DEAR MAYO CLINIC: When I wake up in the morning and go to stand up, I have such excruciating pain in my heel that I have to sit back down on the edge of the bed. As the day goes on, it gets somewhat better, but my heel is still tender. What can be causing the pain?

ANSWER: “My heel is killing me!” is, without a doubt, one of the most common sentences uttered in podiatry offices worldwide. Heel pain can range from slightly uncomfortable to utterly debilitating. Most often it’s caused by plantar fasciitis.

The plantar fascia is a band of tissue extending from the heel to the ball of the foot. It supports the arch of the foot and absorbs shock when walking. Although the cause of plantar fasciitis isn't well understood, typically the plantar fascia has been put under tension and stress, which can cause small tears. Repeated stretching and tearing brings on irritation, inflammation and, typically, heel pain.

Plantar fasciitis can affect anyone. However, it’s most common in middle-aged adults, as well as people who take part in activities such as running, ballet and aerobic dance. Obesity also can cause this condition because extra pounds put more stress on the fascia. Other risk factors include high arches, flat feet, and occupations that require walking or standing all day on hard surfaces.

The primary sign of plantar fasciitis is excruciating heel pain when you take your first steps in the morning. It's not unusual for the pain to subside as you walk around, but it may return after you've been sitting for a while. Standing for a long time also can make it flare up.

Treatment

The good news about plantar fasciitis is that it’s highly treatable. Early detection makes the condition more manageable and prevents further complications. If left untreated, plantar fasciitis can take a toll on your enjoyment of everyday activities and make you more sedentary. The pain may cause you to change the way you walk, which in turn can lead to various problems such as knee, hip and back pain.

If you suspect you have plantar fasciitis, consult with your health care team. Although X-rays or MRIs usually aren't required, imaging may be requested to rule out a stress fracture. Nonsurgical treatment often has satisfactory results, although it may take several months to get back to normal.

Treatment typically includes:

Surgical treatment isn't recommended often and is reserved for those not responding to conservative treatment. To prevent recurrence of plantar fasciitis, stretch properly before exercising and wear supportive shoes if you'll be on your feet for a long time. — Stephanie Kvas, D.P.M., Podiatric Medicine, Mayo Clinic Health System, Waseca and New Prague, Minnesota

(Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org.)

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