Plantar fasciitis
Plantar fasciitis is the commonest cause of heel pain in adults. What hurts is not the bone but a thick band of fibrous tissue running from the heel bone to…
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Medicines commonly prescribed for Plantar fasciitis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 100 mg / 5 mlActive substance: ibuprofenManufacturer: Laboratorio Aldo Union S.L.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 600 mgActive substance: ibuprofenManufacturer: Laboratorios Normon S.A.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 400 mgActive substance: ibuprofenManufacturer: Laboratorios Normon S.A.Prescription not required
Plantar fasciitis is the commonest cause of heel pain in adults. What hurts is not the bone but a thick band of fibrous tissue running from the heel bone to the base of the toes: it holds up the arch and works like a spring at every step. When the load on that band outgrows what it has had time to adapt to, tiny tears appear where it anchors into the heel. The pain behaves so distinctively that a doctor often suspects the diagnosis from the story alone, before touching the foot.
The first steps of the morning give it away
The picture is typical. You get out of bed, put your foot down, and a sharp stabbing pain flares in the heel as though something had been driven into the sole. After ten or twenty steps it eases, and by the middle of the day you barely think about it. But sit at a desk for half an hour, stand up again, and the whole thing repeats, if more gently. After a long day on your feet the heel usually aches in a dull, even way, without the morning sharpness.
Other pointers in the same direction:
- the pain sits near the inner edge of the heel rather than spreading across the whole sole;
- it hurts when the toes bend upwards: going up stairs, walking uphill, pushing off at the end of a stride;
- pressing one finger on a single spot at the front edge of the heel bone reproduces exactly that pain;
- there is no swelling, redness or heat; when there is, the cause is usually something else.
Almost always only one foot is affected. If both heels hurt equally, that is a reason to look for one shared cause rather than assume two separate cases of fasciitis have coincided.
Why the sole stops coping
Underneath this is not inflammation in the usual sense but wear: the tissue at the heel anchor cannot recover between efforts and gradually loses its strength. Hence the main rule of treatment — change the load rather than damp down an inflammation.
Several things usually come together:
- the load went up in a jump: you took up running, added mileage, or moved to a job that keeps you standing all day;
- hard surfaces — tarmac, concrete, tiled floors — and flat, worn-out shoes with no cushioning;
- short calf muscles and a tight Achilles tendon, so the ankle bends upwards poorly and the whole push-off falls on the sole. This is the most fixable factor of the lot;
- extra weight: every kilogram passes through the heel thousands of times a day;
- the shape of the foot — a dropped arch, or the opposite, a high rigid one;
- being between forty and sixty, when the tissue is already less elastic but activity is still high.
A word about heel spurs. That bony spike shows up on the X-rays of a great many people who have never once complained about their heels, and it can be absent in someone with severe pain. It is the trace of old bone remodelling, not the source of the pain, and removing it on its own achieves nothing.
What genuinely helps in the first weeks
Complete rest is not needed and is actually unhelpful: without load the tissue does not get stronger. What is needed is different load. Put running, jumping and long walks aside for about six weeks, but keep moving — cycling, swimming and the cross-trainer spare the sole.
Three simple exercises do the work, and they need doing every day rather than in courses.
- Stretching the sole before the first step. Still in bed, cross one leg over the other, take hold of your toes and pull them towards you until you feel the taut band under the skin. Ten seconds, ten times, and only then stand up. This is what takes the sting out of the first morning steps.
- Calf stretch against a wall. Hands on the wall, the sore leg back, heel kept flat on the floor, knee straight — thirty seconds. Then the same with the knee slightly bent, to reach the deeper soleus muscle. Three sets, two or three times a day.
- Heel raises with a towel under the toes. Put a rolled towel under your toes, rise slowly onto the ball of the foot and lower just as slowly. Every other day, building up the repetitions. This is the exercise that gradually returns strength to the fascia.
Easing the pain while the foot recovers
In the evening it helps to roll the sole over a bottle of cold water for five to ten minutes. Ice wrapped in a cloth for ten to fifteen minutes after exertion also dulls the pain — but what heals is the graded loading and the stretching, while cold simply makes the day easier to get through.
Painkillers are a support, not a treatment. Paracetamol suits most people. Anti-inflammatories such as ibuprofen or diclofenac as a gel act on the spot and are therefore safer than tablets; tablets are taken as a short course, with food, and are avoided if you have a stomach ulcer or kidney disease, if you take blood-thinning medicines, if your asthma flares with painkillers, and in the second half of pregnancy. If you are unsure, ask a doctor or pharmacist.
Be patient: a clear improvement usually arrives after four to six weeks, and the pain goes away completely over several months.
Shoes, insoles and a night splint
Footwear here is not a detail but half the treatment. A good pair has a firm heel counter that does not collapse when you squeeze it, a low heel of one to three centimetres, a sole that will not fold in half, and cushioning under the heel. High heels, narrow pointed toes, flip-flops and backless slippers have to be set aside for a while: in them the sole works with nothing to lean on.
