Plantar Fasciitis: Why Your Heel Hurts With the First Steps

If you feel a sharp, stabbing pain in the sole of your foot the moment you put weight on it after getting up — especially after sitting for a while or first thing in the morning — you've probably heard of plantar fasciitis. It's one of the most common causes of heel pain we see in clinic, and although it can sound alarming, in most cases it responds well to a well-planned approach. In this article we explain what it is, why it happens, and how we work with it at KINEO Benidorm as part of your Itinerario KINEO (your personalised KINEO care pathway).

What is plantar fasciitis?

The plantar fascia is a band of connective tissue that runs along the sole of the foot, from the heel to the base of the toes. Its job is to absorb impact when walking or running and help maintain the arch of the foot. When this structure takes on repeated load beyond what it can tolerate at that moment, the tissue reacts with pain, especially where it attaches to the heel bone (the calcaneus). We call it plantar fasciitis when this process persists over time and the pain becomes recurrent.

Why does it happen? Causes and risk factors

There's usually no single cause, but rather a combination of factors that increase the load on the fascia beyond what the tissue can tolerate at that moment:

• Sudden increases in physical activity, especially running or sports with repeated impact.

• Recent changes in footwear or training surface.

• Excess body weight.

• Spending many hours standing on hard surfaces.

• Alterations in foot mechanics (flat feet or high arches), or stiffness in the ankle and calf muscles.

• Weakness of the intrinsic foot muscles.

Usually it's not a single factor that causes the problem, but the combination of several at a time when the tissue doesn't have enough capacity to tolerate them.

Most common symptoms

The most characteristic symptom is a sharp pain on the inner part of the heel that appears with the first steps in the morning or after a period of rest, and which usually improves — though not completely disappear — as you keep walking. It's also common for the pain to return after spending a long time standing, or at the end of the day, especially after a day with more activity than usual.

How is it diagnosed?

The diagnosis of plantar fasciitis is mainly clinical: the exact location of the pain, how it behaves throughout the day, and a functional assessment of the foot and ankle are usually enough to guide the case. In some situations, when progress isn't as expected or there's diagnostic doubt, musculoskeletal ultrasound lets us visualise the state of the fascia and rule out other causes of heel pain.

How we approach it at KINEO Benidorm: your Itinerario KINEO

Every case of plantar fasciitis is different, depending on how long it's been going on, each person's usual work or training load, and their history. That's why, after the initial assessment, we design a personalised Itinerario KINEO (your KINEO care pathway), with the general goal of reducing pain, progressively improving the fascia's capacity to tolerate load, and helping you safely return to your usual activity.

Within that pathway, one of the tools we consider, depending on the case, is shock wave therapy, especially indicated in processes that have been going on for several weeks. Which tools are used, at what point and how often, is always decided individually in consultation, since it depends on how each person responds; it can't be replaced by a generic protocol valid for every case.

In the meantime: what's reasonable to do

While you wait for your assessment, the most reasonable approach is usually to temporarily moderate the activities that clearly reproduce the pain, and pay attention to the footwear you use day to day. It's not about stopping moving altogether, but about avoiding sudden spikes in load until you've had an individual assessment to guide you on how to progress safely. If you're looking for day-to-day relief, in this article about gel insoles we explain in which cases they can help and when they're not enough.

Frequently asked questions

Does plantar fasciitis heal on its own?

In some mild cases the tissue adapts on its own over time, but when the pain persists for several weeks or limits your daily activity, a specialised assessment helps identify the factors keeping it going and can shorten its course.

How long does it take to improve?

It depends on each case: how long it's been going on before starting treatment, the daily load on the foot, and individual response. That's why follow-up and adjusting the pathway are a key part of the process.

Is it the same as a heel spur?

Not necessarily. A heel spur is a calcification that can be seen on imaging and that, in many people, produces no symptoms at all. Having one doesn't mean you have active plantar fasciitis, and not having one doesn't rule it out.

Can I keep doing sport with plantar fasciitis?

In many cases it's possible to maintain some level of activity, adapting the load to what the foot tolerates at each stage. That adaptation is individual and should be assessed in consultation, since it depends on the type of sport, intensity and how the condition is progressing.

When should I ask for an assessment?

If heel pain persists for more than a week or two, limits your usual activity, or doesn't improve with relative rest, it's a good time for an assessment that identifies the specific cause and guides the most suitable pathway for you.

At KINEO Benidorm we assess every case of plantar fasciitis individually, using the diagnostic and therapeutic tools suited to each stage of the process. If you recognise yourself in what we've described, we can help you understand what's going on and design the pathway you need.

Article written by Chema, physiotherapist at KINEO Benidorm (registration no. 4474, Col·legi Oficial de Fisioterapeutes de la Comunitat Valenciana).