Written by Zita Sham, Fairuuz Saleh and Shiv Mohan Banka, Principal Physiotherapists at Phoenix Rehab.Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H.Last reviewed 6 October 2026.
Your alarm goes.
You swing your legs off the bed, put your foot down, and something under your heel stabs. Sharp. Right in the middle of the underside, slightly towards the inside edge.
So you hobble. Short steps, weight on the outside of the foot, holding the wall to the bathroom. It eases off. Then you sit through a two hour meeting, stand up, and it is back. Same stab. Same twenty steps.
That pain in the heel is almost certainly coming from the plantar fascia, the thick band of tissue running along the sole of your foot. Our physios at Phoenix Rehab see more of this than almost any other foot problem.
Here is the honest part first. This one is slow. It is also, for most people, very treatable. The people who do best accept both.
What plantar fasciitis actually is
Run your thumb firmly along the sole of your foot, from the front of your heel bone towards your toes. Under the skin and the fat is a thick sheet of fibrous tissue. That is the plantar fascia.
It anchors into the underside of your heel bone, fans out across the sole, and attaches near the base of each toe. Think of your foot as a bow, the arch as the curve, the fascia as the bowstring pulled tight underneath. Every time you put weight through that foot the arch tries to flatten, and the fascia holds it together.
When the demand outruns what the tissue can handle, the fibers near the heel attachment change. They thicken and lose their neat organization. They become sensitive. Pressing that exact spot reproduces your pain almost every time, which is the most useful finding in an examination.
About the name
Plantar fasciitis ends in “itis”, which normally means inflammation. That is why the first thing anyone reaches for is an anti-inflammatory.
The tissue tells a different story. In long standing cases, what shows up looks less like classic inflammation and more like degeneration and overload. The fibers are disorganized rather than angry. Some clinicians now prefer plantar fasciopathy, or plantar heel pain.
This is not word games. If the tissue is overloaded rather than inflamed, calming inflammation alone will disappoint you, which is what most people find. And loading the tissue properly starts to make sense as treatment rather than something to avoid.
How to tell if this is what you have
The pattern matters more than the pain. Plantar fasciitis has a signature specific enough that you can usually tell within a minute whether your heel fits.
- Sharp or stabbing pain under the heel, worst on the first few steps after getting out of bed
- It eases within five to fifteen minutes of walking around
- It returns after sitting still, after driving, after a long meeting
- It worsens again late in the day if you have been on your feet a lot
- Pressing the inside front corner of the underside of your heel is tender, sometimes sharply so
- Pulling your toes back towards your shin makes that spot feel tighter and often more sore
- Walking barefoot on hard tiles is worse than walking in cushioned shoes
Rest settles it temporarily and does nothing for the capacity of the tissue, which is why it comes straight back.
The conditions it gets confused with
Heel pain is not one thing, and the wrong label leads to months of the wrong treatment.
Achilles tendon problems. The pain is at the back of the heel, not underneath, where the cord at the back of your ankle meets the bone. Squeezing that cord is sore, and going up on tiptoe is often uncomfortable. Behind rather than below, look here first.
Fat pad irritation. Under your heel sits a natural cushion of fatty tissue that absorbs impact. When it is bruised or thins with age, the pain sits in the centre of the heel rather than the front edge, and feels deep and bruised rather than sharp.
Calcaneal stress fracture. A small crack in the heel bone, usually from a sudden jump in running or marching load. Squeezing the heel from both sides at once hurts, which plantar fasciitis does not. It also behaves the opposite way, getting worse with every step rather than easing after the first few minutes.
Nerve entrapment. A small nerve runs close to the inside of the heel, and when irritated the pain changes character. Burning. Tingling. Sometimes numbness, sometimes pain at rest and at night. Burning rather than stabbing needs a look.
Inflammatory joint conditions. Pain in both heels at once, in a younger adult, with morning stiffness in the back or other joints lasting more than half an hour, points somewhere else entirely.
If the pain sits under the ball of the foot instead, closer to the toes, that is a different problem again.
