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At a glance
- Plantar fasciitis is the commonest cause of heel pain, from irritation of the thick band of tissue running along the sole of the foot.
- The classic sign is sharp heel pain with the first steps in the morning, or after sitting for a while.
- It is linked to overuse, tight calves, unsupportive footwear, standing jobs and carrying extra weight.
- Most cases settle with stretching, supportive footwear and time; a smaller number need physiotherapy or other treatments.
Symptoms
The typical symptom is a stabbing or bruised pain under the heel, usually towards the inner side where the fascia attaches to the heel bone. It is at its worst with the first few steps after waking, or when you stand up after sitting for a while, then often eases as the foot warms up. The pain can creep back later in the day after long periods of standing, walking or exercise. It usually affects one foot, but can affect both. The heel may feel tender to press, and some people notice stiffness in the arch. Sharp pain that comes on suddenly during activity, or pain with tingling, numbness or a burning feeling, points away from plantar fasciitis and is worth having checked.
What causes it
The plantar fascia is a strong sheet of tissue that spans the sole from the heel to the base of the toes, helping to support the arch and absorb load with each step. When it is repeatedly overloaded, small strains and irritation develop where it anchors to the heel, and the tissue becomes painful and less able to cope. Common contributors include a sudden increase in walking or running, especially on hard surfaces, standing for long stretches at work, tight calf muscles and Achilles tendon (which pull on the heel), flat feet or very high arches, worn-out or unsupportive shoes, and carrying extra body weight, which raises the load through the fascia. Often it is a combination of these rather than a single cause, and many people cannot point to one clear trigger.
Who is at risk
Plantar fasciitis can affect anyone, but some groups are more prone to it. Runners and people who take up a new exercise routine quickly are frequently affected, as are those in standing occupations such as retail, teaching, nursing, security work and hospitality. It is most common in the middle years of adult life. Foot shape plays a part, with both flat feet and high arches changing how load spreads across the sole. Tight calf muscles, reduced ankle movement and a higher body weight all add strain. Wearing thin, flat or unsupportive footwear for long hours, including walking barefoot on hard floors at home, can also make it more likely.
How it is diagnosed
Plantar fasciitis is usually a clinical diagnosis, meaning a doctor can identify it from your description and a simple examination without special tests. They will ask about the pattern of pain, particularly the first-step-in-the-morning history, your activity, work and footwear, and any recent change in exercise. On examination they typically press along the inner heel to find the tender spot and check your calf tightness, arch shape and ankle movement. Imaging such as X-ray or ultrasound is usually not needed. It may be used in cases that are not improving, when the diagnosis is unclear, or to help rule out other causes such as a stress fracture, nerve irritation or, rarely, other conditions. A heel spur seen on X-ray is a common incidental finding and is generally not the source of the pain.
Course and complications
For most people plantar fasciitis is self-limiting and improves gradually with time and simple treatment, though recovery is often measured in weeks to months rather than days, which can be frustrating. A minority develop long-standing (chronic) symptoms that persist and need more structured care. Because a sore heel changes how you walk, some people start to limp or shift weight onto the other foot, which can lead to new aches in the other heel, the ankle, knee, hip or lower back. Persistent pain can also make regular exercise harder to keep up. These knock-on effects usually ease once the heel pain settles and normal walking returns.
How it is treated
Most people recover with conservative care, and it is worth giving this a fair trial, as it works for the majority. Helpful steps include:
- Load management: cut back on activities that flare the pain, such as long runs or extended standing, without stopping moving altogether; low-impact options like swimming or cycling can keep you active.
- Stretching: regular calf stretches and specific plantar-fascia stretches (for example rolling the arch over a bottle or ball, and gently pulling the toes back) are among the most effective measures.
- Supportive footwear and insoles: well-cushioned shoes with good arch support, worn even around the house, plus over-the-counter cushioned or arch-support insoles, reduce strain on the fascia.
- Ice: applying something cold to the heel after activity can ease soreness.
- Pain relief: simple over-the-counter pain-relieving or anti-inflammatory medicines may help for short periods; a pharmacist or doctor can advise on what is suitable for you.
- Weight: where relevant, reducing excess weight lowers the load through the foot.
If symptoms are stubborn or not settling after a reasonable period of self-care, a doctor may refer you for further assessment and add other options. These can include physiotherapy for a guided stretching and strengthening programme, night splints that hold the foot in a gentle stretch overnight, custom orthotics, steroid injections for short-term relief in selected cases, and shockwave therapy for persistent pain. Surgery is rarely needed and is reserved for the small number of severe, long-standing cases that do not respond to everything else. A GP, polyclinic doctor, physiotherapist, podiatrist or orthopaedic specialist can help decide which steps suit you.
Living with it and self-care
Consistency matters more than intensity. Doing your calf and fascia stretches a few times a day, especially before the first steps out of bed, tends to help more than occasional heavy sessions. Keep supportive shoes on rather than walking barefoot on hard floors, and replace worn-out footwear. When returning to running or sport, build up gradually rather than jumping back to previous distances, and warm up beforehand. Vary hard training surfaces where you can. If your work involves long hours standing, a cushioned mat and supportive footwear can make a difference. Where excess weight is a factor, gradual, sustainable changes to activity and diet reduce the ongoing load. Recovery is often slow and can have ups and downs, so patience and sticking with the basics are key. HealthHub has general foot-care guidance for Singapore residents.
When to see a doctor
See a doctor if heel pain is severe, is not improving after a few weeks of self-care, follows a specific injury or a sudden pop, or stops you walking normally. Also seek advice if there is numbness, tingling or a burning feeling in the foot, marked swelling, redness or warmth, fever, or if the heel gives way, as these can suggest another cause that needs different treatment. People with diabetes or poor circulation should have foot problems assessed early, as they are more prone to complications. A GP or polyclinic is a sensible first stop, and can refer you to physiotherapy, a podiatrist or an orthopaedic specialist if needed.
Common questions
Why is my heel pain worst in the morning?
The fascia tightens overnight while the foot is at rest, so the first steps stretch and load it suddenly, causing sharp pain that usually eases as the foot warms up.
How long does plantar fasciitis take to heal?
It often improves over several weeks to months with stretching and supportive footwear, though it can be persistent and recovery is rarely quick. Sticking consistently with self-care gives the best chance of settling.
What footwear helps?
Supportive shoes with good cushioning and arch support, worn even at home, along with cushioned or arch-support insoles, reduce strain on the fascia. Avoid long periods barefoot on hard floors or in thin, flat shoes.
Can I keep exercising?
Usually yes, but ease off high-impact activities that flare the pain and switch to lower-impact options like swimming or cycling for a while. Return to running gradually as the pain settles rather than all at once.
Related guides
Sources
- HealthHub Singapore — heel pain.
- Ministry of Health Singapore — musculoskeletal conditions.
- American Academy of Orthopaedic Surgeons — plantar fasciitis.
- UK NHS — plantar fasciitis (heel pain).
This article is for general information only and does not replace a consultation with a qualified doctor. Please seek personalised medical advice for your situation.