Plantar fasciitis: why do the first steps hurt?
By Oriol Martínez Picas, registered physiotherapist (Col. 10224) · Published
Heel pain on the first steps in the morning, or when standing up after sitting, is the most typical symptom of plantar fasciitis. It can be treated and in most cases it improves, but it needs time and consistency.
Why it hurts in the morning
During rest, the plantar fascia, the tissue linking the heel to the toes, loses tension. When you put weight on it suddenly, it stretches sharply at a point that is already sensitive. That is why the pain is worse at the start and usually eases as you warm up.
What really helps
- Progressive strength exercise for the foot and calf, increasing the load over time.
- Temporarily reducing impact and mileage, without stopping completely.
- Shoes with good cushioning and, sometimes, insoles or a heel lift in the short term.
- Manual therapy and techniques such as dry needling if there is a lot of muscle tension.
What usually does not work
Complete rest and stretching alone rarely solve the problem. The fascia needs controlled loading to recover.
When to consider ultrasound or EPI
Ultrasound shows the thickness of the fascia and rules out a tear. If the pain has lasted months and has not responded to a good exercise programme, ultrasound-guided EPI can be an option within the plan.
How long it takes
As a guide, from a few weeks to a few months; in chronic cases it can reach six months. Gradual improvement is what to expect.
When to seek advice without waiting
- Night pain or pain that does not depend on load.
- Numbness or tingling in the foot.
- Swelling, redness or fever.
- Pain after a blow.