Heel fat pad syndrome: the bruise that is not plantar fasciitis
The pad of fat under your heel is the shock absorber you land on with every step. It can be bruised by a hard landing, and it thins with age and after steroid injections into the heel. When it is the problem, the pain is a deep bruise in the middle of the heel, not a sharp pull at the front inner edge.a
| Heel fat pad | Plantar fasciitis | |
|---|---|---|
| Where it hurts | The middle of the heel, under the bone | The front inner edge of the heel, where the arch begins |
| When it is worst | Standing and walking on hard floors, barefoot, and later in the day | The first steps out of bed, and after sitting |
| Pressing on it | Tender in the center, like a bruise | Tender at the front edge; stretching the toes up often reproduces it |
| What usually helps first | Cushioned shoes or a heel cup, and no barefoot walking on tiles for now | A loading program for the fascia and calf |
The two often come together. Fat pad pain from a bruise usually settles over weeks once the heel is cushioned. Thinning from age does not come back, so the cushioning becomes part of how you buy shoes. If the pain followed a fall from a height, or you cannot put weight on the heel, see a doctor the same day.
Source: a. Yi TI, Lee GE, Seo IS, Huh WS, Yoon TH, Kim BR. Clinical characteristics of the causes of plantar heel pain. Ann Rehabil Med. 2011;35(4):507-513.
The heel spur myth
Our physios have this conversation almost every week. Someone arrives with an X-ray report and a sentence they have carried for months. There is a spur. They have pictured it ever since as a bone spike stabbing into their foot with every step. That is not what is happening, and letting go of that picture usually changes the whole recovery.
A heel spur is a small growth of bone extending forward from the underside of the heel bone. Spurs are common in people with no heel pain at all. Where a spur and pain occur together, the spur is generally understood as a consequence of long term traction rather than the cause. Removing it is rarely the answer, because heel pain routinely settles completely while the spur stays where it is.
Nobody did anything wrong by telling you about the spur. It is genuinely there on the film, and reporting what is visible is right. The spur is a finding, not an explanation. Your symptoms come from the tissue, and tissue responds to treatment.
What causes it
Almost always a mismatch. The tissue was handling what you asked of it, then the ask went up or the capacity went down.
Sudden increases in load. A new running program. A 10K signed up for after two years off. A holiday spent walking twenty thousand steps a day. A new job on your feet for nine hours instead of sitting.
Standing work on hard surfaces. Retail floors, hawker stalls, kitchens, wards, security posts. Standing mostly still on unforgiving ground is harder on the fascia than walking is.
Weight changes. Gaining weight loads the arch harder with every step, and so does pregnancy. Physics, not a judgement.
Tight or weak calves. Your calf and Achilles connect to the back of your heel bone, and the plantar fascia connects to the underside. A tight calf pulls the heel upwards at the back, and the fascia takes more strain at the front. This is why calf work sits at the centre of treatment.
Footwear and foot shape. Flat, unsupportive shoes give the arch nothing to work with, and worn out running shoes do the same. Very flat feet and very high rigid arches load the fascia differently, though neither makes the problem certain.
The Singapore part
Flip flops and slides are daily footwear here, not holiday footwear. Flat, thin, and your toes grip slightly to keep them on. Hours of that is a genuine contributor, and our physios see it constantly in people who believed their footwear was neutral.
Home floors are tiled, and most of us are barefoot on them from the moment we get home until bed. That is often the biggest block of unsupported standing in the day. Retail, service and hawker work adds long hours on concrete, and a Saturday on the marble at Orchard is several kilometers with no give at all. Long runs on concrete pavements in this heat count too.
When you need to get this looked at
Most heel pain is not sinister. Some is. These warrant medical review, not waiting.
