Hello. I am Director An Jae-seok of seoul chungdam dr ahnapa clinic (specialized clinic in pain medicine, dermatology, and rehabilitation medicine). As a specialist in anesthesia and pain medicine, I have been treating various pain patients for approximately 25 years, including headaches, neck and shoulder pain, lower back pain, knee pain, calf pain, ankle pain, and foot and heel pain. Through this process, an important principle I have come to value is: "Do not only look at the painful area, but also examine why that area repeatedly bears a burden." Today, I will explain plantar fasciitis and heel and foot pain, which are commonly encountered conditions.
If Your Heel Hurts When Taking Your First Step in the Morning, You Should First Examine the Structure of the Plantar Fascia
The plantar fascia is a fibrous tissue extending from the heel bone to the toes, and when repetitive load accumulates, pain tends to be prominent in the first steps taken in the morning.
The plantar fascia supports the arch of the foot and absorbs the impact that occurs when walking or running. When repetitive stress is applied to this tissue, pain may appear on the inside of the heel or on the sole of the foot. The following symptoms are typically representative:
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Pain appears when taking the first step after waking up in the morning
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Pain recurs when standing up after sitting for a long time
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Heel pain becomes severe again after standing or walking for long periods
Pain caused by repetitive stress on the plantar fascia can be reported to repeat for weeks to several months.
However, a more important question to examine here is: "Why is repetitive overload repeatedly applied to a specific area?"
Foot Pain May Not Be Just a Foot Problem
If the cause of foot pain is sought only in the foot itself, treatment may be repeated, so it is important to examine the overall left-right and front-back balance of the body.
While treating pain patients for 25 years, an important aspect I have observed is the left-right and front-back balance of the body. For example, if there is a habit of sitting with weight on one hip for long periods, it is easy for the trunk and pelvis balance to collapse to one side. When such imbalance accumulates over several months to years, continuous tension can develop in the same-side erector spinae and muscles around the pelvis, and the muscle usage patterns of the lower extremities may also change. As a result, I frequently observe in clinical practice sequential tension from the thigh, shin, calf, ankle, to sole of the foot, or more weight being placed on one foot.
This does not mean it is a single cause applicable to all plantar fasciitis patients. However, from a clinical perspective, there is a need to examine posture and weight distribution in the process of finding the reason for repetitive overload on one foot.
Why Calf Tension and Gait Pattern Should Be Examined Together
Excessive tension in the calf muscles can affect ankle movement and gait pattern, so verification is needed along with foot pain.
When treating plantar fasciitis patients, I check not only the sole of the foot but also the calf and lower extremity tension. If two or more of the following symptoms appear simultaneously on one side, there is a need to examine the overall body balance:
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One side of the lower back is frequently sore
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The knee on the same side also hurts
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The shin feels tight
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The calf frequently gets tense
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Leg cramps occur at night
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Only one heel or sole of the foot repeatedly hurts
In such cases, rather than viewing each symptom separately, it is necessary to examine whether they are connected and appear from a single weight-bearing pattern.
Five Key Elements Confirmed During Consultation
In plantar fasciitis consultation, in addition to the sole of the foot, a total of five elements are confirmed together: left-right weight distribution, erector spinae tension, pelvis and lower extremity muscles, gait habits, and foot structure.
Generally, various factors can influence plantar fasciitis, including activity level, foot shape, gait type, body weight, footwear, and repeated impact. Therefore, treatment targeting only the sole of the foot may be insufficient. During consultation, the following five elements are confirmed:
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Left-right weight distribution: Check which hip more weight is placed on when sitting.
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Left-right tension in the erector spinae: Confirm whether one side's erector spinae is continuously tense from the lower back to the neck.
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Pelvis and lower extremity muscle tension: Examine which side of the thigh, shin, or calf is more tense.
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Weight transfer when standing and walking: Check which foot weight remains on for longer.
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Structural problems of the foot itself: Check for flat feet, high arches, foot deformities, footwear problems, etc.
The Goal of Treatment Goes Beyond Pain Relief to Prevention of Recurrence
During periods of severe pain, medication, physical therapy, and injection therapy may be considered, but the ultimate goal of treatment is to find the cause of repeated weight bias and correct posture.
During periods of severe pain, various methods such as medication, physical therapy, or injection therapy can be considered depending on the patient's condition. In cases where excessive tension of nerves and muscles is observed in specific areas around the spine, cases are reported where nerve block treatment and other appropriate procedures are performed, and tension and pain in the lower extremity muscles are alleviated within 1-2 weeks. However, the ultimate goal of treatment is not the injection itself. I believe that finding why weight is continuously placed on a specific foot and improving that posture is important in reducing recurrence.
The Key to Preventing Recurrence Is Posture Education
The final stage of pain treatment is posture education, and improving long-accumulated habits typically requires weeks to several months of consistent effort.
A body that has been used incorrectly for a long time does not immediately change its living habits even with a few treatments in the treatment room. Therefore, I explain the following content adapted to each patient's condition:
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How to distribute left-right weight when sitting
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How to reduce the habit of bending the upper body forward
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Methods to avoid leaning on only one leg when standing
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Exercises to restore front-back spinal balance
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How to utilize walking and running
Ultimately, patients themselves must be able to understand and modify their own posture, and such habit correction typically requires weeks to several months.
Cases Requiring Differentiation from Other Conditions
Not all heel and foot pain is plantar fasciitis, so if pain suddenly worsens, accurate diagnosis should take priority.
