What Is Plantar Fasciitis?

Plantar fasciitis is one of the most common causes of heel pain. It is often described as a bruising or aching sensation in the heel or arch of the foot. The pain is a result of bone or nerve irritation from too much tension, inflammation, or scar tissue in the fascia—the thick band of connective tissue on the bottom of the foot that connects the heel to the toes. Pain can also be caused by repetitive microtrauma of the plantar fascia ligament.

What Is Plantar Fasciitis?

Plantar fasciitis is inflammation of the plantar fascia. The pain is usually felt where the fascia attaches to the heel, but it can also be experienced over the entire bottom area of the foot. The condition is caused by a number of factors ranging from a heel injury to overuse, to the type of shoes you wear or the surfaces you're walking on. Some people, depending on their foot structure, may be more prone to developing plantar fasciitis than others.

A primary care physician or podiatrist can usually provide an initial diagnosis for plantar fasciitis by examining the tender areas of the foot and/or heel and assessing the level of pain you're experiencing. In some cases, a doctor may recommend an X-ray, ultrasound, bone scan, or magnetic resonance imaging (MRI) to rule out other possible conditions.

Symptoms

Plantar fasciitis is often described as a shooting or stabbing pain in the heel or arch of the foot. The pain is often worse in the morning as you take your first few steps of the day, or when you stand up after a long period of sitting or inactivity.

Plantar fasciitis pain can worsen with more walking or longer bouts of standing. But it also can flare up just following physical activity rather than during the activity itself. While plantar fasciitis is usually experienced in one foot, it can occasionally occur in both feet at the same time.

Causes of Plantar Fasciitis

Walkers and runners don't necessarily get plantar fasciitis more often than the general population, although long-distance running may increase the risk. Those who spend a lot of time walking or standing on hard surfaces or perform exercises that include a lot of jumping are also more susceptible to plantar fasciitis.

In addition, the type of running or walking shoes you wear can increase your risk. Worn-out footwear or shoes with poor arch support are common culprits. Inappropriate footwear combined with an increase in load (stress) in a short amount of time (such as walking many miles on vacation in flip-flops or taking up a new recreational sport) can lead to plantar fasciitis. Investing in the right shoes that offer additional support can help reduce your risk.

Another cause of plantar fasciitis is often attributed to weakness in the muscles of the calves and feet. When these muscles tire out and don't do their job, the stress and load of physical activities are absorbed by the plantar fascia. 

Risk Factors

Some people are more prone to plantar fasciitis than others. There are several risk factors that can increase your chances of developing this condition including:

• Age: Plantar fasciitis affects 1 in every 10 adults, but it is especially prevalent among adults over 50 and can be particularly disabling for this age group.
• Weight: An individual's body mass index (BMI) can factor into whether they develop plantar fasciitis. Research shows that overweight individuals are more prone to this condition. (Note that BMI is a dated, biased measure that doesn’t account for several factors, such as body composition, ethnicity, race, gender, and age. Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.)
• Pregnancy: Foot pain associated with plantar fasciitis is common among pregnant people, particularly during the third trimester.
• High arches: People with high-arched feet are often more susceptible to plantar fasciitis than others.
• Tight calf muscles: If your calves are particularly tight or they're not stretched properly prior to exercise you are more at risk for developing plantar fasciitis.
• Athleticism: Plantar fasciitis is common among many athletes, particularly runners and jumpers.

Complications

In some cases, prolonged plantar fasciitis can lead to other complications that may require additional medical treatment. Some people may try to avoid plantar fasciitis pain by changing their gait, but this can lead to additional foot, knee, hip, or back problems, and other conditions, such as the following.

Heel Spurs

A heel spur is a growth of bone from the heel that is often associated with plantar fasciitis pain. It can develop when you have plantar fasciitis for a long period of time and a calcium deposit forms where the plantar fascia attaches to your heel bone. The plantar fascia pulls on the bone, and the body responds to the stress by laying down more bone. 

Treatment for heel spurs is often similar to treatment for plantar fasciitis. However, in some cases, a heel spur may require surgical removal. But in most cases, plantar fasciitis with bone spurs can be treated without removing the spur.

Treatment

The pain associated with plantar fasciitis and heel spurs can be debilitating for anyone, especially for those who enjoy walking, running, or other forms of fitness. Trying to walk through the pain can often create more pain and result in months of recovery.

Consult your doctor or a podiatrist if your foot pain is ongoing. They can recommend specific treatments for your condition, or refer you to a physical therapist for an individualized rehab program.

The treatment may be some combination of stretching, physical therapy, and non-steroidal anti-inflammatory drugs (NSAIDs). In addition, many people find that topical ointments, heel spur creams, and even CBD oil can offer some relief. Some providers even recommend special footwear like motion control shoes if you pronate a lot or orthotics if you need some type of realignment.

Plantar fasciitis pain might last for just a few weeks or it can become chronic. In those cases, a healthcare provider may recommend shock wave therapy, a cortisone injection, or even surgery. But 90% of plantar fasciitis cases usually resolve within a year. Here are some of the most commonly recommended treatments for plantar fasciitis.

Medication

Over-the-counter NSAIDs such as ibuprofen (Advil or Motrin IB) and naproxen sodium (Aleve) may help to relieve some of the pain and inflammation caused by plantar fasciitis.