- Heel pain that began after a fall, a landing from height, or a sudden traumatic moment
- Inability to put weight through the foot
- Pain that worsens with every step through the day rather than easing after the first few minutes
- Numbness, burning, or pins and needles in the heel or sole
- Pain in both heels in a younger person, especially with morning stiffness in the back or other joints
- Fever, or a heel that is red, hot and swollen
- Any heel pain in someone with diabetes or reduced sensation in the feet
Beyond those, the signal is trajectory, not intensity. Heel pain slowly improving over four to six weeks of sensible self-management is on the right road. Heel pain that is the same or worse after six weeks is the point to get assessed, rather than to try a fourth pair of insoles. You can reach us on WhatsApp at 8336 6009.
What happens if you leave it
Plantar fasciitis will not destroy your foot. It takes over more of your life than you expect, slowly, while you wait for it to sort itself out. Many cases do settle eventually without treatment. The honest caveat is that eventually can mean a year or more, and that is a long time to organize your day around your first ten steps.
The bigger cost is what people do to avoid the pain. You start landing on the outside of your foot. You stop walking to the MRT and take a Grab. You drop the weekend run, then badminton, then notice you have not exercised in four months. The calf on that side gets weaker, and the other hip starts to complain because it has been doing extra work.
Pain present for many months also tends to take longer to settle. That does not close the door. It means starting sooner is worth something real.
How it gets treated
Plantar fasciitis treatment, ordered from least to most invasive. Most people never get past the first three.
Load management. Not rest. Rest alone costs you fitness and gives back nothing. Bring the daily load under the level that keeps flaring it while you build the tissue up. Cut the long standing blocks, wear supportive shoes indoors instead of going barefoot on tiles, and keep fitness through cycling or swimming.
Stretching. Calf and plantar fascia stretching gives fast symptom relief, especially for that first morning step. Worth doing, and on its own incomplete. Stretching alone is the most common thing we see people doing for months without progress.
Progressive loading of the fascia. Almost everyone arrives having stretched and rested. Far fewer arrive having loaded the fascia, and this is the part that matters most. Strong, slow, heavy loading, through heel raises with the toes held in an extended position, appears to produce better outcomes than stretching alone. It gives the fascia a reason to remodel and rebuild capacity rather than simply being told to calm down. The program is in the next section.
Footwear and arch support. Shoes with a cushioned heel and a firm midsole reduce strain through the fascia. Over the counter arch supports help a meaningful number of people within weeks, and custom orthotics are an option where foot shape calls for it. Support lowers load while the tissue recovers. It does not build capacity, so it sits alongside the loading work, never instead of it.
Taping. A supportive tape job under the arch settles symptoms quickly. A short term tool for getting through a working week, not a fix.
Night splints. A brace holding the ankle at ninety degrees while you sleep, so the fascia does not rest all night shortened. It targets exactly that first morning step. Plenty of people cannot sleep in one. If you can, it is worth trying for stubborn heel pain in the morning.
Corticosteroid injection. A doctor’s decision, not ours. It can give useful short term relief when pain is severe. It also carries real risks, including thinning of the protective fat pad under the heel and, uncommonly, rupture of the fascia. It does not address the capacity problem, so pain often returns if nothing else changes. It makes most sense as a window for doing the loading work.
Shockwave therapy. An option for cases that have not responded to several months of good rehabilitation. Not a first line answer.
Surgery. Rare, and a last resort after a genuine trial of everything else.
What physiotherapy actually adds is the assessment first. Whether this is fascia, fat pad, nerve or bone changes the entire plan, and that is worth more than any single technique. After that it is a loading program matched to your real capacity, and someone keeping you on it through the months where nothing appears to be changing.
Exercises and what to do at home
These are general. Get assessed first, particularly if your pattern does not match the picture above, because the wrong exercises for a stress fracture or a nerve problem waste months.
1. Plantar fascia stretch, before your first step. Sit on the edge of the bed. Cross the sore foot over the opposite knee. Pull your toes back towards your shin until the band along your sole goes tight. Hold 10 seconds, 10 repetitions. Do this before your feet touch the floor, and again before standing after any long sit. For morning pain, this is the highest value thing on the list.