Achilles tendon disease, nerve compression, fractures, and joint diseases can also be causes of foot and heel pain. If severe pain suddenly appears and rapidly worsens within a few hours, the foot becomes swollen and red, it is difficult to bear weight after trauma, or sensory loss is present, accurate diagnosis should take priority over self-management.
Treatment Comparison: Differences Between Self-Management, Physical Therapy, and Nerve Block Treatment
Since plantar fasciitis management methods have different purposes, effect onset times, and suitable candidates, it is important to choose according to the patient's condition.
| Distinction | Self-Management (Massage Ball/Foam Roller) | Physical Therapy | Nerve Block Treatment |
|---|---|---|---|
| Purpose | Fascia and muscle tension relief and prevention | Musculoskeletal function recovery | Local tension and pain relief |
| Effect onset time | Several days to weeks | After several treatments (approximately 2-4 weeks) | Within 1-2 weeks after procedure |
| Effect durability | Maintainable with consistent practice | Varies by individual | Varies by individual |
| Suitable candidates | Mild cases or for prevention | Patients with moderate or greater functional decline | Patients with severe acute pain |
| Cost range | Relatively low (tool purchase level) | Non-covered; determined within range through consultation | Non-covered; determined within range through consultation |
These methods are not mutually exclusive, and many cases involve using them in combination. For non-covered items, accurate costs are best confirmed through treatment consultation.
Self-Management Methods You Can Practice at Home
Self-management using massage balls and foam rollers is more of a supplementary method to reduce repeated tension and prevent recurrence rather than treatment to fundamentally eliminate pain.
As important as treatment is regular management. In addition to posture and weight-bearing habit correction in the clinic, I introduce methods that can be helpful with consistent practice at home.
1. Using a Massage Ball (Tennis Ball) to Release Plantar Fascia
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Place a tennis ball or massage ball on the floor and press down with the sole of your foot while rolling it back and forth.
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Roll evenly from the heel to the bulging area below the toes.
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Once you find a point where pain is felt, press gently for 10-15 seconds, then repeat rolling.
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It is good to do this for 5-10 minutes a day at an intensity that does not cause severe pain, for both feet.
During acute swelling or very severe pain, it is recommended to seek treatment first rather than forcefully pressing.
2. Using a Foam Roller to Release Calf Muscles
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Place the foam roller on the floor, place your calf on it, and slowly roll it back and forth while supporting your body with your hands.
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Roll alternately inside, outside, and center areas of the calf.
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Where tension or tenderness is felt, pause briefly and press gently.
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Proceed for 1-2 minutes per side, alternating left and right.
If there is a habit of placing more weight on one leg, that side's calf is often more tense, so comparing the left-right difference can also be helpful.
Consistent Management and Accurate Diagnosis Are Both Needed
While self-management can help prevent recurrence, if pain persists for more than 4 weeks, consultation is needed to understand the cause.
This self-management is rather a supplementary method to reduce repeated tension and prevent recurrence rather than treatment to fundamentally eliminate pain. If you stand or walk for long periods, it can be helpful to practice briefly and consistently as you end the day. However, if pain has already progressed significantly or repeats for more than 4 weeks, self-management alone may have limitations, so consultation is needed to identify the cause of why specific areas repeatedly bear burden.
Integrated Consultation Provided by seoul chungdam dr ahnapa clinic
In addition to pain treatment, we operate a comprehensive consultation system addressing various areas including problematic nails and skin concerns.
seoul chungdam dr ahnapa clinic (specialized clinic in pain medicine, dermatology, and rehabilitation medicine) provides one-on-one customized consultation with experienced medical professionals to check patients' posture and weight distribution. Additionally, for those experiencing inconvenience from ingrown toenails or toenail fungus, we provide accurate and prompt diagnosis and problematic nail treatment. For those concerned with droopy eyelids or fine wrinkles around the eyes, we operate non-surgical eye area iron laser lifting to naturally improve eye area elasticity and fine wrinkles, and for those concerned with pores, we operate pore iron laser programs that smoothly improve the appearance with 2-week intervals and 3-5 sessions.
Frequently Asked Questions (FAQ)
Q. Is it plantar fasciitis if only the heel hurts when taking the first step in the morning?
It is one of the typical symptoms commonly appearing in plantar fasciitis. However, similar symptoms can appear in other heel conditions, so if pain repeats, it is good to confirm the accurate cause through consultation.
Q. Is there a relationship between frequently tense calves and plantar fasciitis?
The load on the ankle and foot is related to the movement of the calf and entire lower extremity. Therefore, it is necessary to examine the calf and gait pattern together during treatment.
Q. What is the reason only one foot repeatedly hurts?
Various factors can be involved, including foot structure itself, gait habits, pelvic alignment, and left-right weight-bearing habits. In particular, it is important to first check whether there is a lifestyle habit of placing weight to one side.
Q. Is treatment complete once the pain disappears?
Just because pain is reduced does not mean that existing posture and weight-bearing habits have also been corrected. If pain repeats, it is important to correct the lifestyle habits and posture that are the cause.
Q. I have a job where I stand for long periods. Are there any special areas I should pay attention to for plantar fasciitis prevention?
When working while standing for long periods, repetitive stress tends to accumulate in the feet and calves. In such cases, distributing weight evenly left and right during work, and combining self-management that gently releases the sole and calf for about 5-10 minutes a day can be helpful. If pain persists, it is good to confirm the cause through consultation.
※ This article is general content provided for health information, and treatment results may vary depending on individual health conditions, so please be sure to consult with a specialist.