Heel Pain in the Morning: Understanding and Treating Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain. The classic presentation — sharp pain with the first steps in the morning that eases after a few minutes, then worsens again after long periods of standing — is almost diagnostic on its own.

Why it's a loading problem, not an inflammation problem

Plantar fasciitis was historically classified as an inflammatory condition. Current evidence shows it is a tendinopathy — a failure of the tissue to adapt to load. This changes the treatment completely: anti-inflammatories and rest are not the primary answer.

What the evidence supports

• —Heavy slow resistance loading: Progressive calf raises (with particular emphasis on the soleus) with load sufficient to cause discomfort during, resolving within 24 hours after
• —Stretching: Plantar fascia stretching in the morning before first steps reduces morning pain acutely
• —Load management: Reducing overall volume temporarily while increasing tissue capacity with specific loading