associated swelling. Applying a cold pack wrapped in a towel for approximately 10–20 minutes at a time may provide temporary relief, and cold can also be useful if the foot becomes irritated again following physical activity. Some people find that gently rolling the sole of their foot over a cool water bottle provides additional comfort, although excessive pressure should be avoided.

Once the initial irritation has settled, gentle heat may help ease stiffness or tightness in the surrounding muscles. Warmth increases local blood circulation and can make movement more comfortable, although heat alone won't repair damaged plantar fascia tissue. Avoid applying heat over an area that remains unusually hot, red or significantly swollen, and seek professional advice before using temperature-based treatments if you have reduced sensation or circulation problems.

4. Physiotherapy, Stretching and Strengthening

Physiotherapy is an important part of treatment for many cases of persistent plantar fasciitis. A rehabilitation program may include gentle plantar fascia stretching, calf stretching and exercises designed to strengthen the muscles supporting your foot and ankle.

For example, plantar fascia-specific stretching may help improve flexibility through the sole, while appropriate strengthening can help the surrounding muscles better tolerate everyday activity. However, exercises should be selected carefully and shouldn't be forced through significant pain. Your physiotherapist can help determine an appropriate program and gradually increase the intensity as your symptoms improve. [2]

5. Night Splints and Foot Taping

Some people with plantar fasciitis find that wearing a night splint helps reduce the discomfort experienced during those first few steps in the morning. These splints are designed to maintain a gentle stretch through the plantar fascia and calf while sleeping.

Foot taping may also be recommended to provide temporary support and reduce discomfort during certain activities. Neither approach is suitable for everyone, but they may be useful alongside other appropriate treatments, particularly when morning heel pain is a persistent problem. [2]

6. Medication and Other Medical Treatments

Pain-relieving or anti-inflammatory medication may sometimes be recommended to help manage symptoms, although these medicines aren't suitable for everyone. For persistent plantar fasciitis, other options may include extracorporeal shockwave therapy or specialist procedures.

Corticosteroid injections may provide temporary pain relief in selected cases, but they also carry risks, including potential weakening or rupture of the plantar fascia and damage to the cushioning tissues beneath the heel. Surgery is rarely required and is generally reserved for selected cases where an appropriate course of non-surgical treatment hasn't provided sufficient improvement. [4]

7. Drug-Free, Non-Invasive Swelling Relief with OSMO Patch

If your plantar fasciitis is accompanied by swelling and associated pain, OSMO Patch offers a drug-free, non-invasive home treatment option designed to help reduce swelling and discomfort while you sleep.

Developed in Australia and trusted for over 15 years, OSMO Patch is applied externally over the affected area before going to bed, following directions for use.

Unlike medication, it contains no drugs or steroids and doesn't require injections or invasive procedures. It may be considered alongside adequate rest, supportive footwear and avoiding activities that continue to irritate the affected tissues.

However, not everyone with plantar fasciitis experiences significant swelling, and OSMO Patch isn't intended to repair damaged plantar fascia tissue or replace appropriate rehabilitation.

Looking for a drug-free, non-invasive way to help manage foot swelling and associated pain?

→ Try OSMO Patch Today

(ALWAYS FOLLOW THE DIRECTIONS FOR USE. Not suitable for individuals with seafood or shellfish allergies)

How Long Does Plantar Fasciitis Take to Heal?

Recovery times vary depending on how long symptoms have been present, how much strain is being placed on the plantar fascia and how well the condition responds to appropriate treatment. Some mild cases may begin improving within several weeks after reducing aggravating activities and making suitable footwear changes, while persistent plantar fasciitis can take several months to improve, particularly when the tissue has been subjected to repeated strain over an extended period.

Using OSMO Patch alongside adequate rest and avoiding activities that irritate the affected area may help support the recovery process where swelling and associated pain are present. However, it's worth remembering that feeling less pain doesn't necessarily mean the plantar fascia has fully recovered. Returning too quickly to strenuous activities may aggravate the condition, so a gradual return to normal walking and exercise is generally recommended.

 

Frequently Asked Questions About Plantar Fasciitis

Why Does Plantar Fasciitis Hurt So Much in the Morning?

Morning heel pain is one of the most common symptoms of plantar fasciitis. After resting overnight, the plantar fascia may feel stiff and painful when it is first placed under tension. As you begin walking, the discomfort may ease, although it can return later after prolonged standing or activity.

Can I Keep Walking if I Have Plantar Fasciitis?

Gentle walking may be appropriate if it doesn't significantly aggravate your symptoms. However, longer distances, hills and walking on hard surfaces may increase discomfort, particularly during a painful flare-up. Temporarily reducing your walking distance and gradually increasing activity as symptoms improve may help.

Is Plantar Fasciitis the Same as a Heel Spur?

No. Plantar fasciitis affects the connective tissue running along the underside of your foot, while a heel spur is a bony growth that may develop on the heel bone. Although the two conditions can occur together, many people have heel spurs without experiencing pain, so a heel spur doesn't necessarily mean that it's responsible for your symptoms.

Should I Stretch My Foot if I Have Plantar Fasciitis?

Appropriately selected plantar fascia and calf stretching exercises can be helpful for many people with plantar fasciitis. However, stretching should be gentle and shouldn't be forced through significant pain. A physiotherapist or podiatrist can recommend exercises suitable for your symptoms and stage of recovery.

Can Plantar Fasciitis Affect Both Feet?

Yes. Although plantar fasciitis may initially affect one foot, some people experience symptoms in both feet. This may be associated with repetitive strain, prolonged standing, footwear or other contributing factors. If you're experiencing pain in both feet, particularly alongside numbness, burning or other unusual symptoms, arrange a medical assessment to confirm the cause.

Can Plantar Fasciitis Go Away Without Surgery?

Yes. Most people improve with appropriate non-surgical treatment, including activity modification, supportive footwear, stretching, strengthening and other conservative therapies. However, recovery may take several months, particularly when symptoms have been present for a long time. Surgery is generally considered only when persistent symptoms haven't responded to an appropriate course of non-surgical treatment.

 

When Should You Seek Medical Attention?

If your heel pain persists, worsens or begins interfering significantly with walking, work or everyday activities, consult a qualified healthcare professional. Seek prompt medical attention if you experience sudden severe pain following an injury, cannot bear weight, notice significant swelling or develop redness and warmth accompanied by fever.

Persistent numbness, tingling or loss of sensation should also be assessed, particularly if you have diabetes or another medical condition that may affect circulation or nerve function.

Medical References

[1] Healthdirect Australia: Plantar Fasciitis – Treatment, Symptoms and Causes. Read the Healthdirect medical guidance

[2] Academy of Orthopaedic Physical Therapy: Heel Pain – Plantar Fasciitis: Revision 2023 Clinical Practice Guideline. Read the clinical practice guideline

[3] NHS: Plantar Fasciitis – Symptoms and Treatment. Read the NHS medical guidance

[4] Evaluation and Treatment of Chronic Plantar Fasciitis: Review of Diagnosis, Conservative Treatments and Specialist Interventions. Read the published medical review