Why does my heel hurt most when I get out of bed in the morning?

The plantar fascia tightens overnight while you rest. When you stand up and put weight on it, the suddenly-loaded fascia stretches sharply at the point where it attaches to the heel bone, producing the classic stabbing first-step pain. After a few minutes of walking the tissue warms and lengthens, and the pain typically eases. The pain often returns later in the day after prolonged standing or at the end of a long shift. A simple habit that helps many people: do gentle plantar fascia and calf stretches before getting out of bed, and keep a supportive pair of slippers or shoes by the bed rather than walking barefoot on hard floors.

Do I need a scan to diagnose plantar fasciitis?

Usually no. Plantar fasciitis is a clinical diagnosis — your GP can confirm it from the typical history (first-step morning pain), examination findings (tenderness at the inner heel, pain reproduced by pulling the toes back), and risk factors. Plain X-rays often show a heel spur, but spurs are common in people without any heel pain, so a spur does not confirm or change treatment. Ultrasound or MRI is only considered if the pain is not behaving typically, if there is suspicion of a stress fracture or tear, or if symptoms have not improved after several months of proper conservative care. Imaging early on usually does not change what your GP recommends.

Which stretches actually work for plantar fasciitis?

Two stretches have the best evidence. First, the plantar fascia-specific stretch: sit down, cross the affected leg over your other knee, and gently pull your toes back toward your shin until you feel a stretch along the arch — hold 10 seconds, repeat 10 times, three times daily. Second, calf stretches: stand facing a wall with the affected leg back, heel down, lean forward until you feel the stretch in your calf — hold 30 seconds, three repetitions, three times daily. Doing the fascia stretch before getting out of bed in the morning can dramatically reduce first-step pain. Stretching every day for at least 8 weeks is what gives results — sporadic stretching tends not to work.

Should I get a steroid injection into my heel?

Steroid (corticosteroid) injections can give short-term pain relief over a few weeks to a couple of months, but the longer-term benefit is modest and there are real risks worth knowing about. The two main concerns are thinning of the protective fat pad under the heel, and a small but recognised risk of rupturing the plantar fascia itself — particularly with repeated injections. Most clinicians reserve injections for cases that have not responded to several months of stretching, footwear changes, and load management, limit them to one or two within a 12-month period, and use ultrasound guidance to improve accuracy. Discuss the trade-offs carefully with your GP or sports medicine doctor before deciding.

How long does plantar fasciitis usually take to get better?

Most people are better within 6 to 12 months of starting consistent treatment — sometimes longer. This timeframe surprises and frustrates many patients, who expect a quick fix. The reality is that the plantar fascia is a slow-healing tissue and the pain you feel reflects months or years of accumulated overload. The good news is that around 90% of people do recover with simple conservative measures (stretching, supportive footwear, weight management, activity modification) and do not need injections or surgery. Patience and consistency with the basics is what makes the difference. If you are still significantly disabled after 6 months of properly applied conservative care, that is the point at which your GP would consider referral for shockwave therapy, injection, or specialist review.

Will losing weight help my heel pain?

Yes, for many people it makes a measurable difference. Body weight is the single strongest modifiable risk factor for plantar fasciitis — every step transmits roughly two to three times your body weight through the heel and plantar fascia. Studies consistently show higher BMI is associated with both developing plantar fasciitis and with slower recovery. Even modest weight loss of 5 to 10% can substantially reduce the load on the fascia and improve symptoms. A referral to a dietitian, accessible through a GP chronic disease management plan in many cases, can support this. Weight is sensitive territory and your GP should raise it with care, but for plantar fasciitis it genuinely matters.

Plantar fasciitis (plantar fasciopathy / plantar heel pain)

Plantar fasciitis: heel pain causes, stretches, and treatment

By Dr HB Lo, FACRRM Reviewed 30 May 2026 9 min read

Plantar fasciitis is a wear-and-tear problem of the fibrous band along the sole of the foot, where it attaches to the heel bone. The hallmark is sharp, stabbing heel pain on the first steps out of bed, easing with walking and worsening with prolonged standing.

About 90% of cases settle over 6 to 12 months with daily plantar fascia and calf stretches, supportive footwear, heel cups or arch supports, and short courses of pain relief. Scans are usually not needed, and injections or surgery are reserved for pain that persists despite months of conservative care.

What plantar fasciitis is

Plantar fasciitis is the most common cause of heel pain in adults. The plantar fascia is a thick, fibrous band of tissue that runs along the sole of the foot, from the heel bone (calcaneus) to the base of the toes. It supports the arch and helps the foot work like a spring during walking and running.

