What Is Plantar Fasciitis?
Medically reviewed by Danielle McNeil, D.P.M
Plantar fasciitis is inflammation of the plantar fascia—a thick band of tissue that supports the arch of your foot and connects the toes to the heel bone. The plantar fascia absorbs the stress you place on your feet when standing, walking, and running. Sometimes repetitive strain or stress on your foot can injure or tear the plantar fascia, causing inflammation, swelling, and pain to occur.
People with plantar fasciitis often experience foot and heel pain, especially in the morning or after periods of inactivity and rest. Plantar fasciitis is one of the most common foot injuries and nearly 10% of adults will experience the condition in their lifetime. Though plantar fasciitis usually improves with time and simple lifestyle modifications, treatment can help relieve symptoms and promote recovery.
Symptoms
Knowing the symptoms of plantar fasciitis can help you recognize when you should seek care from a healthcare provider. Here are some common symptoms to look out for:
Sharp, stabbing pain or dull aching pain in the heel or along the arch of the foot
Intense aching while taking your first steps in the morning or after long periods of rest
Pain that worsens after prolonged walking, standing, or running
Causes
Plantar fasciitis occurs when the thick band of tissue supporting the foot arch (known as the plantar fascia) becomes inflamed. Strain, overuse, or excessive stress from activities that involve the feet—such as running, jumping, or walking long distances—is the most common reason people develop symptoms of plantar fasciitis.
Risk Factors
Anyone can develop plantar fasciitis, but certain risk factors can make you more prone to developing it, including:
Having flat feet or high foot arches
Experiencing tight calf muscles or tight Achilles tendons
Engaging in a sudden increase in activity
Standing or walking on hard surfaces for long periods of time
Being between the ages of 40 and 60
Wearing flat shoes or shoes with less support
Diagnosis
If you suspect you have plantar fasciitis, it's best to see your healthcare provider for proper testing. Your provider will first learn about your medical history and then conduct a physical exam to assess your symptoms. They may also ask you any of the following questions:
When did you first start experiencing symptoms?
How frequently do you have heel pain?
Did you have any recent injuries?
Do you have a history of foot pain?
Is there anything that helps relieve the pain?
What (if anything) worsens your symptoms?
During the physical examination, your healthcare provider will examine your foot, looking for signs of inflammation such as redness, tenderness, or swelling. They may stretch your toes towards your shin to assess the range of motion in your foot and determine if the stretch causes heel pain.
Your healthcare provider can also order diagnostic tests to rule out other conditions and confirm a plantar fasciitis diagnosis. Common tests used include:
X-rays: While X-rays do not directly diagnose plantar fasciitis, they help rule out other conditions that cause similar symptoms, such as fractures or arthritis.
Ultrasound: This imaging test can provide real-time images of the foot, allowing the healthcare provider to visualize the plantar fascia and assess its thickness and any signs of inflammation.
Magnetic resonance imaging (MRI): Another imaging technique that creates detailed images of the soft tissues in the foot, which helps identify inflammation or tears in the plantar fascia.
Treatment
If you receive a diagnosis for plantar fasciitis, your healthcare provider will work with you to figure out a treatment plan that helps reduce inflammation and pain, while also maintaining your foot's function. While there is no cure for plantar fasciitis, most people notice a significant reduction in symptoms with treatment within 12 months.
Your exact treatment plan will depend on your symptoms and the severity of your condition, but may include a combination of rest, lifestyle changes, exercise, and medication.
Getting Rest
Resting your foot and limiting or avoiding activities that worsen symptoms are essential for relieving pain and promoting healing. This means avoiding activities that may worsen inflammation, including running, jumping, dancing, or standing for long periods of time, especially on hard surfaces.
Applying Ice
Applying ice to the affected area helps constrict blood vessels, which can aid in reducing swelling and relieving discomfort. Apply an ice pack or a frozen water bottle wrapped in a thin towel to your foot for 15 to 20 minutes several times daily. Icing can be beneficial after exercise or stretching to help reduce post-activity inflammation.
Exercising
Stretches and strengthening exercises are recommended to help improve symptoms and prevent flare-ups (or, periods where symptoms are active or worsening). Stretching exercises can help improve the flexibility of the plantar fascia and mobility in your foot. Effective stretches include the calf stretch, Achilles tendon stretch, and towel stretch.
