That sharp pain when you first step out of bed in the morning. Heel pain after sitting for a while. Discomfort that returns after a long day on your feet.

These are common signs of plantar fasciitis, one of the most frequent causes of heel pain.

The plantar fascia is a strong band of connective tissue that runs along the bottom of the foot from the heel toward the toes. It helps support the arch and absorbs stress as you walk, stand, run, and exercise.

When repeated strain places excessive stress on this tissue, the plantar fascia can become irritated and painful.

The result is often plantar heel pain, particularly near the inside or bottom of the heel.

Although the condition is commonly called plantar fasciitis, chronic cases may involve degenerative changes in the plantar fascia rather than inflammation alone.

One of the most recognizable symptoms is heel pain with your first steps in the morning.

You may also notice:

• Sharp or stabbing pain underneath the heel
• Pain when getting out of bed
• Heel pain after sitting or resting
• Pain after prolonged standing
• Pain after walking for extended periods
• Heel pain during or after exercise
• Tenderness along the bottom or inside of the heel
• Tightness in the calf or Achilles tendon
• Symptoms that improve temporarily after moving but return later in the day

If your heel pain keeps returning, determining why it is happening is an important part of preventing it from becoming a chronic problem.

There is rarely one single cause.

Plantar fasciitis often develops when the amount of stress placed on the plantar fascia exceeds the tissue's ability to tolerate that stress.

Contributing factors may include:

• Tight calf muscles or Achilles tendon
• Flat feet or excessive pronation
• High arches
• Changes in walking mechanics
• Poorly supportive footwear
• Spending long periods standing on hard surfaces
• Running or repetitive high-impact activity
• Sudden increases in exercise or activity
• Increased stress placed on the feet
• Limited ankle mobility
• Changes in training surfaces or footwear

At Hillside Foot & Ankle, we look beyond the painful area itself to determine what may be contributing to the problem.

Heel pain can have several different causes.

Depending on your symptoms, Dr. Alfandari may evaluate for other conditions including:

• Achilles tendinitis
• Stress fractures
• Heel pad injuries
• Nerve irritation or entrapment
• Tarsal tunnel syndrome
• Bursitis
• Arthritis
• Other soft-tissue or structural conditions

That is why persistent heel pain should be properly evaluated rather than automatically assuming it is plantar fasciitis.

Your visit begins with a comprehensive foot and ankle evaluation.

Dr. Alfandari will discuss when your symptoms began, where the pain occurs, what makes it better or worse, your activity level, footwear, and any previous treatments you have tried.

Your examination may include an assessment of:

• Location of heel tenderness
• Plantar fascia
• Foot structure
• Arch mechanics
• Ankle mobility
• Calf and Achilles flexibility
• Walking mechanics
• Areas of weakness or instability
• Footwear and activity-related factors

When clinically appropriate, diagnostic imaging may be recommended to evaluate the heel and rule out other causes of pain.

Plantar fasciitis commonly causes pain underneath the heel. One of its classic symptoms is significant discomfort during the first few steps after getting out of bed or after sitting for an extended period.

The plantar fascia and surrounding tissues can become relatively tight during periods of rest. When you suddenly place weight on the foot, the tissue is loaded again, which may produce the characteristic first-step pain associated with plantar fasciitis.

A heel spur may be visible on an X-ray, but the presence of a heel spur does not necessarily mean it is causing your pain. Many people have heel spurs without experiencing heel pain.

Orthotics may be helpful when foot mechanics or pressure distribution are contributing to plantar fascia stress. Dr. Alfandari can determine whether custom orthotics are appropriate after evaluating your foot structure and mechanics.

Shockwave therapy may be considered for chronic plantar fasciitis that has not responded adequately to conservative care. Whether it is appropriate depends on your diagnosis, symptoms, and previous treatment.

Some cases improve with time and conservative care, but persistent symptoms can last for months. Recurring or worsening heel pain should be evaluated to confirm the diagnosis and determine whether underlying biomechanical or activity-related factors are contributing.

Consider scheduling an evaluation if your heel pain is persistent, keeps returning, interferes with normal walking or exercise, or is becoming progressively worse.