Plantar fasciitis is a common cause of heel pain and stiffness. It happens when ligaments on the sole of your foot (the plantar fascia) become over-stretched and inflamed.
Signs and symptoms
The plantar fascia is a thick band of ligaments that connect the heel bone to the base of the toes. Plantar fasciitis occurs when small tears develop in the plantar fascia, leading to inflammation and heel pain. Redness, swelling, and warmth over the affected area may also be noticed.
Diagram courtesy of Wellington Chiropractic
The pain is usually most severe in the middle of the heel though it may radiate along the sole of the foot. The pain is most often felt when walking first thing in the morning or after a period of rest. As walking continues the pain may decrease. The pain may disappear when resting, as the plantar fascia is relaxed.
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".
Chronic plantar fasciitis may cause a person to change their walking or running action, leading to symptoms of discomfort in the knee, hip, and back.
Plantar fasciitis is caused by the repetitive overstretching of the plantar fascia. If the tension on the plantar fascia is too great, this overstretching causes small tears and inflammation in the plantar fascia.
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.
Some of these risk factors can also contribute to the development of Achilles tendonitis, which is inflammation of the tendon that connects the calf muscles to the heel.
Diagnosis of plantar fasciitis is based on a medical history, the nature of symptoms, and the presence of localised tenderness in the heel.
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.
If the condition does not respond to initial treatment, corticosteroid therapy may be recommended. This involves the injection of corticosteroid medication such as hydrocortisone into the affected area in order to directly treat the inflammation and thus relieve the pain. Wearing a night splint to prevent the plantar fascia and Achilles tendon tightening during sleep may also be recommended at this stage.
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.
Mayo Clinic (2019). Plantar fasciitis (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846 [Accessed: 01/09/20]
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
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