Strengthening exercises, such as toe curls or marble pickups, can help strengthen the muscles in the foot and ankle to help stabilize your foot and improve its ability to withstand the stress of daily activities, such as walking or standing.
Using Orthotics
Orthotics are assistive devices like heel cups or gel-pad shoe inserts that can improve pain by providing foot support and cushioning. These devices are designed to support the arch and cushion of the heel to reduce strain or stress on the plantar fascia. You can purchase some orthotics over the counter. However, your provider can also prescribe custom-made orthotics to ensure the devices suit your individual needs and work effectively.
Taking Medication
Your healthcare provider may also recommend short-term use of over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain in the plantar fascia. If NSAIDs don't work for you, your healthcare provider may inject steroids (cortisone) into the affected area of your foot to relieve pain and swelling.
Casting
Placing a cast on your foot may be helpful if other treatments are ineffective. Your healthcare provider may apply a cast to your foot or ask you to wear a walking boot to restrict movement and support the foot. This helps reduce stress on the plantar fascia and minimize inflammation.
Trying Extracorporeal Shockwave Therapy (ESWT)
Extracorporeal shockwave therapy (ESWT) involves directing high-energy soundwaves toward the tender area of your foot to stimulate healing and reduce pain. ESWT is an effective treatment for relieving pain in people with chronic plantar fasciitis, especially those who have not noticed an improvement in symptoms with other treatments.
Getting Surgery
If plantar fasciitis pain persists for longer than a year and you don't feel symptom relief with other treatment options, your healthcare provider may recommend one of the following surgical procedures:
Plantar fascia release: In this procedure, the plantar fascia is partially detached from the heel bone to relieve tension and reduce pain.
Gastrocnemius recession: This procedure involves lengthening the calf muscle (gastrocnemius) to ease tension and stress on the plantar fascia.
How to Prevent Plantar Fasciitis Flare-Ups
Many people with plantar fasciitis experience occasional flare-ups of symptoms after stopping treatment. Certain strategies can help minimize the frequency of flare-ups and reduce pain, including:
Maintaining a body weight that is right for you to reduce excess stress on your feet
Wearing supportive footwear that provides proper arch support, cushioning, and shock absorption
Continuing daily plantar fasciitis stretches and strengthening exercises to keep the foot strong and flexible, while also lowering the risk of injury
Incorporating low-impact activities, such as swimming or cycling, into your exercise regimen to reduce repetitive stress on the feet
Related Conditions
While there are no specific conditions that are directly caused by plantar fasciitis, there are certain conditions that are more common in people with plantar fasciitis. Some conditions associated with plantar fasciitis include:
Achilles tendinitis: This condition involves inflammation of the Achilles tendon, which connects the calf muscles to the heel bone.
Heel spur: A heel spur is a bony growth on the heel. While not directly caused by plantar fasciitis, repetitive pulling of the plantar fascia on the heel bone can increase your risk of developing a spur formation over time.
Living With Plantar Fasciitis
Plantar fasciitis can be a frustrating condition to live with, especially when it interferes with activities in your daily life. Fortunately, treatment and lifestyle changes can help you manage symptoms and improve your quality of life.
It may take some trial and error to find what works for you when it comes to plantar fasciitis pain—and that's OK. Work closely with your healthcare provider, who can provide guidance and support and tailor treatment options that meet your needs. With time, treatment, and self-care, trust that you can soon find symptom relief and enjoy your daily activities pain-free.
Frequently Asked Questions
Does plantar fasciitis ever go away?
Plantar fasciitis often improves and resolves with appropriate treatment and self-care measures within several months. However, the timeline for recovery can vary from person to person. Some people may notice a significant reduction in a few months, while others can have lingering symptoms for a longer period of time.
What time of day is plantar fasciitis worst?
Plantar fasciitis symptoms often worsen in the morning after sleeping and a longer period of inactivity. The pain and stiffness may gradually improve throughout the day with movement and stretching, but can worsen again by the end of the day due to prolonged standing, walking, and other daily activities.
Does walking on tiptoes help plantar fasciitis?
Walking on tiptoes may help strengthen muscles in the foot to reduce plantar fasciitis symptoms. One small study found that participants with plantar fasciitis who engaged in a gradual toe-walking exercise program had a small reduction in pain after six weeks but were not pain-free. More research is needed to determine whether toe walking is effective long-term. Talk to your healthcare provider about whether toe-walking would be appropriate for you.
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