Some people feel a sharp, stabbing pain in their heel the moment they get out of bed and take their first step after waking up. However, the pain often eases somewhat after walking a few steps, leading many to dismiss it as insignificant. If this symptom keeps recurring, though, it may be a sign of plantar fasciitis rather than simple fatigue.
The plantar fascia is a thick, fibrous band of tissue that extends from the heel bone toward the toes. It plays an important role in maintaining the arch of the foot and absorbing the shock generated when walking. Because it repeatedly bears the force of body weight and the ground every time we walk or run, it can become damaged if excessive strain continues.
Risk factors include lifestyles involving prolonged standing or walking, a sudden increase in exercise, repetitive weight-bearing activities such as running, weight gain, and reduced flexibility in the ankle joint. In particular, the burden placed on the plantar fascia can increase when people who do not normally exercise suddenly increase their activity level or walk for long periods.
Because of the name plantar fasciitis, it is easy to think that inflammation is the entirety of the condition. However, in chronic cases, repeated microdamage and degenerative changes in the tissue occur along with, or rather than, inflammation. For this reason, the condition is also described as plantar fasciopathy in recent usage.
The most characteristic symptom of plantar fasciitis is pain with the first steps after rest. Pain occurs when the tissues on the sole of the foot suddenly stretch as a person begins moving after sleeping or sitting for a long time. It usually develops on the inner side of the heel, where the plantar fascia attaches to the heel bone, and temporarily improves after a few steps. However, the pain may intensify again after prolonged walking or standing.
Of course, not every case of heel pain is plantar fasciitis. Problems with the heel fat pad, Achilles tendon disorders, nerve compression, and stress fractures of the heel bone can also cause similar symptoms. In particular, if numbness or burning accompanies the pain, or if the pain persists after a recent sharp increase in exercise, it is necessary to check whether another cause is involved.
Diagnosis is based on a comprehensive assessment of the pattern and location of the pain reported by the patient, along with a physical examination. Imaging tests are not always necessary when the symptoms are typical. However, if the pain persists for a long time or it is necessary to distinguish the condition from other diseases, tests such as ultrasound or X-rays may be performed. Ultrasound can help identify increased thickness of the plantar fascia and changes in the tissue.
The most important principle of treatment is to reduce the repeated burden placed on the plantar fascia and restore foot function. In the early stages, it is helpful to adjust activities that cause pain, sufficiently stretch the plantar fascia and calf muscles, and perform exercises to strengthen the muscles around the foot and ankle. Recent clinical practice guidelines also recommend exercises to strengthen the muscles around the toes and ankle, in addition to stretching the plantar fascia and calf muscles, as an important treatment method.
Choosing the right shoes is also important. Wear shoes that adequately support the arch of the foot and absorb shock, and use insoles or heel pads when necessary. Because the same treatment is not effective for every patient, the treatment method should be selected by considering the shape of the foot, the cause of the pain, and lifestyle factors.
If pain persists for a long time despite conservative treatment, additional treatment may be considered. Extracorporeal shock wave therapy is sometimes used for chronic plantar fasciitis, but research findings on its effectiveness have not been consistent. Therefore, the decision should be based on the patient's condition and response to previous treatment. Surgery is generally considered cautiously only for some patients whose symptoms persist for a considerable period despite nonsurgical treatment and who experience severe limitations in daily life.
Plantar fasciitis is not a life-threatening condition, but if the pain persists for a long time, it can change the way a person walks and affect quality of life. Above all, it is not advisable to simply endure heel pain.
In particular, if heel pain repeatedly occurs with the first step in the morning or in the same area when standing up after sitting for a long time, plantar fasciitis may be suspected. It is important to accurately determine whether the pain is caused by the plantar fascia or another condition and begin appropriate treatment.
Healthy feet support our bodies and make daily movement possible without requiring conscious attention. When foot pain develops, rather than dismissing it by thinking, “It is probably because I walked too much,” it is worth considering what recurring pain may mean. Pain with the first step in the morning can sometimes be the clearest signal the feet are sending.
