Heel pain in the morning: is it plantar fasciitis?

Urgent Care / Foot Pain / Plantar Fasciitis

What is plantar fasciitis?

The plantar fascia is a thick band of tissue that runs along the bottom of your foot, from your heel to your toes. It supports your arch and absorbs shock every time you take a step.

When that band is overloaded again and again, it can become irritated and painful where it attaches to the heel bone. That's plantar fasciitis. It most often affects one foot, but it can affect both.

What does plantar fasciitis feel like?

Compare your symptoms to this list:

• Pain on the bottom of the heel, or just in front of it, not the back of the heel
• Pain that is worst with your first steps in the morning, or when you stand up after sitting for a while
• Pain that eases a bit once you get moving, then comes back after long periods of standing or walking
• A sharp, stabbing or bruised feeling, rather than burning or tingling
• Tenderness when you press on the inside bottom of your heel
• Little or no swelling, and no redness or warmth

If that sounds like you, plantar fasciitis is a likely explanation. Other problems can cause heel pain too, such as an irritated Achilles tendon, a stress fracture or a pinched nerve. That's one reason it's worth having a clinician take a look.

Who gets it, and what makes it worse?

Plantar fasciitis is most common in middle-aged and older adults. Things that raise your risk include:

• Extra body weight, which puts more load on the feet
• Standing or walking on hard surfaces for many hours
• Tight calf muscles or a tight Achilles tendon
• Flat feet or very high arches
• Worn-out or unsupportive shoes, flip-flops, or walking barefoot on tile
• A sudden increase in activity, like a new walking routine, a long trip or a day of sightseeing

In Florida, where many of us live in sandals and walk barefoot on tile floors at home, the last two are worth a second look.

What can you do at home?

These simple steps are safe for most people and are often the first line of care:

• Stretch your calf and the bottom of your foot, especially before your first steps in the morning. Gently pulling your toes back toward your shin while sitting on the edge of the bed is a good start.
• Roll your foot over a water bottle or a firm ball for a few minutes.
• Ice the heel for about 15 minutes at a time, with a thin cloth between the ice and your skin.
• Wear supportive shoes with a cushioned heel and good arch support, including around the house.
• Avoid going barefoot on hard floors for now.
• Cut back on high-impact activity for a while. Swimming or cycling can keep you active while the foot calms down.

Over-the-counter pain relievers can help some people. Check with a clinician or pharmacist first if you have kidney disease, stomach ulcers, heart disease or high blood pressure, or if you take a blood thinner.

How is plantar fasciitis treated?

Most people with plantar fasciitis get better without surgery. A clinician can confirm the diagnosis, rule out other causes and build a plan with you. Depending on your situation, that plan may include:

• A specific stretching routine for the calf and plantar fascia
• Heel cups or shoe inserts for cushioning and arch support
• A night splint that keeps the foot gently stretched while you sleep
• A referral to physical therapy
• Anti-inflammatory medicine, over the counter or by prescription, if it's appropriate for you
• For pain that doesn't improve, a referral for in-person options such as an injection, or to a foot specialist

Your clinician decides what fits, based on your health history and the other medications you take.

What does a video visit at MD Care look like for heel pain?

A lot of the diagnosis comes from your story and a few simple checks, which work well on camera. Your clinician will:

• Ask when the pain started, when it's worst and what you've tried
• Ask you to point to exactly where it hurts, and to press on that spot
• Look at both feet and ankles for swelling, redness or bruising
• Watch you stand, walk a few steps, and point and flex your foot
• Review your medications and health conditions before recommending any treatment

Wear shorts or roll up your pants, and set your phone or laptop on the floor or a low chair so your feet are in view. You can also share photos.

A video visit is $50 without insurance, with no membership. For a simple follow-up question, a $20 message visit may be enough, when your clinician agrees it's appropriate. If you have Medicare, we confirm your coverage before your visit, and you pay your plan's share. Most patients are seen within three hours, and you need to be in Florida at the time of your visit. See pricing and Medicare.

When should heel pain be seen in person?

Go to an in-person urgent care or see a doctor in person if:

• The pain started after a fall, a jump or another injury. You may need an X-ray to check for a fracture.
• You can't put weight on the foot, or you're limping badly
• You felt a sudden pop in the back of the heel or ankle, which can be a sign of an Achilles tendon tear
• The heel is red, hot or very swollen, or you have a fever
• You have numbness, tingling or burning in the foot
• You have diabetes and notice a sore, blister or wound on the foot, or a change in color
• The pain is severe at rest or at night, or keeps getting worse despite home care