That sharp stab beneath the heel with the first few steps in the morning is a familiar discomfort for many, but when it keeps returning, it could be plantar fasciitis. Often mistaken for ordinary foot fatigue, the condition can make the simplest routines, be it getting out of bed, standing for long hours or taking a walk, increasingly uncomfortable. And while the pain may ease after a few minutes of movement, doctors say that pushing through it without addressing the underlying cause can allow the problem to linger.
“Plantar fasciitis is a common condition, but not every heel pain is plantar fasciitis,” says Dr Ajay Singh Thakur, consultant – orthopaedic surgery, arthroscopy & sports medicine, STAR Hospitals, Banjara Hills. The typical pain, he explains, is felt under the heel, usually towards the inner side, and is particularly severe with the first few steps after waking up or after sitting for a long time. “The pain often improves after walking for a while but may return after prolonged standing or walking. The tenderness is typically localised to the medial calcaneal tubercle, where the plantar fascia originates,” he adds.
That familiar first-step pain has a mechanical explanation. Dr Ajay explains, “The previously irritated fascia is suddenly stretched and loaded. This mechanical loading stimulates pain-sensitive tissue around the plantar fascia origin, producing the characteristic sharp first-step pain. As you continue walking, the tissues become progressively loaded, and the pain often temporarily ceases.” Plantar fasciitis is not restricted to people who stand for long hours. Runners and athletes can develop it after suddenly increasing their training, while someone who is usually sedentary may experience symptoms after taking up long walks. Footwear, body weight, tight calf muscles and foot structure can also influence susceptibility.
Dr Ravi Teja Rudraraju, consultant orthopaedic surgeon, Apollo Hospitals, Financial District further highlights, “An effective treatment plan usually combines activity modification, stretching, strengthening and appropriate footwear. Calf stretches and plantar fascia-specific exercises are particularly important because tight calf muscles and weakness can increase stress on the plantar fascia. Physiotherapy can help patients perform exercises correctly, improve flexibility and strengthen the foot and lower limb.” The problem is that many people continue with their usual routine despite the pain. Over time, that can affect the way they walk. “Walking through heel pain may seem harmless, but persistent plantar fasciitis should not be ignored. Continued strain can cause thickening of the plantar fascia, altered walking patterns and increasing pain,” he adds.
Despite its name, chronic plantar fasciitis is also not necessarily an inflammatory condition. It is often associated with repeated micro-injury, tissue degeneration and inadequate recovery. Dr Ajay notes, “If the underlying problem is overload and impaired tissue adaptation, treatment also needs to address these issues. This includes reducing or modifying excessive loads, gradual plantar fascia and calf strengthening, improving ankle flexibility where appropriate, correcting relevant biomechanical or training errors, and gradually returning to activity rather than prolonged rest.” Recovery from plantar fasciitis can vary considerably. Many patients improve within several weeks to a few months with appropriate conservative treatment, although some may experience symptoms for six months or longer. “The duration depends on symptom severity, body weight, activity levels, footwear, calf tightness, foot biomechanics and adherence to rehabilitation. Continuing activities that aggravate pain or stopping exercises once symptoms improve can increase the risk of prolonged or recurrent symptoms,” highlights Dr Ravi, adding, “When symptoms persist despite several months of appropriate conservative treatment, doctors may consider additional options. Shockwave therapy can be useful in selected patients with chronic plantar fasciitis. Injections, including corticosteroids, may provide short-term relief but need careful consideration because repeated steroid injections can weaken the plantar fascia. Surgery is rarely required and is generally reserved for persistent, disabling cases after other treatments have failed. Each option has benefits and limitations.”
