Heel pain when waking up

Patient

Q: When I first get up may heels (only part of my foot) hurt. After several steps they seem to loosen up and walking is okay.

Doctor

A:    According to your brief description, you might be experiencing the start of a Plantar Fasciitis which is produced by inflammation of the insertion on the heel of the plantar fascia (a fibrous layer that supports the plantar arch muscles and ligaments), causing remarkable heel and arch pain that alters your normal daily activities.  Initially the pain tends to decrease with walking but gets worse throughout the day as activity increases. The pain worsens by walking barefoot on hard surfaces or walking up stairs. The causes of Plantar Fasciitis are: aging, heel fat pad thinning, too low-arched or too high arched foot, weakness of the calf muscles, leg-length discrepancy, walking or running with inappropriate shoe type on poor cushioned surfaces, a change in the walking or running routine. In your case wearing high heels could have caused retraction of the plantar fascia, and now when you wear flat shoes the stretching of the fascia is what hurts. The suggested strategy to treat conservatively plantar fasciitis would be: physical therapy aimed to stretch the muscles of the calf and foot, using ice packs after the exercise routine to decrease inflammation and pain, relative rest (avoiding activities that reproduce the heel pain), use of anti inflammatory drugs (example: “Advil”) and replacement of worn-out shoes by adequately cushioned shoes.

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