​Does your heel feel painful when you get up from bed every morning, or when you get up after sitting down for a long period of time?

If you often experience this sort of pain, known as 'first step pain', you could be suffering from plantar fasciitis (pronounced fash-ee-eye-tus), an inflammation of the plantar fascia, or the band of muscle under the foot. Plantar fasciitis is the most common cause of heel pain.

"This condition is most commonly seen in people who make poor choices of footwear, wearing thin soles or footwear which is not supportive enough, or those who suddenly go back to strenuous activity after a long period of rest. It can also occur in people who have a short calf musculature or a poor ankle range of motion," explains Ms Marabelle Heng Li-Wen, Senior Podiatrist, Department of Podiatry, Singapore General Hospital (SGH), a member of the SingHealth group.

However, she says that it is not necessary to rush to a doctor if you experience heel pain. Instead, you could try resting your foot first and switching to more comfortable and supportive footwear. If your pain does not clear up after a week of wearing better footwear, then you should see a doctor.

The doctor may advise you to get a diagnostic ultrasound or x-ray after assessing your symptoms and medical history.

Causes and symptoms of plantar fasciitis

Commonly affecting middle-aged men and women, plantar fasciitis is caused by strain to a muscle under the foot that gives support to the arch. This muscle band may have small tears and inflammation from recurrent strain, causing pain and swelling in the foot. It can occur in one foot or both feet.

The most common symptom of plantar fasciitis is'“first step pain'.

How plantar fasciitis can be treated

Ms Heng says, "Treatment includes resting, icing and the use of orthotics or foot supports, and anti-inflammation drugs. Doctors may sometimes also give a steroid injection to settle the inflammation. Surgery is a last resort after all other conservative means have been exhausted in chronic cases."

Patients are usually advised to rest for 3-8 weeks, with an average of six weeks, depending on the severity of the injury.

It is also recommended that patients wear good supportive footwear at all times, even at home, and exercise the calf muscles several times a day. Effective daily exercises include calf stretches which can also be done using a towel.

Calf stretch with towel

  • Sit down with your legs stretched out in front of you and place a medium size towel under the ball (top portion) of your foot.
  • Hold the two ends of the towel in separate hands, pulling the towel gently towards you while keeping your knees straight.
  • Hold for a minimum of 10-15 seconds and repeat a few times.

Calf stretch against the wall

  • Stand up and place your hand against the wall, keeping one leg in front with your knees bent.
  • Keep the other leg behind with your knees straight and lunge forward.
  • Hold for a minimum of 10-15 seconds and repeat a few times.

Can you still do sports and other activities?

People suffering from plantar fasciitis should refrain from active sports and other physical activities during periods of acute injury, advises Ms Heng. Those with chronic heel pain, however, can do light exercises using supportive footwear that has been fitted with insoles or braces.

Ms Heng suggests that as a preventive measure, women who favour high heels stretch their calf muscles daily to ensure that their calf muscles are not shortened by prolonged or continuous use of the high heels. Shortening of calf muscles may predispose one to plantar fasciitis.

"Plantar fasciitis usually has a very good prognosis as long as you comply with the treatment as advised," she observes.

Ref. T12