A patient told me something last week that I hear almost every week, in some form or another. She said the worst part of her day was not the long shifts on her feet at work, not the evening walk by the river with her dog, not doing grocery shopping at the shops. The worst part was simply the first ten steps out of bed every single morning. The stabbing pain through her heel, like stepping on a piece of broken glass, got her bracing herself each time, and that, frankly, was just not the best way to start the day.
But, that’s plantar fasciitis. It’s one of the most common reasons people end up in my clinic.
The Plantar Fascia
The plantar fascia is a thick band of tissue that runs along the bottom of your foot, from your heel to your toes. Think of it like a bowstring holding up the arch. Every time you take a step, it stretches and springs back, absorbing load and helping push you forward. It’s built to do this thousands of times a day, for as much as you walk on your feet.
The Plantar Fascia’s Enemy
Like all tissues in the body, the plantar fascia has a limit as to how much load it can tolerate. If you have been inside a lift, you would have seen a sign in there that tells you the maximum weight the lift can operate with safely. Going over the limit the lift will beep and prompt some people to get out. The plantar fascia is the same. It has a limit and pain is the signal that it has been overloaded.
As long as the load stays within the capacity of the plantar fascia, it can function properly perpetually. On the other hand, overloading the plantar fascia will cause micro-tears near its attachment to the heel bone.
What Causes the Overloading
Many factors are in play when we look at the load applied to the plantar fascia. Your weight, the amount of time spent on your feet, your footwear, your foot type, gait, biomechanics…etc. all contribute to the amount of load the plantar fascia experiences on a daily basis.
When the fascia starts to break down faster than it can repair, it results in that sharp, stabbing pain which is worst first thing in the morning or after sitting for a while. The first few steps are always the worst because the fascia tightens up at rest and then gets wrenched back into action the moment you stand.
I’ve seen it in FIFO workers, nurses, and teachers alike who spend hours a day on their feet. I’ve seen it in people who enjoy walking daily for their health and wellbeing. I’ve seen it in people who have had good feet all their life until one day the pain hits from nowhere. Because overloading is not dramatic. It happens quietly in the background, and that is why plantar fasciitis feels like a very sudden occurrence to most people.
If There’s One Thing You Need To Know…
It is that plantar fasciitis rarely fixes itself by waiting it out and masking the pain with anti-inflammatory. People often push through it for months, even years sometimes, hoping it’ll settle, and it just doesn’t. Or that it settles for a period of time, only recurring with sharper pain next time around.
What your painful heel needs is a proper look at why the load got too high in the first place. It’s by reducing the load, the source of damage, that the plantar fascia can heal itself with time.
Every foot loads differently, and a fascia that’s already under strain needs support built specially around how you stand, walk and run. Get that right, alongside the right footwear and a sensible return to activity, most people are surprised how much a foot that’s been giving them grief for months can start to settle.
If your mornings start with that same stabbing step my patient described, it might be worth having a proper look at what’s causing it.
