In my practice, I often see patients who describe a sharp pain under the heel, especially when they take their first few steps in the morning or stand up after sitting for a long time. One of the most common reasons for this pattern of pain is plantar fasciitis. It is one of the most frequent causes of heel pain and can affect walking, prayer, work, household duties, and daily mobility.[1][2]
For Bangladeshi patients, heel pain may seem like a small problem at first, but it can quickly start affecting commuting, standing in the kitchen, working in a shop, teaching, hospital duty, factory work, or even walking through crowded streets and staircases. When the pain continues, people often start changing the way they walk, which can then put extra strain on the ankle, knee, hip, or lower back.[1][3]
The good news is that plantar fasciitis often improves with the right diagnosis, activity modification, stretching, footwear changes, and patience. In many cases, early treatment helps avoid long-term discomfort.
What Is Plantar Fasciitis?
The plantar fascia is a thick band of tissue that runs along the bottom of the foot from the heel toward the toes. It helps support the arch of the foot and absorbs stress during standing and walking. When this tissue becomes irritated from repeated strain, it can cause pain near the heel. This problem is called plantar fasciitis.[1][2]
Patients usually feel the pain:
– at the bottom of the heel
– near the inner side of the heel
– during the first steps after waking up
– after standing for a long time
– after rest followed by walking again
Although many people think every heel pain means a “bone problem” or “heel spur,” that is not always true. Plantar fasciitis is usually a soft-tissue overuse problem rather than a fracture or a simple skin issue.[1][2]
Common Symptoms of Plantar Fasciitis
The symptoms can start gradually or appear after a sudden increase in walking, standing, exercise, or strain.
Sharp Heel Pain in the Morning
This is one of the most typical symptoms. Many patients tell me that the first steps out of bed are the most painful. After walking a little, the pain may ease, but it can return later in the day.[1][3]
Pain After Long Standing or Sitting
The heel may hurt after standing at work, waiting in line, cooking for a long time, or getting up again after rest.[1][3]
Pain After Activity
Unlike some injuries that hurt most during exercise, plantar fasciitis may feel worse after prolonged activity. Patients often notice increased discomfort after a busy day.[1][2]
Tightness in the Sole or Calf
Some people also have tight calf muscles or a tight Achilles tendon, which can increase strain on the plantar fascia.[1][2]
Difficulty Walking Comfortably
When pain is persistent, the patient may start limping or walking on the outer side of the foot to avoid the painful heel. Over time, that altered walking pattern can create additional problems.[3]
Why Does Plantar Fasciitis Happen?
In my practice, I usually explain that plantar fasciitis develops when repeated stress overloads the tissue under the foot. Sometimes it happens because of one clear trigger, and sometimes it develops slowly over weeks or months.[1][2]
Common Risk Factors
Trusted medical sources consistently identify several common risk factors:
– long periods of standing
– sudden increase in walking or exercise
– tight calf muscles or Achilles tendon
– flat feet or high arches
– improper footwear
– excess body weight
– occupations that require prolonged standing or walking on hard surfaces[1][2][3]
Daily-Life Triggers in Bangladesh
In Bangladesh, I often see this problem in people who:
– stand for long hours in kitchens, shops, schools, clinics, factories, or religious settings
– walk or commute extensively every day
– wear worn-out sandals or unsupportive slippers for long periods
– suddenly increase exercise or walking for weight loss
– spend most of the day on hard floors without supportive footwear
These practical realities matter because a treatment plan only works if it fits the patient’s real lifestyle.
Who Is More Likely to Get It?
Plantar fasciitis can affect many different adults, but it is more common in certain groups.[1][2]
People with Standing Jobs
Teachers, shopkeepers, nurses, factory workers, security personnel, and homemakers often stand for long periods, sometimes on hard floors.
People Who Walk a Lot
Patients who walk long distances daily, use stairs frequently, or depend on walking-based commuting can overload the heel tissue.
Runners or Active Adults
Exercise is good for health, but sudden increases in running, jogging, or brisk walking can strain the plantar fascia if the body is not conditioned properly.[2][3]
People with Foot Mechanics Issues
Flat feet, high arches, or abnormal gait patterns can change how force is distributed through the heel and arch.[1][2]
How I Diagnose Plantar Fasciitis
When I evaluate a patient with heel pain, I first want to understand exactly where the pain is, when it is worst, and what activities trigger it. The history is very important because not all heel pain is plantar fasciitis.
Clinical History
I ask questions such as:
– Is the pain worst in the morning?
– Is it under the heel or behind the heel?
– Did it start after increased walking or standing?
– Is there numbness, burning, or swelling?
– Has there been any recent fall or injury?
Physical Examination
During examination, there is often tenderness at the bottom of the heel, especially on the inner side. I also check:
– calf tightness
– ankle flexibility
– foot arch pattern
– gait
– signs of nerve irritation or other causes of pain[1][2]
Are X-rays or Scans Always Needed?
Usually not. In straightforward cases, plantar fasciitis can often be diagnosed clinically. Imaging may be considered if:
– the symptoms are unusual
– there was trauma
– a stress fracture is suspected
– symptoms are not improving
– another foot problem may be present[2][4]
One important point is that a heel spur on X-ray does not automatically mean it is the true cause of pain. Heel spurs can be seen in people with and without plantar fasciitis.[1]