(*This column was contributed by Choi Junyoung, professor of orthopedic surgery at Ilsan Paik Hospital.*)
The plantar fascia is a thick, fibrous band of tissue that extends from the heel bone toward the toes. It plays an important role in maintaining the arch of the foot and absorbing the shock generated when walking. Because it repeatedly bears the force of body weight and the ground every time we walk or run, it can become damaged if excessive strain continues.
Risk factors include lifestyles involving prolonged standing or walking, a sudden increase in exercise, repetitive weight-bearing activities such as running, weight gain, and reduced flexibility in the ankle joint. In particular, the burden placed on the plantar fascia can increase when people who do not normally exercise suddenly increase their activity level or walk for long periods.
Because of the name plantar fasciitis, it is easy to think that inflammation is the entirety of the condition. However, in chronic cases, repeated microdamage and degenerative changes in the tissue occur along with, or rather than, inflammation. For this reason, the condition is also described as plantar fasciopathy in recent usage.
The most characteristic symptom of plantar fasciitis is pain with the first steps after rest. Pain occurs when the tissues on the sole of the foot suddenly stretch as a person begins moving after sleeping or sitting for a long time. It usually develops on the inner side of the heel, where the plantar fascia attaches to the heel bone, and temporarily improves after a few steps. However, the pain may intensify again after prolonged walking or standing.
Of course, not every case of heel pain is plantar fasciitis. Problems with the heel fat pad, Achilles tendon disorders, nerve compression, and stress fractures of the heel bone can also cause similar symptoms. In particular, if numbness or burning accompanies the pain, or if the pain persists after a recent sharp increase in exercise, it is necessary to check whether another cause is involved.
Diagnosis is based on a comprehensive assessment of the pattern and location of the pain reported by the patient, along with a physical examination. Imaging tests are not always necessary when the symptoms are typical. However, if the pain persists for a long time or it is necessary to distinguish the condition from other diseases, tests such as ultrasound or X-rays may be performed. Ultrasound can help identify increased thickness of the plantar fascia and changes in the tissue.
The most important principle of treatment is to reduce the repeated burden placed on the plantar fascia and restore foot function. In the early stages, it is helpful to adjust activities that cause pain, sufficiently stretch the plantar fascia and calf muscles, and perform exercises to strengthen the muscles around the foot and ankle. Recent clinical practice guidelines also recommend exercises to strengthen the muscles around the toes and ankle, in addition to stretching the plantar fascia and calf muscles, as an important treatment method.
Choosing the right shoes is also important. Wear shoes that adequately support the arch of the foot and absorb shock, and use insoles or heel pads when necessary. Because the same treatment is not effective for every patient, the treatment method should be selected by considering the shape of the foot, the cause of the pain, and lifestyle factors.
If pain persists for a long time despite conservative treatment, additional treatment may be considered. Extracorporeal shock wave therapy is sometimes used for chronic plantar fasciitis, but research findings on its effectiveness have not been consistent. Therefore, the decision should be based on the patient's condition and response to previous treatment. Surgery is generally considered cautiously only for some patients whose symptoms persist for a considerable period despite nonsurgical treatment and who experience severe limitations in daily life.
Plantar fasciitis is not a life-threatening condition, but if the pain persists for a long time, it can change the way a person walks and affect quality of life. Above all, it is not advisable to simply endure heel pain.
In particular, if heel pain repeatedly occurs with the first step in the morning or in the same area when standing up after sitting for a long time, plantar fasciitis may be suspected. It is important to accurately determine whether the pain is caused by the plantar fascia or another condition and begin appropriate treatment.
Healthy feet support our bodies and make daily movement possible without requiring conscious attention. When foot pain develops, rather than dismissing it by thinking, “It is probably because I walked too much,” it is worth considering what recurring pain may mean. Pain with the first step in the morning can sometimes be the clearest signal the feet are sending.
(*This column was contributed by Choi Junyoung, professor of orthopedic surgery at Ilsan Paik Hospital.*)