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🏥 Gotokuji Orthopedic Clinic / Patient Guide

Plantar Fasciitis

When your first step in the morning hurts -- understanding heel pain

On the bottom of your foot, a tough band of tissue called the plantar fascia runs from the heel to the base of the toes.
When this band is overloaded repeatedly and becomes painful, it is called plantar fasciitis. Despite the "-itis" in the name, the main problem is thought to be microscopic damage and degeneration of the fascia rather than strong inflammation.
The most common symptom is sharp heel pain with the first step in the morning.

1
Repeated stress on the plantar fascia

Running and prolonged standing put ongoing stress on the sole of the foot

2
Tiny tears build up in the fascia

Small amounts of damage accumulate over time from repeated strain

3
The fascia degenerates and becomes painful

The fascia is damaged particularly near the inner side of the heel, where pain appears

4
Pain is worst with the first step after rest

The fascia tightens during sleep, and putting weight on it suddenly stretches it and causes pain

🏃 Running 🧍 Standing jobs 🦶 Flat feet or high arches 👴 Age 40+ ⚖️ Obesity
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Sharp heel pain with the first step in the morning
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Tenderness when pressing the inner side of the heel
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Pain that gets worse with prolonged walking
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Pain worsens when standing on tiptoe
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Pain eases with a little walking but returns after long periods of rest
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Stretching
Calf and plantar fascia stretches are the foundation of treatment
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Insoles
Arch-support insoles reduce strain on the sole of the foot
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Icing
Apply ice for 15 to 20 minutes to ease the pain
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Anti-Inflammatory Medication
Oral medication or patches to relieve pain and inflammation
Shockwave Therapy
Considered when conservative treatment alone is not enough. Our clinic uses a radial device, so it is provided as self-pay (non-insured) care at 3,000 yen (tax included) per session — please also see the note below
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Injection Therapy
Steroid injections are sometimes used for severe cases, but repeated injections can cause rupture of the plantar fascia or atrophy of the heel fat pad, so we limit the number and use them cautiously

Shockwave therapy: cost and risks
In Japan, public health insurance covers "extracorporeal shockwave pain therapy" only when a focused device is used for refractory plantar fasciitis (cases that have not improved after six months or more of conservative treatment). Our clinic uses a radial device, so we provide it as self-pay (non-insured) care at 3,000 yen (tax included) per session. Temporary pain, redness, swelling, or bruising may occur at the treated area.

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Most patients improve with proper conservative treatment

With consistent stretching, insoles, and other conservative measures, most people get better. However, if left untreated for too long, the condition can become chronic, so early attention is important.

💡 Habits to Prevent Heel Pain

  • Make daily calf stretching a habit
  • Wear shoes with good cushioning or use supportive insoles
  • Avoid standing for long periods; take regular breaks
  • If pain persists, do not push through it -- see an orthopedic specialist early