Which condition presents with acute or recurrent pain on the bottom of the feet aggravated by walking and worst with the first steps in the morning?

Which condition presents with acute or recurrent pain on the bottom of the feet aggravated by walking and worst with the first steps in the morning?

• A. Morton's neuroma
• B. Achilles tendinopathy
• C. Plantar fasciitis
• D. Metatarsalgia

Answer: (C)

The key idea is heel pain that is sharpest with the first steps after a period of rest, coming from inflammation or degeneration of the plantar fascia at its heel attachment. This tissue tightens overnight, so taking the first weight-bearing steps pulls it and causes a painful, stabbing sensation that often decreases with movement as the fascia warms up. Over time, the pain may recur with prolonged activity or standing. Morton’s neuroma usually causes numbness, tingling, or burning between the toes rather than at the bottom of the heel. Achilles tendinopathy involves pain along the back of the heel where the Achilles tendon inserts, typically with push-off activities, not the sole of the foot. Metatarsalgia presents as pain under the ball of the foot, not at the heel, and is related to forefoot loading. Therefore, the presentation fits plantar fasciitis best.

The key idea is heel pain that is sharpest with the first steps after a period of rest, coming from inflammation or degeneration of the plantar fascia at its heel attachment. This tissue tightens overnight, so taking the first weight-bearing steps pulls it and causes a painful, stabbing sensation that often decreases with movement as the fascia warms up. Over time, the pain may recur with prolonged activity or standing.

Morton’s neuroma usually causes numbness, tingling, or burning between the toes rather than at the bottom of the heel. Achilles tendinopathy involves pain along the back of the heel where the Achilles tendon inserts, typically with push-off activities, not the sole of the foot. Metatarsalgia presents as pain under the ball of the foot, not at the heel, and is related to forefoot loading. Therefore, the presentation fits plantar fasciitis best.