Heel pain has a signature, and most people describe it the same way. You get out of bed, put your foot down, and the first few steps feel like standing on a stone. By the time the kettle has boiled it has eased. Then you sit at your desk for an hour, stand up, and it is back.
From October onwards this is one of the most common complaints walking through the door at our Bromley clinic, and the pattern is fairly predictable. Runners who have moved off the muddy trails onto hard pavement now the evenings are dark; people who have swapped cushioned summer trainers for flat boots and backless slippers; and anyone who spends the working day upright on a hard floor. Here is what is usually going on, what genuinely helps, and when you should see a doctor rather than a therapist.
What first-step heel pain usually is
Nine times out of ten we are talking about plantar heel pain, still widely called plantar fasciitis. The plantar fascia is a thick band of tissue running from the underside of your heel bone to the base of your toes, and it works a bit like a bowstring holding the arch of your foot. When the load going through it outstrips what it can repair, small tears accumulate where it attaches to the heel. The tissue thickens and becomes sore, usually in one specific spot on the inside of the heel that you can press with a thumb and find straight away.
The “-itis” is slightly misleading. This is an overloaded tissue that has not kept up with repair rather than a hot, inflamed joint, which is why anti-inflammatory tablets often take the edge off without fixing anything.
Why it is worst in the morning
Overnight your foot settles into a pointed position. The calf and the fascia shorten slightly and the repairing tissue sets in that shortened state. Your first steps load it suddenly and at full body weight, and the sensitive attachment at the heel complains loudly. After a few minutes of walking the tissue has lengthened and warmed, and the pain fades.
That is also why it returns after you have been sitting at a desk or in the car. If your pain is sharp on the first steps, easier with movement, then sore again late in the day after a lot of standing, it is a fairly classic picture.
What makes it more likely
- A sudden jump in running or walking volume, or coming back to exercise after a break
- Hard, flat surfaces at work, and long periods standing still rather than moving
- Tight or weak calf muscles, which change how much load the fascia has to absorb
- Unsupportive footwear, including flip-flops, flat fashion shoes and backless slippers, and a lot of barefoot walking on hard floors
- A meaningful increase in body weight over a short period
What actually helps
The order of importance here is not what most people expect. The approach with the best track record is progressively loading the tissue so it tolerates more: calf and foot strengthening, usually slow heel raises, often with the toes propped on a rolled towel so the fascia is stretched as you lift. It is unglamorous, it needs doing several times a week, and it works over months rather than days.
Alongside that:
- Wear shoes with a cushioned heel and real arch support, indoors as well as out; gel insoles or heel pads help a lot of people
- Pace rather than stop. Keep moving, but swap some of your running for cycling or swimming while the heel settles
- Stretch the calf and roll the sole of the foot over a cold bottle, particularly before your first steps of the day
- In a flare-up, ice for ten to fifteen minutes a couple of times a day and back off the aggravating activity for a week
What we do at the clinic sits around that, not instead of it. Hands-on work through the calf and the sole with sports massage commonly makes those first steps less brutal and makes the strengthening more tolerable. Medical acupuncture into tight points in the calf is often used where the calf is the obvious driver. Taping can take some load off the arch for a few days, which is useful if you have a race or a long shift coming. But the exercise programme you take home is what changes the heel. Anyone promising to fix plantar heel pain in a session or two on the couch alone is overselling it.
When a therapist is not the answer
Most heel pain is mechanical and safe to treat. Some is not. Please see your GP, or go to A&E where it says so, if:
- You felt a sudden snap or pop at the back of the ankle, have bruising there, and cannot push off or stand on tiptoe. That needs assessing the same day at A&E
- Your heel is hot, red and swollen and you feel unwell or feverish
- The pain came on after a fall or a big jump, hurts when you squeeze the heel from both sides, and is getting worse rather than better with rest, which can point to a stress fracture
- Both heels hurt, especially if you are under 40 and also have morning stiffness in your lower back, or other sore joints, psoriasis or gut symptoms. That combination can suggest an inflammatory cause which needs blood tests, not massage
- You have numbness, pins and needles or burning spreading into the sole or toes
- Pain wakes you at night, or comes with unexplained weight loss
How long it takes
Longer than anyone wants. A single flare-up often settles inside six weeks, but the problem as a whole frequently takes several months. Beyond six months it is generally harder to shift and worth a review, as there are further options such as shockwave therapy or injections available elsewhere. The people who do best start the loading work early and keep it going after the pain has gone.
Book sports massage in Bromley
We are at SMSM Therapy, Carlton Chambers, 5 Station Road, Bromley BR2 0EY. Come through the red side gate to the right of the building. It is a three-minute walk from Shortlands station.
Call or text 07896 257328, email info@smsmtherapy.co.uk, or book online. You can see our prices and how to find us on the site.
We see clients from Bromley, Beckenham, Shortlands, Hayes, West Wickham, Chislehurst, Petts Wood and Orpington.
Written by Dharam Vyas, sports therapist and clinic director at SMSM Therapy, Bromley.
