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.

What causes plantar fasciitis?

Inflammation and pain in the fascia can be caused by:

• An increase in activity level (like starting a walking or running program)
• The structure or shape of the foot
• The surface on which you are standing, walking or running
• The type of shoes you are wearing
• The weight you carry

Less commonly, plantar fasciitis may develop due to other medical conditions, such as lupus or rheumatoid arthritis.

What are the symptoms of plantar fasciitis?

The pain of plantar fasciitis usually increases gradually and is typically felt near the heel. Sometimes the pain can be sudden, occurring after missing a step or jumping from a height. The pain tends to be the worst when you get up in the morning or after other periods of inactivity. That’s why it is known as first-step pain. The degree of discomfort can sometimes lessen with activity during the day or after warming up but it can become worse after prolonged or vigorous activity. The pain may also appear more intense in bare feet or in shoes with minimal support.

Plantar Fasciitis Diagnosis

Plantar fasciitis is one of many conditions causing heel pain. Some other possible causes include:

• Nerve compression in the foot or in the back
• Stress fracture of the calcaneus
• Loss of the fatty tissue pad under the heel

Plantar fasciitis can be distinguished from these and other conditions based on medical history and examination by a physician. 

Heel spurs are often wrongly thought to be the sole cause of heel pain. Although they are common, they are nothing more than the bone's response to traction or pulling forces from the plantar fascia and other foot muscles. Heel spurs often don’t cause any pain. A truly enlarged and problematic spur requiring surgery is rare.

Plantar Fasciitis Treatment

In general, the longer the symptoms have been present and the more severe the pain, the longer the treatment may take. Additionally, high-demand athletes, such as cross-country or marathon runners, may require a longer course of treatment.

Plantar fasciitis treatment options include:

Stretching and Physical Therapy

Stretching is one of the best treatments for plantar fasciitis. Stretching should be focused on the plantar fascia and the Achilles tendon. A physical therapist can show you stretching exercises that you can repeat at home several times a day. Along with stretching, the exercises can also strengthen your lower leg muscles, helping stabilize your ankle.

Icing and Medication

Icing the sore spot on your sole several times a day may help with pain and inflammation. Your doctor may also recommend nonsteroidal anti-inflammatory medication.

Rest, Activity Modification and Orthotics

It helps to keep the weight and stress off your foot, at least partially, while your plantar fascia is healing. Your doctor may recommend a combination of the following:

• Changing to a more shock-absorbing exercise surface
• Switching to shoes with arch support or trying heel cups or other orthotics to cushion the heel
• Applying athletic tape to your foot to support muscles and ligaments
• Wearing night splints to continue stretching your foot while you sleep
• Decreasing distances and duration of walking or running
• Switching from jumping or running to swimming or cycling

Shock Wave Therapy

This therapy is based on delivering low-energy or high-energy shock waves to a specific area. The shock waves create microscopic trauma, which triggers a healing response from the body. This process is thought to help promote healing in the plantar fascia.

Steroid Injections

In most cases, plantar fasciitis improves after a few months of stretching. If your symptoms continue after two months of treatment, your doctor may recommend steroid injections to decrease inflammation.

Gastrocnemius Recession

Surgery is rarely needed for plantar fasciitis but is an option in severe cases. The surgery for plantar fasciitis is called gastrocnemius recession or gastrocnemius release. The goal is to lengthen the gastroc tendon, which is a part of the Achilles tendon. There is a known connection between the tension in the Achilles tendon and the tension in plantar fascia. This surgery may be recommended for patients who have an equinus contracture — tightness in the calf muscles and tendons that leads to the inability to hold a foot in a neutral position (a 90-degree angle to the leg).