Q. I have been waking up with a stabbing pain in my heel that is worse when I get out of bed and slowly improves as the day progresses. I have been told that it might be plantar fasciitis. What exactly is that and what can I do about it?
A. What you just described sure sounds like it could be plantar fasciitis. As is the case with many “itis” conditions, we are discussing an inflammation, specifically of the plantar fascia. The plantar fascia is a thick, web-like ligament that connects the heel to the front of the foot which supports the arch of your foot and acts as a shock absorber during your activities (walking, running, dancing etc.). Over time, too much stress on this tissue can lead to small tears, and repeated strain can lead to pain, inflammation, and eventually plantar fasciitis. Therefore, it is not surprising to learn that it is particularly common among athletes but it can also occur in people who stand for prolonged periods, or those with foot structure issues like flat feet or high arches. Poor footwear can also play a role, especially shoes that don’t offer enough arch support or cushioning.
The main symptom of plantar fasciitis is a sharp pain near the heel, especially with the first steps of the day or after sitting for extended periods. If you are wondering why that would be, most of us sleep with their feet pointed downward and sit in a relaxed position which allows the plantar fascia to relax and shorten. With continued strain on these fibres, the shortening and tightening of the fascia can become more pronounced. When you get out of bed or take that first step after resting, you are in effect stretching the fascia.
When the fascia has been overworked and put under much strain, you could be stretching a partially torn ligament which is the cause of the pain we see with plantar fasciitis. Some describe it as a stabbing sensation, and it often decreases as the foot “warms up” through activity. However, standing for long periods or getting up after prolonged rest can trigger the pain again.
Other symptoms associated with plantar fasciitis could be pain that flares up after exercise rather than during it, stiffness in the heel or along the arch of the foot or swelling/tenderness around the heel. All these symptoms can vary in intensity, and for some people, the pain may be persistent, difficult to manage and affect their mobility. While plantar fasciitis can be stubborn, several treatment methods have shown success in reducing pain and supporting healing.
Here are some of the best approaches for treating plantar fasciitis:
1. Rest and Ice – Giving your feet a break from high-impact activities can provide relief, while icing the affected area helps reduce inflammation. Try rolling a frozen water bottle under your foot for 10–15 minutes to relieve pain.
2. Stretching and Strengthening Exercises – Regularly stretching the plantar fascia, Achilles tendon, and calf muscles can help loosen tight tissues. Exercises like calf stretches, rolling the foot over a tennis ball, or using a towel to pull the toes toward you are beneficial. Strengthening the muscles in your feet and lower legs can help prevent future strain on the plantar fascia.
3. Supportive Footwear – Choosing shoes with proper arch support and cushioning is essential. Avoid walking barefoot on hard surfaces, as this can increase strain on the plantar fascia. For additional support, custom orthotic inserts are often recommended, especially for those with foot structure issues like high arches or flat feet.
4. Pain Relief Medication – Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help with pain and inflammation. Acetaminophen may help reduce the pain but will not help with the inflammation. There are other anti-inflammatories available by prescription that might be an option for you. Consult with your pharmacist regarding treatment and doses since NSAIDs are not safe for everyone to take
5. Topical Compounded Pain Relief – Topical diclofenac can be tried and is available without a prescription as regular (1.13%) to be applied four times daily or as extra strength (2.26%) which is formulated to last longer and be applied twice daily. If you are finding the diclofenac topically isn’t strong enough, we can always compound diclofenac into a higher strength as a prescription. We also prepare a compounded topical treatment specifically for plantar fasciitis that many of our patients find helpful. This compound includes anti-inflammatory and pain-relieving ingredients tailored to relieve heel pain and reduce inflammation locally. Topical treatments can offer significant relief directly where the pain occurs without the systemic side effects that oral medications might cause.
6. Physical Therapy – A physical therapist can offer targeted treatment options, including massage, ultrasound, and custom exercise programs to strengthen and stretch the foot and leg muscles that support the plantar fascia.
7. Night Splints – Night splints are a special type of brace that stretches your foot while you sleep. Keeping the foot flexed can help lengthen the plantar fascia and calf muscles overnight, potentially reducing morning pain.
While many people find relief from one or more of the above treatments, plantar fasciitis can be persistent. If your symptoms haven’t improved after several months, despite the above suggestions, it may be time to consult with your doctor or nurse practitioner.
For more information on this or any other health related topic, contact your pharmacist.
