Signs and symptoms
The onset of plantar fasciitis is gradual and only mild pain may be experienced initially. However, as the condition progresses the pain tends to become worse.
Plantar fasciitis can lead to a build-up of bone (a "spur") at the point where the plantar fascia connects to the heel bone. For this reason, plantar fasciitis is sometimes referred to as "heel spur syndrome".
Factors that contribute to the development of plantar fasciitis include:
- Having very high arches or flat feet
- Gender — while anyone can develop plantar fasciitis, it tends to occur more commonly in women
- Exercises such as running, walking, and dancing — particularly if the calf muscles are tight
- Activities or occupations that involve walking or standing for long periods of time — particularly on hard surfaces
- Age — plantar fasciitis most commonly occurs between ages 40 and 60 years.
- Wearing high-heeled shoes and/or shoes that do not offer adequate arch support and cushioning
- Being overweight — additional weight increases the tension on the plantar fascia
- Poor biomechanics — extra tension is placed on the plantar fascia if weight is not spread evenly when standing, walking, or running
- Rapid change in activity level
- Tightness in the hamstring muscles, calf muscles, and the Achilles tendon.
X-rays or magnetic resonance imaging (MRI) may be recommended to rule out other causes for the symptoms, such as bone fracture or arthritis and to check for evidence of heel spurs.
The initial treatment of plantar fasciitis focuses on reducing pain and inflammation. Resting the affected foot is the most important aspect of this treatment. Other initial treatment may include:
- Applying ice to the sole of the foot
- Anti-inflammatory medications
- Gentle stretching of the plantar fascia and Achilles tendon
- Physiotherapy (including stretching and strengthening exercises)
- Taping the foot and ankle to provide adequate support and alignment
- Wearing supportive footwear with shock-absorbing soles or inserts.
Another treatment that may be offered if the plantar fasciitis becomes chronic and does not respond to other therapies is extracorporeal shock-wave therapy (ESWT). This procedure involves bombarding the affected area with high-pressure sound waves to stimulate blood flow and healing.
Surgery is rarely used in the treatment of plantar fasciitis. It is generally only used where the pain is severe and all other treatments have failed. The procedure, known as fasciotomy, usually involves the partial or full release of the plantar fascia from the heel bone.
Factors that help prevent plantar fasciitis and reduce the risk of recurrence include:
- Exercises to strengthen the muscles of the lower leg and ankle
- Stretching to increase the flexibility of the Achilles tendon and calf muscles
- Warming up before commencing physical activity
- Increase exercise or activity levels gradually
- Maintaining a healthy body weight
- Wearing supportive shoes
- Avoiding high-heeled footwear
- Using orthotic devices such as arch supports and heel raises in footwear — particularly for people with very high arches or flat feet
- Daily stretches of plantar fascia and Achilles tendons.
MedlinePlus (2018). Plantar fasciitis (Web Page). Bethesda, MD: US National Library of Medicine (NIH). https://medlineplus.gov/ency/article/007021.htm [Accessed: 01/09/20]
Young, C.C. (2020). Plantar fasciitis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/86143-overview [Accessed: 01/09/20]
Last reviewed: September 2020