Despite the “-itis” ending, the condition is not really an inflammation problem. When researchers look at the tissue under a microscope they find disorganised collagen fibres and degeneration rather than active inflammatory cells. For this reason, the more accurate term is plantar fasciopathy — a wear-and-tear, overload problem of the fascia where it attaches to the heel bone. The everyday name “plantar fasciitis” has stuck, and that is what most patients will hear.

The hallmark of plantar fasciitis is sharp, stabbing heel pain on the first steps in the morning or after sitting for a while. The pain usually eases after a few minutes of walking, then returns and worsens with prolonged standing, walking on hard surfaces, or at the end of a long day on your feet.

About 1 in 10 adults will experience plantar heel pain at some point in life. It is most common between ages 40 and 60, slightly more frequent in women, and particularly common in people whose work or hobby involves long hours of standing or impact through the feet — retail and hospitality workers, healthcare workers, runners, dancers, and athletes in jumping sports.

What causes it

Plantar fasciitis is fundamentally an overload injury. The fascia is not designed for unlimited cumulative load, and certain factors increase the demand placed on it or reduce its capacity to handle that demand.

The strongest modifiable risk factor is higher body weight. Every step transmits two to three times your body weight through the heel, so increases in BMI translate directly into increased fascia load. Studies consistently link higher BMI with both developing plantar fasciitis and slower recovery.

Other common contributors include:

Prolonged standing occupations — retail, hospitality, healthcare, hairdressing, teaching
Sudden increase in activity — a new running program, a job change involving more standing, a renovation project
Tight calf muscles (gastrocnemius and soleus) — these tug on the back of the heel and increase tension through the fascia
Foot shape — both high arches (pes cavus) and flat feet (pes planus) can predispose
Unsupportive footwear — thin-soled or worn-out shoes, prolonged barefoot walking on hard floors
Age — the fascia becomes less elastic with age, particularly from the 40s onward

A common myth is that the heel spur seen on X-rays causes the pain. Heel spurs are found in roughly half of people with plantar fasciitis, but they are also found in 20% of people with no heel pain at all. The spur is a consequence of long-term traction on the heel bone, not the source of the pain, and treating the spur is not the treatment plan.

How it is diagnosed

Plantar fasciitis is, in almost all cases, a clinical diagnosis — meaning your GP can confirm it from the history and examination alone, without scans.

Your GP will ask about:

The location of the pain (typically the inner part of the heel)
The pattern of pain (first-step morning pain that eases with walking, returns with prolonged standing)
How long it has been going on
What makes it better or worse
Your work, exercise, footwear, and recent changes
Weight, general health, and any conditions like diabetes or thyroid disease that affect tendon and fascia health

On examination, your GP will press firmly at the inner aspect of the heel, looking for the characteristic tender spot at the fascia’s attachment point. They will pull your toes back into a stretched position to see if this reproduces the pain (the windlass test), and check your calf flexibility, foot shape, and how you walk.

Imaging is usually not needed at the first visit. Your GP may consider an ultrasound or X-ray if:

The pain came on suddenly and severely (raising suspicion of a tear or stress fracture)
The pain is constant even at rest, or wakes you at night
There are signs suggesting a different problem, such as numbness or tingling in the foot
The pain has not improved after several months of proper conservative treatment
Both heels are affected and there are other inflammatory features (raising the possibility of an underlying inflammatory arthritis)

Blood tests are similarly only ordered selectively — typically if your GP suspects an inflammatory arthritis, diabetes, thyroid issues, or gout might be contributing.

What helps — the conservative basics

The good news is that around 90% of people with plantar fasciitis recover with simple measures applied consistently over months. Australian and international guidelines — eTG, the Australian Podiatry Association, and the JOSPT 2023 international clinical practice guideline — all converge on the same core conservative bundle.

Stretching

Daily stretching is the single most evidence-supported intervention. Two stretches have the strongest data:

Plantar fascia-specific stretch (the DiGiovanni protocol): Sit down, cross your affected leg over the opposite knee. With one hand, pull your toes back toward your shin until you feel a stretch along the arch of your foot. Hold for 10 seconds. Repeat 10 times. Do this three times a day, ideally including before you get out of bed in the morning. Published data from a JBJS 2003 trial showed this stretch is particularly effective for plantar fasciitis.
Calf stretches: Stand facing a wall, hands on the wall. Step the affected leg back, keep the heel flat on the floor, and lean your hips forward until you feel a stretch in the calf. Hold 30 seconds. Repeat three times. Do this with the back knee straight (stretches gastrocnemius) and again with the back knee slightly bent (stretches soleus). Three sessions daily.