2. Calf stretch, knee straight then knee bent. Hands on a wall, sore leg back, heel flat. First with the back knee locked straight, leaning forward until you feel it in the upper calf. Then the same position with the back knee slightly bent, which drops the stretch lower towards the ankle. Hold 30 seconds, 3 repetitions each. Both are needed because they reach different muscles, and the deeper one attaches nearer the heel where your problem sits.
3. Rolling the sole. Freeze a small water bottle and roll it under your arch with moderate pressure for 5 minutes at the end of the day. This is for comfort. It builds nothing, so do not let it replace the next one.
4. The progressive heel raise loading program. This is the one that changes things. Stand with the ball of the sore foot on a step, heel hanging off the back. Roll a towel under your toes so they are bent upwards while you stand. That toe position pulls the fascia tight and puts the load where you want it.
Rise slowly onto the ball of the foot over 3 seconds. Hold 2 seconds. Lower over 3 seconds. The tempo is not optional, because the slowness is what makes the load count.
Start on both feet, 12 repetitions, 3 sets, every second day. When that feels comfortable, shift more weight onto the sore side, then single leg, then add load in a backpack.
The progression rule. Pain during the exercise up to about 4 out of 10 is acceptable. What matters is the next morning. If your first steps are worse, hold at the level you were at. Same or better, you are ready to add.
What recovery actually looks like
The gap between expectation and reality is what makes people quit. This is a slow condition. Most people improve substantially, and it takes months rather than weeks. Three to twelve months is realistic for a case that has been going on a while.
What our patients say
Google reviews from our clinics in Singapore.
Here is the most useful sentence on this page. The single biggest reason heel pain drags on for years is that people stop the loading program as soon as the morning pain eases.
The morning pain settles first, well before the tissue has rebuilt its capacity. So around week six or eight, when you can reach the bathroom without holding the wall, stopping feels reasonable. Then comes a heavy week at work, it returns, and you decide the exercises did not work.
They did work. They were stopped at halfway. Keep the loading going for at least three months past the point where you feel better. That one decision separates the people who are finished with this from the people who still have it next year.
Recovery is slower when the pain has been there over a year, when the standing load cannot be reduced, when calf tightness is not addressed, and when footwear does not change.
Getting assessed at Phoenix Rehab
The first appointment starts with sorting out what is actually causing your pain in the heel. Our physios ask about your morning pattern, your working day on your feet, what changed in the weeks before it started, and what you have already tried. Then they examine the foot, pressing the spots that separate fascia from fat pad from bone, checking calf length and strength, and watching you walk.
From there you get a plan you can actually run. The loading program set at the level your tissue handles now, footwear guidance for your working day, and a timeline so you know whether you are on track at week four instead of guessing.
We see people at Orchard, Tampines, Serangoon and Tanjong Pagar, with Jurong East opening 20 October 2026.
Frequently asked questions
Why does my heel hurt most in the morning?
Overnight your foot rests with the toes pointed, and the plantar fascia settles into a shortened position. The first steps out of bed stretch it suddenly, and the sensitive tissue at the heel attachment objects. After a few minutes of walking it has adapted again and the pain eases. Stretching the fascia before your first step makes a real difference.
Is my heel spur causing my pain?
Almost certainly not directly. Heel spurs are found in plenty of feet that have never hurt, and where a spur and pain occur together the spur is generally understood as the result of long term load rather than its cause. Heel pain regularly settles completely with the spur still there. Treatment targets the tissue, not the bone.
How long does plantar fasciitis take to heal?
Longer than most people expect. Substantial improvement usually takes months rather than weeks, often three to twelve depending on how long it has been going on. The main reason it drags is stopping the strengthening work once the morning pain eases, before the tissue has rebuilt its capacity.
Do I need an X-ray or a scan for pain in the heel?
Usually not. The pattern is distinctive enough that a careful examination is generally sufficient. Your doctor may suggest imaging if the story does not fit, if there was a traumatic onset, if a stress fracture is suspected, or if the heel has not responded to proper rehabilitation.
Are insoles worth it for plantar fasciitis?
