Why is plantar fasciitis worse in the morning?

Overnight the foot rests in a pointed position and the tissue under the arch shortens and stiffens. The first few steps load it suddenly, which produces that sharp, bruised feeling, and it eases as the tissue warms and the foot starts moving. Pulling the toes back towards your shin and rolling the sole over a ball before standing up often takes the worst of it away.

Are heel spurs the cause of my heel pain?

Almost certainly not. Heel spurs show up on x-rays of a great many people who have never had heel pain, and plenty of people with painful heels have no spur at all. A spur is generally a sign that the tissue under the heel has been loaded over a long period rather than the thing producing the pain, and removing it is rarely the answer.

Do insoles help plantar fasciitis?

Many people find supportive shoes, a heel cushion or an over-the-counter arch support noticeably more comfortable, particularly if they stand all day. They reduce the load rather than fixing the underlying problem, so they work best alongside calf and foot strengthening. It is worth trying an inexpensive over-the-counter support first to see whether that kind of help suits your foot before spending more.

Where can I get plantar fasciitis treatment in Bromley?

SMSM Therapy is at Carlton Chambers, 5 Station Road, Bromley BR2 0EY. The entrance is the red side gate to the right of the building, a three-minute walk from Shortlands station. We also see people from Beckenham, Shortlands, Hayes, West Wickham, Chislehurst, Petts Wood and Orpington. Call 07896 257328 to arrange an assessment or to talk through whether treatment is likely to suit you.

Plantar Fasciitis and Heel Pain Treatment in Bromley

The plantar fascia is a thick, fibrous band running from under the heel bone to the base of the toes, acting as a tie-rod for the arch. When it becomes painful the pattern is unmistakable: the first few steps out of bed are sharp and bruising under the heel, it eases after a minute or two of walking, and it returns after any long spell of sitting.

At our Bromley clinic this arrives in two sorts of people. First, runners who put their mileage up, changed to flatter shoes or added hills. Second, and more commonly, people whose feet simply had a change of job: nurses, teachers, retail staff, or anyone who spent a fortnight of summer in flat sandals. Most have had it for months before booking.

How to tell if that is what you have

The pattern matters more than the spot.

Sharp pain under the heel on the first steps of the morning, or on standing after sitting.
It eases within a few minutes of walking, then worsens after a long day upright.
A tender point you can find with a thumb, towards the front and inner side of the heel bone.
Worse barefoot on hard floors, better in cushioned or supportive shoes.
Little or no swelling, redness or bruising.

A bruised heel fat pad is tender in the middle of the heel and lacks the morning pattern. A stress fracture hurts constantly, worsens through a run, and is sore when you squeeze the heel from both sides. Burning or tingling suggests a nerve, and pain at the back of the heel is an Achilles problem. Heel spurs appear on x-rays of plenty of people with no pain and are not the cause.

What actually causes it

The fascia is loaded every time your weight passes over the foot, and that load rises as the toes bend at the end of each step. Trouble starts when demand climbs faster than the tissue can adapt: more miles, more standing hours, a new surface, a change of footwear, or a change in body weight. Stiff ankles and a tight or weak calf are common contributors.

Despite the name, long-standing cases show tissue that has degenerated and thickened rather than tissue that is acutely inflamed. That is why anti-inflammatories and repeated rest so often disappoint, and why approaches that build tolerance in the calf and foot do better over time.

How we treat it at the clinic

We look at the foot, the calf, ankle movement and how you walk, and ask what changed in the weeks before it started. That last question answers more cases than any test.

An exercise programme is the core of it. Slow, heavy calf and foot strengthening, progressed over months, has the best supporting evidence of anything available here, and beats stretching alone.

Sports massage through the calf and sole usually reduces the morning sharpness and makes the loading more comfortable. If your heel is more comfortable in supportive shoes than barefoot, an over-the-counter arch support or heel cushion is usually worth trying alongside the strengthening.

What you can do yourself

Warm the foot up before your first steps. Pull your toes back towards your shin and hold, a few times, then roll the sole over a ball for a minute.
Stop going barefoot on hard floors at home. Supportive shoes indoors, plus a cheap heel cushion or arch support, often make an obvious difference within days.
Spread the load rather than removing it: two shorter walks instead of one long one.
Build calf strength: slow heel raises, some with a rolled towel under the toes, three times a week.

How long it takes

Honestly, this one is stubborn. Most people improve substantially over three to six months, and a proportion take up to a year. Expect the first change within four to six weeks, usually as fewer bad mornings.

Morning pain is the last symptom to leave, so it is the best measure of progress. If nothing has shifted after about three months, a GP review may lead to imaging, podiatry, an NHS physiotherapy referral or a discussion about injections.

When to see a doctor instead

See your GP rather than a therapist if any of these apply.

The pain began after a fall or a jump from height, which can fracture the heel bone.
Pain that is constant, present at night and steadily worsening, or a heel sore when squeezed from both sides, which can mean a stress fracture.
Numbness, burning or pins and needles spreading into the foot or toes.
A hot, red, swollen heel, particularly with fever.
Any foot pain, broken skin or altered sensation if you have diabetes.
Both heels sore in a younger adult alongside back stiffness, other painful joints or inflamed eyes.

Book plantar fasciitis treatment in Bromley

The clinic is at Carlton Chambers, 5 Station Road, Bromley BR2 0EY, and the entrance is the red side gate to the right of the building. We are a three-minute walk from Shortlands station and see people from across Bromley as well as Beckenham, Shortlands, Hayes, West Wickham, Chislehurst, Petts Wood and Orpington.

Call 07896 257328 to talk through what has been happening with your heel, or book an appointment online. See our prices, or the location page for directions.

Written by Dharam Vyas, sports therapist and clinic director at SMSM Therapy, Bromley.