Consistency matters far more than intensity — daily for at least 8 weeks is what produces results.

Supportive footwear and orthoses

Wear shoes with cushioned heels and arch support for most of the day
Avoid prolonged barefoot walking on hard floors, especially first thing in the morning
Over-the-counter heel cups or arch supports from a pharmacy or sports store are often as effective as expensive custom orthoses for short-term symptom relief, as shown in a Cochrane review of orthoses for plantar heel pain
Custom orthoses prescribed by a podiatrist may help if you have a significant biomechanical contributor (very high or very flat arches) or if over-the-counter options have not provided relief

Activity modification and load management

Reduce — but do not stop entirely — activities that are aggravating the heel
Cross-train with low-impact options: cycling, swimming, rowing, the elliptical trainer
Return to running or impact sports gradually as the pain settles

Pain relief

Short courses of paracetamol or anti-inflammatory tablets (such as ibuprofen) can help manage pain during flare-ups. Topical anti-inflammatory gels are a useful alternative if oral medications are not suitable. Rolling a frozen water bottle under the foot for 10 to 15 minutes after activity provides both cold therapy and a gentle stretch. Discuss any medication choice with your GP or pharmacist, particularly if you have other health conditions.

Weight management

Where higher body weight is contributing, even modest weight loss of 5 to 10% can substantially reduce fascia load and improve symptoms. Your GP can connect you with a dietitian — accessible in many cases through a GP chronic disease management plan.

Podiatry and physiotherapy

A podiatrist (the primary allied health provider for foot conditions) or a physiotherapist can supervise a structured stretching and strengthening program, assess your gait and footwear, prescribe orthoses if needed, and apply taping or strapping techniques that provide short-term symptomatic relief.

When conservative care has not been enough

If you have done the basics consistently for several months and are still significantly limited, a few additional options exist — these are not first-line and your GP will discuss the trade-offs.

Extracorporeal shockwave therapy (ESWT): A focused sound-wave treatment typically delivered as 3 to 5 sessions over a few weeks. Modest evidence of benefit in chronic refractory cases. Not subsidised on the PBS, so out-of-pocket costs apply.
Corticosteroid injection: Provides short-term pain relief over weeks to a couple of months. Longer-term benefit is modest. The two important risks are thinning of the protective heel fat pad and a recognised risk of plantar fascia rupture, particularly with repeated injections. Most clinicians use ultrasound guidance and limit injections to one or two within a 12-month window.
Platelet-rich plasma (PRP) injection: An emerging option offered by some sports medicine clinics. Not PBS subsidised; out-of-pocket cost.
Night splints: Worn overnight to keep the foot in a stretched position. Some patients find them helpful, but tolerance varies and sleep disturbance is common.
Surgery: Rarely needed. Considered only after 12 months or more of failed comprehensive conservative care, and involves partial release of the fascia. Recovery takes months and outcomes vary.

When to see your GP

Make a GP appointment if:

Heel pain has lasted more than 4 to 6 weeks despite trying basic measures (rest, stretches, supportive shoes)
The pain is severely limiting your work, exercise, or daily life
You are not sure if what you have is plantar fasciitis
Self-care is not improving things

Your GP can confirm the diagnosis, rule out other causes of heel pain, arrange a Chronic Disease Management plan if appropriate (which can subsidise visits to a podiatrist or physiotherapist), and coordinate referrals if needed.

Red flags — see a doctor sooner

Some heel pain is not plantar fasciitis. See your GP — or attend an emergency department for severe presentations — if you have:

Sudden severe heel pain with a popping sensation or a visible gap in the fascia (possible plantar fascia rupture)
Constant pain that persists even at rest or wakes you at night (raises suspicion of a stress fracture, inflammatory arthritis, or rarely a bone tumour or infection)
Fever alongside heel pain (possible bone or joint infection)
Numbness, pins and needles, or weakness in the foot (possible nerve entrapment such as tarsal tunnel syndrome)
Pain in both heels, plus other joints, finger or toe swelling, skin rash (especially psoriasis), or eye inflammation (possible inflammatory arthritis such as spondyloarthritis or psoriatic arthritis)
Heel pain in a child or adolescent (different conditions affect growing bones, such as Sever’s disease)
Heel pain after a recent fall, jump, or running injury in a runner, athlete, or military recruit (possible calcaneal stress fracture)
Significant unexplained weight loss alongside heel pain

These features are not common, but they matter — they change what tests are needed and what treatment is appropriate. For Australian consumer-friendly information, see HealthDirect — Plantar fasciitis and Better Health Channel — Plantar fasciitis.

