Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).
Plantar fasciitis (fashee-EYE-tiss) is the most common cause of pain on the bottom of the heel. Approximately 2 million patients are treated for this condition every year.
Plantar fasciitis is common in middle-aged people. It also occurs in younger people who are on their feet a lot, like athletes or soldiers. It can happen in one foot or both feet.
Plantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed.
Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move, the pain normally decreases, but it might return after long periods of standing or when you stand up after sitting.
Plantar fasciitis is a common cause of heel pain in adults. The pain is usually caused by collagen degeneration (which is sometimes misnamed “chronic inflammation”) at the origin of the plantar fascia at the medial tubercle of the calcaneus. This degeneration is similar to the chronic necrosis of tendonosis, which features loss of collagen continuity, increases in ground substance (matrix of connective tissue) and vascularity, and the presence of fibro-blasts rather than the inflammatory cells usually seen with the acute inflammation of tendonitis.1 The cause of the degeneration is repetitive microtears of the plantar fascia that overcome the body’s ability to repair itself.
What Is Plantar Fasciitis?
Plantar fasciitis is one of the most common conditions causing heel pain. It involves inflammation of the plantar fascia — a tough, fibrous band of tissue that runs along the sole of the foot. The plantar fascia attaches to the heel bone (calcaneus) and to the base of the toes. It helps support the arch of the foot and has an important role in normal foot mechanics during walking.
Tension or stress in the plantar fascia increases when you place weight on the foot, such as withstanding. The tension also increases when you push off on the ball of the foot and toes. Both of these motions occur during normal walking or running. With overuse or in time, the fascia loses some of its elasticity or resilience and can become irritated with routine daily activities.
The normal foot has 28 bones, 33 joints and more than 100 muscles, tendons and ligaments. It does so much! The plantar fascia itself supports the arch of your foot. It absorbs pressure — think of the shock absorbers of your car. It bears your weight. Pain is inevitable when the tissues are inflamed, or partially or completely torn.
The word “fasciitis” means “inflammation of the fascia of a muscle or organ” while “plantar” relates to the sole of the foot. Two million patients get treatment for plantar fasciitis, annually. That makes it the most common cause of heel pain. It’s common especially for athletes — specifically, runners. The repetitive motion of pushing off with your feet can injure the tissues.
Plantar Fasciitis Symptoms
Plantar fasciitis causes pain and tenderness of the bottom of the foot. The tenderness is usually toward the heel, but the entire sole of the foot can be affected. A sign of abnormal tension or tightness that can lead to plantar fasciitis is a bony prominence (heel spur) that develops where the inflamed plantar fascia attaches to the heel bone (calcaneus).
Plantar fasciitis can make walking and running difficult. It can make the foot feel particularly stiff and sensitive in the morning or when rising after sitting or getting out of a car. Plantar fasciitis makes it difficult to walk barefoot on hard surfaces. Sometimes the bottom of the foot can feel warm, swollen, and tender.
When a person has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed. As the stress placed on the inflamed plantar fascia continues, microtears develop, which may eventually lead to the development of a bony growth called a heel spur.
While it’s not uncommon for people with plantar fasciitis to have a heel spur (seen on an X-ray), keep in mind that the heel spur is not the source of the pain. In fact, many people with heel spurs have no pain at all.
There are a number of factors believed to increase a person’s risk for developing plantar fasciitis. Some of these factors include:
- Excessive training or exercise, especially long-distance walking or running
- Rapid weight gain
- Prolonged standing
- Recent change in activity
- Tight calf muscles or a tight Achilles tendon
- Improper footwear
- Flat feet
- Very high foot arches
Plantar Fasciitis Diagnosis
Your healthcare provider will, after noting your medical history, perform a physical examination of your foot. If putting pressure on the plantar fascia causes pain, then plantar fasciitis is the likely culprit. If it’s difficult to raise your toes, or if you have tingling or loss of feeling in your foot, those are big red flags.
They will ask questions like “is the pain worse in the morning?” and “does the pain typically decrease throughout the day and with use?” These and other affirmative answers to questions help your healthcare provider determine if it’s plantar fasciitis.
Part of diagnosing plantar fasciitis is a process of elimination. Many conditions are considered when you report foot pain: a fracture, stress fracture, tendinitis, arthritis, nerve entrapment or a cyst in the heel. To determine other possible causes, your healthcare provider may order imaging tests including:
- Bone scans.
- Magnetic resonance imaging (MRI).
How Can I Treat Plantar Fasciitis?
Plantar fasciitis can often be treated without the need to see a healthcare professional.
Paracetamol and ibuprofen can help reduce your pain.
There are some simple self-care tips, known as RICE therapy, that should help it heal:
- Rest – try to avoid putting weight on your heel. Do not exercise, instead try gently moving it from time to time to stop the area getting stiff.
- Ice – put an ice pack or frozen vegetables, covered in a damp cloth, on it for 20 minutes every 2–3 hours.
- Compression – wrap a bandage around the painful area. It should be tight enough to support it, but not so tight that it restricts the blood flow.
- Elevate your foot to reduce swelling.
When it’s painful, rolling a cold drink can over the base of your foot for about 20 minutes should help. Gently massaging and stretching your calf, ankle and foot when you’re resting can also make it easier to get moving again.
You can reduce the pressure on the bottom of your foot by wearing wide-fitting, comfortable shoes with a supportive sole and cushioned insole. They should fasten with a lace or strap and have a heel that is slightly raised by about 2–3cm, such as a good sports shoe.
Try to avoid walking on hard surfaces with bare feet, wearing tight pointy shoes, high-heels, backless slippers, flip-flops, or flat shoes.
Ask your pharmacist about insoles, heel pads and other pain relief. There is no proof that costly magnetic insoles are any better than regular cushioned insoles.
It can take up to 18 months to fully recover from plantar fasciitis. However, if you feel these self-management tips have not helped after two weeks, seek advice from your doctor, a physiotherapist or a podiatrist.
They may recommend:
- specially made insoles or foot supports
- stronger pain relief
- steroid injections in extreme cases
- additional medication to help reduce any inflammation.
Over the long term try to follow a healthy diet. If you are overweight, research shows that reducing the strain on the plantar fascia by losing even a small amount of weight can improve your pain levels.
Exercise. Plantar fasciitis is aggravated by tight muscles in your feet and calves. Stretching your calves and plantar fascia is the most effective way to relieve the pain that comes with this condition.
- Calf stretch. Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.
- Plantar fascia stretch. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.
Cortisone injections. Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit your injections. Multiple steroid injections can cause the plantar fascia to rupture (tear), which can lead to a flat foot and chronic pain.
Supportive shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful.
Night splints. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone.
Physical therapy. Your doctor may suggest that you work with a physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia. In addition to exercises like the ones mentioned above, a physical therapy program may involve specialized ice treatments, massage, and medication to decrease inflammation around the plantar fascia.
Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave impulses stimulate the healing process in damaged plantar fascia tissue. ESWT has not shown consistent results and, therefore, is not commonly performed.
ESWT is noninvasive—it does not require a surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before surgery is considered.