Plantar Fasciitis Explained: 5 Common Causes of Heel Pain
Written by the Klinik Sentosa JB team · Published 24 Aug 2026
Heel pain that is sharpest with the first few steps after rest can have a recognisable pattern, but it still has more than one possible cause.
- Plantar fasciitis is a common cause of pain beneath the heel, especially when discomfort is worse after getting out of bed or standing after a long rest.
- A 2021 systematic review found that higher body mass, higher BMI and greater ankle plantarflexion range of motion were associated with plantar fasciitis in physically active populations.
- Heel spurs may appear on an X-ray, but their presence does not automatically explain heel pain.
A sore heel can make a normal morning routine feel unexpectedly difficult. The first steps out of bed may sting, a walk through the supermarket may become uncomfortable, or standing through a work shift may leave the bottom of the foot aching by the end of the day.
Plantar fasciitis is one possible explanation for this pattern of heel pain. It involves the plantar fascia, a strong band of tissue along the sole of the foot that helps support the arch and transfers load with every step. Repeated strain can irritate this tissue, particularly when changes in activity, footwear, work demands or body load happen faster than the foot can adapt.
Not every painful heel is plantar fasciitis, and no online article can determine the cause of an individual’s symptoms. However, understanding the common contributors can help people notice practical patterns instead of assuming that a single walk, shoe or heel spur is solely responsible.
What is plantar fasciitis and why does it hurt most after rest?
Plantar fasciitis is a common source of pain on the underside of the heel. It often feels most noticeable during the first few steps after sleep or prolonged sitting because the plantar fascia has been relatively still, then suddenly takes body weight again.
The plantar fascia runs from the heel towards the toes. During walking, it helps support the arch while absorbing and transferring force. When the tissue is repeatedly overloaded, pain may develop near the heel. According to the American Academy of Orthopaedic Surgeons’ plantar fasciitis guidance, pain commonly occurs near the bottom of the heel and may improve after a few minutes of walking before returning after prolonged activity.
A useful pattern to notice: pain that is focused under the heel and feels sharper after rest is different from pain that began immediately after a fall, twist or other sudden injury. The timing and location of pain matter when a registered medical practitioner assesses heel symptoms.
Five common contributors to plantar fasciitis and heel pain
Plantar fasciitis usually develops through a combination of repeated loading and individual factors rather than one clear event. The five contributors below are common patterns linked with strain on the plantar fascia, but they do not confirm a diagnosis on their own.
A sudden increase in walking, running or exercise
A rapid jump in activity can expose the plantar fascia to more force before it has adapted. This may happen after starting a running plan, returning to sport after a break, adding hill walking, increasing daily step counts, or changing from mostly seated work to a more active routine.
The important issue is not that activity is harmful. Regular movement supports general health. The concern is a sharp increase in volume, intensity or impact without enough time for the feet and calves to adjust. A gradual progression is generally easier for the body to accommodate than trying to make up several weeks of missed activity in a few days.
Long hours standing or walking on hard surfaces
Prolonged standing can place repeated load through the heel and arch, particularly on hard floors. People in roles that require long periods on their feet may notice that heel discomfort builds late in the day or after several consecutive shifts.
Standing is not automatically the cause of heel pain, but it can be an important contributor when combined with worn footwear, limited recovery time or a recent increase in work demands. Alternating positions where possible, taking regular movement breaks and choosing footwear that remains supportive throughout a shift may help reduce unnecessary strain.
Tight calves and limited ankle movement
Tight calf muscles can increase tension through the heel and sole of the foot during walking. When the ankle does not move comfortably through its usual range, the plantar fascia may have to absorb more strain with each step.
This connection is one reason heel pain can feel like a foot problem while calf flexibility also matters. A 2021 systematic review and meta-analysis of physically active individuals identified differences in ankle movement, body mass and BMI among the risk factors associated with plantar fasciitis. The review also noted that research on several other proposed risk factors remains mixed, so it is sensible to avoid blaming one body feature alone.
Further reading: 2021 systematic review and meta-analysis of plantar fasciitis risk factors
Footwear that no longer matches daily demands
Footwear does not need to be fashionable or expensive to matter. Shoes that are heavily worn, poorly cushioned for the activity involved, or unsupportive for long periods of standing can change how pressure is distributed across the heel and arch.