What this article is and is not

This is general health information drawn from current Australian and international clinical guidelines — including eTG, RACGP resources, the Australian Podiatry Association, Choosing Wisely Australia, the JOSPT 2023 international guideline, and peer-reviewed trial evidence including the DiGiovanni stretching trial and the Cochrane orthoses review. It is not personal medical advice and does not create a doctor-patient relationship. Decisions about your own heel pain — including whether you need imaging, whether to try an injection, or whether to see a podiatrist — should be made with your own GP.

Sources cited

Frequently asked questions

Why does my heel hurt most when I get out of bed in the morning?

The plantar fascia tightens overnight while you rest. When you stand up and put weight on it, the suddenly-loaded fascia stretches sharply at the point where it attaches to the heel bone, producing the classic stabbing first-step pain. After a few minutes of walking the tissue warms and lengthens, and the pain typically eases. The pain often returns later in the day after prolonged standing or at the end of a long shift. A simple habit that helps many people: do gentle plantar fascia and calf stretches before getting out of bed, and keep a supportive pair of slippers or shoes by the bed rather than walking barefoot on hard floors.
Do I need a scan to diagnose plantar fasciitis?

Usually no. Plantar fasciitis is a clinical diagnosis — your GP can confirm it from the typical history (first-step morning pain), examination findings (tenderness at the inner heel, pain reproduced by pulling the toes back), and risk factors. Plain X-rays often show a heel spur, but spurs are common in people without any heel pain, so a spur does not confirm or change treatment. Ultrasound or MRI is only considered if the pain is not behaving typically, if there is suspicion of a stress fracture or tear, or if symptoms have not improved after several months of proper conservative care. Imaging early on usually does not change what your GP recommends.
Which stretches actually work for plantar fasciitis?

Two stretches have the best evidence. First, the plantar fascia-specific stretch: sit down, cross the affected leg over your other knee, and gently pull your toes back toward your shin until you feel a stretch along the arch — hold 10 seconds, repeat 10 times, three times daily. Second, calf stretches: stand facing a wall with the affected leg back, heel down, lean forward until you feel the stretch in your calf — hold 30 seconds, three repetitions, three times daily. Doing the fascia stretch before getting out of bed in the morning can dramatically reduce first-step pain. Stretching every day for at least 8 weeks is what gives results — sporadic stretching tends not to work.
Should I get a steroid injection into my heel?

Steroid (corticosteroid) injections can give short-term pain relief over a few weeks to a couple of months, but the longer-term benefit is modest and there are real risks worth knowing about. The two main concerns are thinning of the protective fat pad under the heel, and a small but recognised risk of rupturing the plantar fascia itself — particularly with repeated injections. Most clinicians reserve injections for cases that have not responded to several months of stretching, footwear changes, and load management, limit them to one or two within a 12-month period, and use ultrasound guidance to improve accuracy. Discuss the trade-offs carefully with your GP or sports medicine doctor before deciding.
How long does plantar fasciitis usually take to get better?

Most people are better within 6 to 12 months of starting consistent treatment — sometimes longer. This timeframe surprises and frustrates many patients, who expect a quick fix. The reality is that the plantar fascia is a slow-healing tissue and the pain you feel reflects months or years of accumulated overload. The good news is that around 90% of people do recover with simple conservative measures (stretching, supportive footwear, weight management, activity modification) and do not need injections or surgery. Patience and consistency with the basics is what makes the difference. If you are still significantly disabled after 6 months of properly applied conservative care, that is the point at which your GP would consider referral for shockwave therapy, injection, or specialist review.
Will losing weight help my heel pain?

Yes, for many people it makes a measurable difference. Body weight is the single strongest modifiable risk factor for plantar fasciitis — every step transmits roughly two to three times your body weight through the heel and plantar fascia. Studies consistently show higher BMI is associated with both developing plantar fasciitis and with slower recovery. Even modest weight loss of 5 to 10% can substantially reduce the load on the fascia and improve symptoms. A referral to a dietitian, accessible through a GP chronic disease management plan in many cases, can support this. Weight is sensitive territory and your GP should raise it with care, but for plantar fasciitis it genuinely matters.

Source quality

Sources grouped by evidence tier. AU primary tier first; international where AU is silent or lagging; named-author reconstruction where guidelines have not yet caught up. How tiers work.

T1 AU primary 7 sources
T2 International primary 2 sources
- JOSPT 2023 — Heel Pain Plantar Fasciitis Clinical Practice Guideline
- Crawford & Thomson — Orthoses for plantar heel pain (Cochrane 2010)
T3 Named-author reconstruction 1 source
- DiGiovanni et al. — Plantar fascia-specific stretching exercise (JBJS 2003)