Do not walk barefoot on tiles or laminate at home either — get indoor shoes with a rigid sole and arch support. Off-the-shelf chemist insoles with an arch rise and a soft heel cushion work just as well at the start as expensive custom ones; moving to made-to-measure insoles makes sense if the simple ones have failed after a couple of months, or if the foot is badly deformed.
When the morning pain refuses to shift, a night splint helps: it holds the foot at a right angle so the fascia cannot shorten overnight. Sleeping in it is awkward at first, but this is exactly the type of pain where it pays off most.
Check what you have been wearing for a long time as well: running shoes lose their cushioning after six to eight hundred kilometres, and nothing about them looks any different.
When heel pain is not fasciitis at all
Plenty of conditions look similar and each is treated differently. Anything that does not fit the pattern of "worst on standing up, better once you get going" deserves a second thought.
- Stress fracture of the heel bone. The pain is constant, only builds with use and does not walk off; squeezing the heel from both sides hurts. It follows a sudden rise in running or long marches, and occurs in people with fragile bones.
- Thinning of the heel fat pad. More often after sixty. It hurts in the very centre of the heel, like treading on a stone, and the morning stab is missing.
- Nerve entrapment in the tarsal tunnel or one of its plantar branches. It burns, tingles and goes numb, the pain does not settle at rest and keeps you awake.
- Pain coming from the lower back. A pinched nerve root pulls from the buttock down the back of the calf into the heel, often with numbness along the outer edge of the foot.
- Trouble with the Achilles tendon or the bursa beneath it. Then it hurts behind and above rather than underneath, and there is a visible swelling over the heel.
- Inflamed tendon attachments in spondyloarthritis. Worth considering if both heels hurt, the person is under forty, the back takes more than half an hour to loosen in the morning, and there is a history of psoriasis, eye inflammation or persistent bowel trouble. This calls for a rheumatologist, not insoles.
- Gout and rheumatoid arthritis occasionally start in the heel — then there is swelling, redness and a sudden onset.
- In children and teenagers plantar fasciitis is very unusual. Heel pain during sport at that age is normally an apophysitis of the heel bone, known as Sever's disease, and it hurts at the sides and back of the heel.
Signs that should not wait
Heel pain on its own is not an emergency. But there are situations that need a doctor the same day or within a few days:
- something snapped in the sole during a jump or a sprint, with sudden pain, swelling and bruising, and you cannot put weight on the foot — that is how a ruptured fascia presents;
- the heel is red, swollen and hot to the touch and your temperature has risen — this looks like an infection;
- numbness or weakness appears and the foot begins to slap the ground as you walk;
- the pain is there at rest and at night, unrelated to activity, especially alongside weight loss or night sweats;
- you have diabetes or reduced sensation in the feet and there is pain, a crack or a wound on the sole — self-treatment is unsafe here and the foot needs looking at without delay;
- the pain started after a fall or a blow and you cannot bear weight — a fracture has to be ruled out.
The European emergency number 112 is dialled for heel pain only when there is obvious severe injury with a deformed foot or an open wound. Everything else can be dealt with at an ordinary appointment.
If the pain drags on for months
When six to eight weeks of conscientious work with the foot have changed nothing, an in-person examination is due. An ultrasound scan is the usual next step — in fasciitis the band is thickened where it meets the heel — and an X-ray is ordered not because of a spur but to avoid missing a fracture or another change in the bone.
From there several options exist.
- Working with a physiotherapist. They fit the exercise programme to your foot and make sure the load rises gradually — the most useful part of all this.
- Custom orthotic insoles, if the ready-made ones did not suit.
- Shock-wave therapy. Several sessions with a device that delivers high-energy pulses to the heel attachment. For pain that has become long-standing this is one of the more dependable choices.
- A steroid injection. It takes the pain away quickly but not for long, and repeated injections raise the risk of rupturing the fascia and thinning the heel fat pad. That is why it is used sparingly and never as the opening move.
- Surgery — partial release of the fascia or lengthening of the calf muscle — is discussed only in isolated cases, after a year without progress.
The outlook is good: in the great majority of people the pain settles without any procedure at all, and the only question is how long it takes.
Online consultation
Heel pain is exactly the sort of problem where a detailed history settles most of the question. In an online consultation the doctor will go through how the pain behaves across the day, what came before it, what shoes you wear and how much standing or running you do, and from those answers will separate fasciitis from a stress fracture, a trapped nerve or a rheumatic cause. They will explain how to do the stretches properly, what to change in your footwear and training, which painkiller suits you given your other conditions, and whether it is time for an ultrasound scan or a referral to an orthopaedic specialist.
A face-to-face visit will still be needed if there has been an injury, or if there is numbness, swelling with fever, or diabetes: a foot cannot be felt or imaged through a screen. What the online appointment does is stop you losing weeks on the wrong approach.
This material is for information only and does not replace medical advice.
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