Plantar Fasciitis: What Helps With Pain Under the Heel?

A stabbing pain under the heel that strikes especially with the first steps in the morning is typical of plantar fasciitis. What is irritated here is the strong tendon plate on the sole of the foot. The good news: in most cases the irritation improves considerably over a few months with consistent relief, stretching and patience. This guide explains what is behind the heel pain, when medical advice is important and which building blocks provide relief in everyday life.

What is behind plantar fasciitis?

The plantar fascia is a firm plate of connective tissue that runs from the heel bone to the toes and supports the longitudinal arch of the foot. If it is permanently overloaded, it can become irritated at its attachment to the heel. This leads to the characteristic, often burning or stabbing pain directly under or on the inner side of the heel.

Contributing factors are overload from a lot of standing and walking, suddenly increased running training, unsuitable footwear, a high body weight as well as foot deformities such as fallen or knock-kneed feet. Shortened calf muscles can also increase the pull on the fascia. The so-called start-up pain is typical: the first steps in the morning or after prolonged sitting hurt the most and ease somewhat with movement.

People who stand a lot on hard surfaces for their job are particularly affected, as are runners who increase their workload too quickly. With increasing age, the fat pad under the heel also loses elasticity, which means the fascia is subjected to greater strain. Anyone who combines several of these factors has a higher risk. The good news: many of these triggers can be influenced, for example through suitable footwear, a moderate build-up of training and regular stretching of the calf muscles.

When you should seek medical advice

If the heel pain lasts longer than a few weeks, worsens or severely restricts you in everyday life, a medical assessment makes sense. You should also have yourself examined in the case of swelling, redness, overheating, numbness or if the pain occurs after an injury. An expert diagnosis distinguishes plantar fasciitis from other causes such as a heel spur, a nerve irritation or rheumatic diseases and determines the appropriate treatment. Often a so-called heel spur, a bony outgrowth on the heel bone, is mentioned in the same breath. However, this is not necessarily the cause of the pain and is also found in people without complaints. That is why the treatment focuses on the irritated fascia, not on the spur alone.

Relief and the right shoes

The most important building block is to relieve the irritated fascia. Temporarily reduce strain such as prolonged standing, walking barefoot on hard ground or intensive jogging. Well-fitting shoes with a supportive footbed and a slightly cushioned heel take pressure off the sensitive spot. Heel pads or individually fitted insoles can additionally support the arch of the foot.

Anyone who walks or exercises a lot should temporarily switch training to joint-friendly forms of movement, such as cycling or swimming. This maintains endurance without further irritating the heel.

When buying shoes, it is worth looking at several details: a sufficiently cushioning but not too soft sole, a firm heel cap that guides the rearfoot, as well as enough room in the toe area. Completely flat shoes or worn-out soles can increase the pull on the fascia. As a transitional option in between, supportive slippers at home are also more sensible than walking barefoot on tiles. Anyone who is unsure should seek expert advice in a specialist shop on which model suits their own foot.

Stretching and strengthening

Targeted stretching exercises for the calf and sole of the foot are among the most effective self-help measures. Stretching the calf muscles against a wall is popular, as is gently rolling the sole of the foot over a ball or a cooled bottle. Exercises that strengthen the small foot muscles, such as gripping a towel with the toes, also support the stability of the arch of the foot.

A particularly well-studied exercise is the targeted stretching of the fascia itself: while sitting, the affected foot is placed over the other knee and the toes are gently pulled upwards towards the shin with the hand. The tension should be clear but not painful and held for a few seconds. Several repetitions spread over the day, especially before getting up for the first time and after longer rest periods, help to keep the fascia supple.

Regularity is important: short exercise sessions several times a day often bring more than rare, intensive training. Anyone who is unsure should have the exercises shown to them by a physiotherapy professional.

A tried-and-tested start to the day: before getting up, gently pull the toes towards the shin and thus carefully stretch the calf before the heel is fully loaded. This can ease the morning start-up pain. Some sufferers additionally use a so-called night splint, which holds the foot in slight extension overnight so that the fascia does not shorten. Whether such a splint makes sense is best clarified with expert advice.

Cooling and adapting everyday life

In the acute phase, many sufferers find cooling pleasant. Cooling rolling of the sole of the foot after exertion can soothe the irritation. Also pay attention to a healthy body weight, because every kilogram less relieves the sole of the foot. With sedentary work, change your position regularly and avoid walking barefoot over hard floors for hours.

At home, soft slippers or padded mats in front of the sink can reduce the strain. Anyone who is out and about a lot should better plan breaks in which the foot is relieved instead of walking long distances in one go. The training programme can also be adjusted: instead of long runs on asphalt, softer surfaces or shorter intervals are advisable until the irritation has subsided. Such small adjustments in the daily routine add up and give the irritated fascia the rest it needs to heal.

Diet and nutrients for connective tissue

A balanced, plant-focused diet with vegetables, fruit, wholegrains and high-quality fats supports a healthy weight and provides nutrients that the connective tissue needs. For the structure of tendons and ligaments, vitamin C, among others, is of interest: Vitamin C contributes to normal collagen formation for the normal function of cartilage and bones. Manganese contributes to the normal formation of connective tissue and copper contributes to the maintenance of normal connective tissue.

These nutrients are found in a colourful everyday diet: vitamin C in peppers, berries and citrus fruits, manganese in wholegrain products and nuts, copper in pulses and wholegrains. A nutrient deficiency can be determined most reliably via a blood test. Such nutrients are a sensible basis, but no substitute for relief and stretching.

An adequate fluid intake and a protein-rich diet with pulses, fish, eggs or lean meat additionally provide building blocks that the body uses for the renewal of connective tissue. Anyone who does a lot of sport should pay attention to a good overall supply, because a high energy and nutrient requirement can otherwise quickly lead to gaps. In principle: a wholesome diet is the most reliable basis, while individual supplements only make sense in a targeted way when a need has been proven.

Honestly assessed: patience is crucial

Plantar fasciitis takes time. It often takes several weeks to months for the irritation to subside completely. There is no miracle cure and no single exercise that makes the pain disappear immediately. What works is the consistent combination of relief, stretching, suitable footwear and patience. If the complaints remain persistent, a medically or physiotherapeutically supervised treatment can open up further options.

It is also realistic that there can be setbacks in between, for example after a long day on your feet. This is no cause for concern, but rather an indication to reduce the strain a little again. Anyone who sticks to the measures consistently and over weeks has a good chance of getting the complaints permanently under control and of preventing a renewed flare-up.

Frequently Asked Questions (FAQ)

Why does the heel hurt most in the morning?

Overnight the fascia shortens in its resting position. With the first steps it is suddenly stretched, which triggers the typical start-up pain. After a few steps it usually eases somewhat.

How long does plantar fasciitis last?

This varies from person to person. In many cases the complaints improve considerably over several weeks to months with consistent relief and stretching. Patience is an important factor here.

Are insoles useful?

Supportive insoles or heel pads can reduce the pressure on the irritated spot and relieve the arch of the foot. Whether and which insoles are suitable is best clarified with expert advice.

Can I do sport with plantar fasciitis?

You should temporarily reduce demanding sports such as jogging. Joint-friendly forms of movement such as cycling or swimming maintain endurance without further irritating the heel.

When should I seek medical advice?

If the pain lasts longer than a few weeks, worsens or is accompanied by swelling, redness and numbness, a medical examination is advisable in order to determine the cause precisely.