A practical check is to look at the sole and heel of frequently worn shoes. Uneven wear, compressed cushioning, a tilted heel or a sole that has lost its structure can be clues that the shoe is no longer providing the same support it did when new. Footwear changes can also matter when someone switches suddenly from supportive shoes to thin-soled sandals, flats or different work shoes.
Body load, age and foot shape
Body load, age and the natural shape of the foot can influence how much stress reaches the plantar fascia. Flat feet, high arches, higher body weight and being between 40 and 60 years old are commonly recognised contributors, although none of them means heel pain is inevitable.
Body weight should be discussed without blame. It is one of many factors that can affect loading through the foot, alongside occupation, activity level, footwear and tissue flexibility. Malaysia’s National Health and Morbidity Survey 2023 reported that 54.4% of adults had overweight or obesity, making conversations about gradual, sustainable movement and foot comfort relevant to many households.
Further reading: Ministry of Health Malaysia: National Health and Morbidity Survey 2023 fact sheet
Could a heel spur be the reason for the pain?
A heel spur can be visible on imaging, but it is not automatically the source of heel pain. Many people have heel spurs without symptoms, while others have plantar heel pain without a visible spur.
This matters because an X-ray finding can sound more alarming than it is. A spur may reflect long-term pulling forces where the plantar fascia attaches to the heel, but the presence of a spur does not by itself explain when pain began, why it feels worse after rest, or what is irritating the tissue now. The American Academy of Orthopaedic Surgeons notes that heel spurs are not considered the cause of plantar fasciitis pain.
Do not assume every heel pain is plantar fasciitis. Sudden severe pain, major swelling, redness, numbness, fever, pain after an injury, or difficulty bearing weight may need prompt medical assessment because other conditions can cause heel pain.
How can daily habits reduce strain on the plantar fascia?
Daily habits can reduce repeated strain on the plantar fascia by matching activity, footwear and recovery to what the feet are doing each day. The goal is not complete rest or pushing through pain, but avoiding abrupt changes that repeatedly overload the heel.
- Increase walking, running or exercise volume gradually rather than making large weekly jumps.
- Use activity-appropriate shoes and replace pairs that are visibly worn or no longer feel supportive.
- Avoid spending long periods barefoot on hard flooring if this consistently aggravates heel discomfort.
- Build regular calf and foot mobility into a routine, without forcing a painful stretch.
- Alternate high-impact activities with lower-impact options when heel pain appears after a training increase.
- Notice whether pain is linked to first steps in the morning, a particular pair of shoes, work shifts or a recent change in exercise.
These measures are general ways to manage loading, not a substitute for an individual assessment. Persistent pain deserves attention because an accurate explanation depends on the full pattern of symptoms, physical findings and relevant health history.
When should persistent heel pain be assessed by a registered medical practitioner?
Heel pain should be assessed when it persists, worsens, affects normal walking or does not improve after sensible changes to activity and footwear. Assessment is also important when symptoms do not follow the usual plantar fasciitis pattern or when there are signs of injury, infection or nerve involvement.
Seek timely medical advice if heel pain follows a fall or sudden force, makes it difficult to put weight on the foot, causes marked swelling or bruising, is accompanied by numbness or burning, or occurs with fever and redness. A registered medical practitioner can consider whether the symptoms may be related to plantar fascia strain or another cause that needs different care.
Frequently asked questions about plantar fasciitis
Is plantar fasciitis always worse in the morning?
Not always, but pain with the first steps after getting out of bed is a commonly reported pattern. Similar discomfort may happen after sitting for a long time, such as after a car journey or desk work. Pain can also return after extended standing, walking or exercise.
Can plantar fasciitis affect both feet?
It can affect one foot or both. When both heels are painful, it is still important not to assume the cause. The location of pain, timing, activity pattern, footwear, medical history and any other symptoms all help a registered medical practitioner decide what may be contributing.
Should exercise stop completely when heel pain starts?
Complete inactivity is not always necessary, but continuing an activity that clearly worsens pain can prolong irritation. Reducing the aggravating activity temporarily and choosing lower-impact movement may be more appropriate than pushing through pain. Individual advice is important when pain is persistent or affects normal walking.
Are flat feet the main cause of plantar fasciitis?
Flat feet may contribute to plantar fascia strain in some people, but they are not the sole explanation. People with high arches can also experience heel pain. Activity changes, calf tightness, standing demands, footwear and body load can all interact, which is why one visible foot feature rarely tells the whole story.
This article is for general information and health education only. It is not a diagnosis or medical advice. Please consult a registered medical practitioner regarding your individual health condition.