Severe heel pain upon waking, particularly when first putting weight on the feet, is often a classic symptom of plantar fasciitis, according to Dr. Martin Scurr. This condition involves inflammation of the plantar fascia, a thick band of tissue that extends from the heel to the toes along the sole of the foot. The pain is typically most acute in the morning because the tissue tightens overnight. It gradually subsides after a few minutes of movement.
Plantar fasciitis is commonly observed in middle-aged individuals due to natural tissue aging. Contributing factors can include wearing unsupportive footwear or a sudden increase in physical activity, such as prolonged walking. A diagnosis can often be made by pressing on a specific point on the underside of the heel, known as the medial calcaneal tubercle, which elicits sharp pain if the fascia is inflamed.
In some instances, an X-ray may be recommended to check for bone spurs extending from the heel bone into the fascia, which can develop as a result of inflammation and the body's repair processes. Pain at the back of the heel, rather than underneath, might indicate damage to the Achilles tendon, with discomfort persisting throughout the day as the tendon bears load.
Dr. Scurr suggests consulting a physiotherapist or podiatrist for a confirmed diagnosis and guidance on stretches to improve flexibility and alleviate pain. The use of an orthotic insole placed under the heel can also help by reducing the strain on the inflamed tissue. These insoles can be purchased commercially, or a healthcare professional can assist in selecting the appropriate type.
For persistent pain that does not respond to conservative treatments, a referral to an orthopedic specialist may be necessary for a corticosteroid injection. However, this is generally considered a last resort due to its painful nature and potential risks, such as rupture of the plantar fascia.