The most common symptom of plantar fasciitis is pain on the bottom, inside part of your heel after periods of rest.
If that is what you are experiencing then you have plantar fasciitis
You may feel the pain differently to what is described on the internet. It could be sharp; it could be dull and always there; it could be achy; it could be burning or stabbing pain. It may be one of these or all of them at different times of the day.
The intensity and type of pain can vary, and how you describe it, but the location is the same.
Plantar Fasciitis is often most painful right after you have woken up in the morning and stand from bed and take your first ten to twenty steps. This can be the most painful part of your day. You’ve rested for the longest part of your day wile you have slept. At night while you sleep your foot relaxes. All of the damaged tissue starts to half heal and repair in this relaxed shortened position. Then when you get up and put weight on your foot your arch lowers and your ankle moves to allow you to stand and stretches the healing done on the fascia overnight.
That increases the pulling on the fascia at the attachment on the heel. As soon as you stand and take your first few steps you are damaging the half heeled fascia from the night before and so the cycle repeats itself.
This start to day is not only painful but starts the pain inflammation loop straight away and damages the heel again.
You may have seen night splints advertised on the internet to hold your foot at 90 degrees so when the healing is taking place over night it heals the fascia with it in its most stressful position (These are available HERE). https://amzn.to/4rJr4EP
Some people find these work, it depends on how long you have had plantar fasciitis and how severe it is. Also how you stand and walk is significant.
Once stood up and taken the first 10 or so steps the pain tends to reduce because you have now re-torn the tissue to a point where you can walk on it with a baseline level of pain.
Just a side note on pain as we all interpret intensity and pain differently at different times. The 0 to 10 scale is useful if you use it like this:
As humans we polarise things to extremes, left right, up and down, right wrong. We do the same with pain but in a different way.
If your Plantar Fasciitis is extremely painful where you can only put limited pressure on the highest is a 9, a 10 is immediate hospital and Accident and Emergency!
The next problem is less pain
Zero is the goal obviously but, I suggest to use a 9 for very high, 6 for medium, but I can do things and 3 is more back ground and can move to a 6 if pain has a noticeable increase.
This 3, 6, 9 system allows not only a scale, but a useable tool to help with baseline pain tracking over a day to allowing you to grade changes more effectively.
So you have re-torn your fascia from standing up first thing, hobbled about and walking has dropped the pain down to a 6 or in lots of cases a 3. This why 20% of people with plantar fasciitis can often be relatively active with plantar fasciitis, and it causes less issues while moving. People who stand a lot due to work or tasks also appear to be on hot bricks and always moving.
Importantly if you sit down for a while and then get up again, the pain gets worse because the tissue starts to try and heal again.
You may have experienced this at work or at home where you have sat working on a computer or just watching television in the evening and had acute pain when you have stood up!
Some of you will be in that much pain, you have to limp to the bathroom in the morning because you cannot stand on your foot. Others say it’s especially bad after sitting at work, or watching television. You may have to walk on your toe, to not put pressure on your heel for the first 10 steps. Stairs can be problematic, especially coming down as you may go side ways on your toes.
What you tend to think is that as the pain reduces after you have got going, its doing it some good, its warmed up so to speak.
What will sound very counterintuitive to you is that by standing and walking this way doing more damage! You don’t tend to associate a reduction in pain with causing more damage, but that is exactly what is happening!
When you realise that plantar fasciitis is an injury, you now understand why the first step for treatment is not to stand or walk on your foot first thing in the morning.
Well you have to get up, but, how you stand and walk, is the difference between reducing damage, or increasing it.
Now this process happens through the day, post sitting for breakfast, getting out of the car after 20 minutes of driving to drop the kids off, or going to work or the shops. Every time you rest for a period of time off your feet the body starts repairing the fascia and when you stand its damaged again.
Now where the conflict of understanding comes in is how bad is your plantar fasciitis?
(3) Early stage or mild plantar fasciitis you may after standing up and walking short distances be in a position where pain and discomfort is low and you can do most things.
(6) Moderate is where most people are with plantar fasciitis when it tends to be impacting more on your life. You start thinking about what you are doing more and are conscious of an issue daily.
(9) Severe Plantar Fasciitis is obviously debilitating and standing and walking is a issue and time on feet is problematic and you tend to try everything to help.
I am a Plantar Fasciitis expert and I tend to see people who are a 6+ on the pain scale and have tried a number of solutions with footwear, insoles, injections and physiotherapy. They have also used different things on the Internet.
When everything else has not worked people come to see me as a last line of defence.
Obviously if you come to see me when your plantar fasciitis is just starting it tends to healed and corrected quickly. That’s why I have written this piece and developed an at home Plantar Fasciitis Rehabilitation Programme that I use to support all of patients I see and 1000s I don’t. This information is an extension of that as I want to help more people in the early stages of plantar fasciitis!