Heel pain can present itself in various ways, but one of the most recognsable and frustrating symptoms is morning pain—the kind that greets you with sharp, stabbing discomfort the moment you take your first steps out of bed.

During sleep, as your body temperature drops, blood flow slows, and the tissues in your foot—particularly the plantar fascia—tighten and stiffen. This reduced circulation and colder body temperature exacerbate inflammation, making it harder for muscles and tendons to stay flexible. As a result, the pain is often at its worst in the morning, when your body is just starting to warm up and loosen.

Although this pain may ease as you move around and the tissues warm up, it often returns after periods of inactivity, such as sitting at a desk or standing still for a while. This cyclical nature of heel pain, worsened by cold or stiffness, is a hallmark symptom of conditions like plantar fasciitis and sub-calcaneal fat pad pain.

Other common symptoms include:

• Sharp, stabbing pain in the heel, especially noticeable with the first steps after rest.
• Aching or throbbing discomfort that worsens after prolonged activity or standing.
• Tenderness when pressing on the heel or along the arch of the foot.
• Swelling or inflammation around the heel, particularly in colder weather, which can indicate a more severe issue.

Heel pain can stem from a variety of conditions, but two of the most common causes are plantar fasciitis and sub-calcaneal fat pad pain. While both can cause significant discomfort, especially in people over 40, they affect the foot differently and require different approaches for treatment. Understanding these differences is key to finding the right solution for your heel pain.

Plantar fasciitis is the most common cause of heel pain and occurs when the plantar fascia, a thick band of tissue that runs along the bottom of the foot, becomes inflamed or damaged. This condition is often triggered by repetitive strain, poor foot mechanics, or improper footwear. The plantar fascia supports the arch of the foot, and when it’s overstressed, it can develop small tears, leading to inflammation and pain.

The hallmark symptom of plantar fasciitis is intense morning pain—that sharp, stabbing sensation you feel with your first steps out of bed. This occurs because the plantar fascia tightens overnight, and the sudden stretching when you step down causes pain. While the discomfort may lessen as the tissue warms up throughout the day, it often returns after prolonged periods of rest or activity.

Sub-calcaneal fat pad pain is less talked about but is another leading cause of heel pain, especially in older adults. The fat pad located beneath your heel acts as a natural cushion, absorbing the impact when you walk or run. Over time, this protective layer can thin due to aging, injury, or repetitive stress, leading to pain when the heel strikes the ground.

Unlike plantar fasciitis, which tends to affect the arch and is more painful during the first steps in the morning, fat pad pain is typically felt directly under the heel. It may worsen after walking on hard surfaces or standing for long periods. Fat pad pain is often confused with plantar fasciitis, but the two conditions are distinct, and treating them requires different strategies.

Sub-calcaneal fat pad pain is often confused with plantar fasciitis, but the treatment approaches differ. Cushioning the heel with padded footwear or inserts is essential to reducing impact, while minimising standing on hard surfaces and addressing weight-bearing activities can help prevent further wear on the fat pad. The goal is to protect the heel from impact, which can alleviate pain and allow the fat pad to recover over time.

Prevention is always better than cure, and there are several steps you can take to reduce your risk of developing heel pain, whether it’s from plantar fasciitis or fat pad issues. The key to prevention is maintaining foot health through proper support, stretching, and paying attention to your body’s signals before pain becomes chronic.

• Footwear Matters

One of the most important factors in preventing heel pain is wearing proper footwear. Shoes that provide adequate arch support, cushioning, and shock absorption are essential for protecting the plantar fascia and fat pad. Avoid wearing unsupportive shoes, such as flip-flops or high heels, for long periods, as these can increase strain on the heel.

• Regular Stretching

Incorporating regular stretching into your routine, especially for your calves, Achilles tendon, and the plantar fascia, can keep these tissues flexible and reduce strain. Stretching first thing in the morning and before engaging in physical activity is especially helpful in preventing plantar fasciitis.

• Strengthen Your Feet

Strengthening the muscles in your feet, ankles, and hips helps improve foot mechanics and supports your arch, preventing overloading of the plantar fascia or fat pad. Exercises like toe curls, heel raises, and resistance band exercises can be done easily at home.

• Maintain a Healthy Weight

Carrying excess weight places additional pressure on the feet, especially the heels. Maintaining a healthy weight can reduce the load on your heels and prevent conditions like plantar fasciitis and fat pad thinning from worsening.

• Listen to Your Body

Don’t ignore early signs of heel pain. If you notice discomfort, especially in the morning or after long periods of standing, take action immediately by adjusting your footwear, resting, or incorporating stretches. Addressing the issue early can prevent it from developing into a chronic condition.

Don’t ignore early signs of heel pain. If you notice discomfort, especially in the morning or after long periods of standing, take action immediately by adjusting your footwear, resting, or incorporating stretches. Addressing the issue early can prevent it from developing into a chronic condition.

Heel pain, while common, doesn’t have to be a part of your daily life. Whether it’s the sharp morning pain of plantar fasciitis or the deep ache of fat pad deterioration, the key to relief lies in understanding the cause and taking early action.

Proper diagnosis and tailored treatment—whether it’s stretching for plantar fasciitis or cushioning for fat pad pain—can make all the difference in how quickly you recover and prevent the issue from becoming chronic.

The Sharp Physio Team