“My heel is agony for the first few steps in the morning, then eases — it’s been weeks”

PLANTAR FASCIITIS is the commonest cause of plantar heel pain, recognised by classic "FIRST-STEP" pain — worst on the first steps in the morning or after rest, easing with walking, and returning after prolonged standing — with tenderness at the MEDIAL CALCANEAL tubercle (plantar-fascia origin); risk factors include overuse/new running, prolonged standing, higher body weight, unsupportive footwear and a tight calf/Achilles; chronic cases are often degenerative and load-related ("plantar fasciopathy"). Diagnosis is clinical (typical history plus localised tenderness, ± pain on dorsiflexing the toes) and imaging is not routinely required. Distinguish it from a calcaneal STRESS FRACTURE (recent increase in load/trauma, point bony tenderness, positive squeeze test), fat-pad atrophy (central heel, older), tarsal tunnel/nerve entrapment (burning/tingling/numbness), Achilles/insertional pathology, and inflammatory/seronegative arthropathy with enthesitis (ask about other joints, back pain, psoriasis, eye/GI symptoms). Manage conservatively — most improve, though recovery commonly takes several months (JOSPT/APTA 2023, international): education, load modification keeping up tolerable activity rather than complete rest, calf and plantar-fascia STRETCHING with progressive strengthening, supportive FOOTWEAR with optional low-cost heel cushioning, WEIGHT discussed sensitively (not a condition of treatment), and paracetamol or a short NSAID course only if suitable (BNF), which are first-line and effective for most. For persistent pain, review adherence and the diagnosis, then escalate to physiotherapy/podiatry, a night splint, a selective corticosteroid injection (risk of fat-pad atrophy/fascia rupture), and specialist referral (extracorporeal shockwave therapy only under NICE HTG200 special arrangements, as effectiveness is uncertain). Reassure about the favourable but slow course, set realistic timeline expectations, give stretching/footwear and load/weight advice, and safety-net for features that would prompt reconsideration (stress-fracture point tenderness, neurological symptoms, inflammatory/systemic features).