Plantar fasciitis

Overview

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 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 more common in runners. People who are overweight and those who wear shoes with inadequate support also have an increased risk of plantar fasciitis.

Plantar fascia and location of heel pain

Plantar fasciitis is an inflammation of the fibrous tissue (plantar fascia) along the bottom of your foot that connects your heel bone to your toes. Plantar fasciitis can cause intense heel pain.

Symptoms

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or when you get up after sitting. The pain is usually worse after exercise, not during it.

Causes

Your plantar fascia is in the shape of a bowstring, supporting the arch of your foot and absorbing shock when you walk. If tension and stress on this bowstring become too great, small tears can occur in the fascia. Repeated stretching and tearing can irritate or inflame the fascia, although the cause remains unclear in many cases of plantar fasciitis.

Risk factors

Even though plantar fasciitis can develop without an obvious cause, some factors can increase your risk of developing this condition. They include:

  • Age. Plantar fasciitis is most common between the ages of 40 and 60.
  • Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and aerobic dance — can contribute to the onset of plantar fasciitis.
  • Foot mechanics. Flat feet, a high arch or even an abnormal pattern of walking can affect the way weight is distributed when you're standing and can put added stress on the plantar fascia.
  • Obesity. Excess pounds put extra stress on your plantar fascia.
  • Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage the plantar fascia.

Complications

Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. Changing the way you walk as a way to relieve plantar fasciitis pain might lead to foot, knee, hip or back problems.

Diagnosis

Plantar fasciitis is diagnosed based on your medical history and physical examination. During the exam, your doctor will check for areas of tenderness in your foot. The location of your pain can help determine its cause.

Imaging tests

Usually no tests are necessary. Your doctor might suggest an X-ray or magnetic resonance imaging (MRI) to make sure another problem, such as a stress fracture, is not causing you pain.

Sometimes an X-ray shows a piece of bone sticking out (spur) from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.

Treatment

Most people who have plantar fasciitis recover in several months with conservative treatment, including resting, icing the painful area and stretching.

Medications

Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) may ease the pain and inflammation caused by plantar fasciitis.

Therapies

Stretching and strengthening exercises or using special devices may relieve symptoms. They include:

  • Physical therapy. A physical therapist can show you a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles. A therapist might also teach you to apply athletic taping to support the bottom of your foot.
  • Night splints. Your physical therapist or doctor might recommend that you wear a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight to promote stretching.
  • Orthotics. Your doctor might prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

Surgical or other procedures

If more-conservative measures aren't working after several months, your doctor might recommend:

  • Injections. Injecting steroid medication into the tender area can provide temporary pain relief. Multiple shots aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture. Using ultrasound imaging, platelet-rich plasma obtained from the patient's own blood can be injected to promote tissue healing.
  • Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more-conservative treatments. Some studies show promising results, but it hasn't been shown to be consistently effective.
  • Ultrasonic tissue repair. This minimally invasive technology was developed in part by Mayo Clinic doctors. It uses ultrasound imaging to guide a needlelike probe into the damaged plantar fascia tissue. Using ultrasound energy, the probe tip vibrates rapidly to break up the damaged tissue, which is then suctioned out.
  • Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It is generally an option only when the pain is severe and other treatments have failed. It can be done as an open procedure or through a small incision with local anesthesia.

Lifestyle and home remedies

To reduce the pain of plantar fasciitis, try these self-care tips:

  • Maintain a healthy weight. Carrying extra weight can put extra stress on your plantar fascia.
  • Choose supportive shoes. Buy shoes with a low to moderate heel, thick soles, good arch support and extra cushioning. Don't walk barefoot.
  • Don't wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet.
  • Change your sport. Try a low-impact sport, such as swimming or bicycling, instead of walking or jogging.
  • Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 minutes three or four times a day. Icing can help reduce pain and inflammation.
  • Stretch your arches. Simple home exercises can stretch your plantar fascia, Achilles tendon and calf muscles.

Preparing for an appointment

While you may initially consult your family physician, he or she may refer you to a doctor who specializes in foot disorders or sports medicine.

What you can do

You may want to write a list that includes:

  • Your symptoms, and when they started
  • Key personal information, including your and your family's medical history and activities you do that could have contributed to your symptoms
  • All the medications, vitamins or other supplements you take, including doses
  • Questions to ask the doctor

For plantar fasciitis, basic questions to ask your doctor include:

  • What's likely causing my symptoms?
  • Other than the most likely cause, what are other possible causes for my symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What's the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • Do your symptoms tend to occur at a particular time of day?
  • What types of shoes do you usually wear?
  • Are you a runner, or do you participate in any sports that involve running?
  • Do you have a physically demanding job?
  • Have you had problems with your feet before?
  • Do you feel pain anywhere besides your feet?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Last Updated Dec 11, 2019


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