For many people, yes, as part of a plan. Over the counter arch supports reduce strain through the fascia and help a meaningful number of people within weeks. Custom orthotics are worth considering where foot shape calls for it. Support lowers load while the tissue recovers, but it does not build capacity, so it works alongside the strengthening.
Can I keep running with heel pain?
Often yes, at reduced volume, if the pain settles within 24 hours and is not worse the following morning. Cut the distance, drop hills and speed work, and run on softer ground rather than concrete where you can. If your first steps the next day are noticeably worse, that run was too much.
Your feet have a lot of years left in them
Heel pain feels small until it starts deciding things for you. Which shoes. Whether you walk or take the car. Whether you run or stay home. Nobody decides any of it, and then a year has gone.
It does not have to go that way. The people who get through this are not the toughest or the fittest. They are the ones who found out what was actually wrong and kept going long enough.
You want to be the person who still walks the long way round because they feel like it. Who plays on the weekend. Who gets older without their feet quietly shrinking the size of their life.
If your heel has been running your mornings, come and have it looked at properly. WhatsApp 8336 6009. One assessment tells you more than four months of guessing.
Had an injection?
The heel injection worked. The first steps out of bed are coming back.
An injection settles the first-step pain in the heel. It does not load the plantar fascia or the calf, which is what changes how the heel copes with a day on your feet.
Calf and arch loading and footwear are the work. Doctors limit repeated steroid injections into the heel, because they can weaken the plantar fascia, so if you are on your second or third, ask your doctor about it.
Also on this site: the page on tarsal tunnel syndrome covers the nerve on the inside of the ankle, and the page on turf toe covers the sprain at the base of the big toe.
Where are you with this right now?
1. It is settling on its own
Foot and ankle problems are slow but usually very treatable. Months rather than weeks is normal, and improvement is judged over a month, not a day. If the first steps in the morning are easier than they were four weeks ago, you are on the right road. You do not need us for this, and we would rather say so.
2. It has stopped improving
The first ten steps out of bed are still the worst part of the day. You choose shoes by how long you will be standing. You still look at the ground when you walk.
Symptoms settle well before the tissue has rebuilt its capacity, which is why stopping the loading work early is the most common reason this drags on for years. That is the gap worth measuring, and it is not measured by how you feel on the day.
The Stalled Recovery Review is three appointments over three weeks with the same therapist, because what a joint does under load cannot be read in one visit. The first finds what is limiting it. The next two measure how it responds. $690, nett, no GST, which is three appointments at $230.
3. You have had surgery, or you have a date
Recovery after an operation has a shape, and knowing which stage you are in tells you whether you are on it. See the recovery programs, or ankle physiotherapy if you are not sure which applies to you.
All of it runs on the same four stages. The Phoenix Recovery Protocol explains what each stage works on and what you have to meet to move up. No referral needed to start.
Next step
Find out which stage you are in
Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.
Prefer to phone? Each of our five clinics has its own number on the clinics page. No referral needed to book.
Related reading
Where we are
Clinics across Singapore
ORCHARD
400 Orchard Road #12-12
Orchard Towers, S238875
NS22 Orchard MRT
Physiotherapy and hand therapy in Orchard →
WhatsApp 8800 1830TAMPINES
9 Tampines Grande #01-20
Asia Green, S528735
EW2DT32 Tampines MRT
Physiotherapy and hand therapy in Tampines →
WhatsApp 8780 9608SERANGOON
265 Serangoon Central Drive #04-269
S550265 · Lift C only
NE12CC13 Serangoon MRT
Physiotherapy and hand therapy in Serangoon →
WhatsApp 8892 4121TANJONG PAGAR
10 Anson Road #02-77A
International Plaza, S079903
EW15 Tanjong Pagar MRT
Physiotherapy and hand therapy in Tanjong Pagar →
WhatsApp 8227 7074JURONG EAST
2 Venture Drive #02-02
Vision Exchange, S608526
NS1EW24 Jurong East MRT
Opening 20 October 2026
Physiotherapy and hand therapy in Jurong East →
WhatsApp 8242 7340