In some cases, a doctor may recommend a steroid injection, which can provide temporary pain relief to areas of tenderness. However, more than one steroid shot is not typically recommended since it can weaken or possibly damage the connective tissues of the plantar fascia.

R.I.C.E.

"R.I.C.E" stands for "Rest, Ice, Compression, Elevate." When you have plantar fasciitis, the foot needs time to heal without further irritation. That means you should rest by walking and running less following the onset of plantar fasciitis pain.

Cold therapy is also helpful for easing pain. Place a cold pack on your foot after walking or massage the foot with an ice bottle. Treat with coldness for 15 minutes.

Many people choose to wear compression socks to alleviate pain and discomfort. When you're not on your feet, it's also recommended to elevate the injured foot, which will help prevent excess blood from flowing into the affected area and cause additional swelling, throbbing, or pain.

Orthotics

Many people find that arch supports are helpful for plantar fasciitis since they help prevent the arches from flattening in footwear. This can help to alleviate discomfort and prevent the condition from reoccurring.

A night splint can also help to shorten recovery time. When you sleep, your foot relaxes and the plantar fascia tightens up. A night splint holds your foot in the position it's in when you're standing, so the plantar fascia remains stretched out. Then, stepping out of bed in the morning doesn't cause a sudden stretching of the fascia which might re-injure it.

If your pain persists and walking is still too uncomfortable, a podiatrist can prescribe an orthotic to relieve the pressure on your foot and to correct any gait problems that may have contributed to your condition. However, this should be a last resort compared to conservative care with activity modification, stretching, and strengthening.

Self-Massage

Self-massage will help restore foot flexibility and gently mobilize the fascia. Before you get out of bed in the morning, or after sitting for a long period of time, use long massage strokes on the ball of the foot to the heel of the foot. Make sure you're careful that you don't push too hard on the sore, sensitive spots.

Acupuncture

Known for its ability to treat a wide range of ailments and promote relaxation, acupuncture can offer some relief from plantar fasciitis. A 2017 study determined that acupuncture can be a safe and effective treatment for the short-term management of this condition.

Physical Therapy

Physical therapy can be very helpful for both pain reduction and rehabilitation, especially if your ability to walk normally has been compromised. A licensed physical therapist will show you various exercises during your sessions that you can do on your own at home. These will help to stretch both the plantar fascia in the foot and the Achilles tendon, which connects your heel to your calf muscle. A physical therapist may also show you how to apply athletic tape to provide additional support for the bottom of your foot.

Ultrasonic Tissue Repair

This minimally invasive technology uses ultrasound imaging and energy to probe into the damaged connective tissue. The needle-like probe breaks up the damaged tissue, which is then removed with suction.

Extracorporeal Shock Wave Therapy

This technology, also minimally invasive, uses shock waves (pressure waves) to treat a number of musculoskeletal conditions including plantar fasciitis to help relieve pain and facilitate healing of the damaged tissues.

Surgery

If plantar fasciitis pain persists beyond 12 months, a doctor may recommend a surgical procedure to help release tension. If a bone spur is present during a surgical release procedure your doctor may recommend that it be removed as well.

Strengthening Exercises

Many people find they can alleviate some of the pain by simply stretching their plantar fascia first thing in the morning. However, stretches should only be performed once you have recovered from the initial pain and swelling.

Plantar fascia stretches and stretches for the Achilles tendon can be helpful during rehabilitation and might lessen the risk of recurrence. Strengthening the surrounding muscles will help strengthen the plantar fascia so it can tolerate the stresses of daily activity including walking and standing. Just remember to listen to your body whenever you're strengthening or stretching and stop if you experience excessive pain.

The following exercises can be performed at home to stretch and strengthen your fascia to help relieve discomfort. You can warm up by stretching your foot with a towel or resistance band prior to getting started.

Plantar Fascia Intrinsic Stretch

1. Sit in a chair and cross the sore foot over the other leg.
2. Pull the toes back on your sore foot using the hand on the same side, stretching the plantar fascia on the sole of the foot.
3. Check to see if you are getting enough of a stretch by rubbing your thumb left to right over the arch of the sore foot while you are pulling the toes back. If you have the right tension on it, it will feel firm.
4. Hold for 10 seconds and release.
5. Repeat 10 times for one set. Perform at least three sets per day.

Achilles and Arch Stretch

1. Stand a few feet back from a wall and lean forward against a wall.
2. Bend one knee while stepping back with the leg that has the sore foot and keep that knee straight with your heel on the ground.
3. You will feel a stretch in the Achilles tendon and foot arch on the rear leg. If you don't, be sure that the knee is straight and the heel is still on the ground.
4. Hold the stretch for 10 seconds, then relax. Repeat 20 times.

Stair Step Stretch

1. Stand on a stair step facing upstairs with your heels off the back of the step.
2. Gently lower your heels to give your arch a stretch.
3. Hold to 10 seconds. Return to level. Repeat 10 times.

Short Foot Exercise

1. Sit in a chair with your feet flat on the floor.
2. Lift your toes while keeping the balls of the feet on the floor, causing the arch to rise.
3. Lower your toes down while holding the arch in the higher position.
4. Pull the big toe toward the heel (this is the "short foot"), while keeping your toes flat. Hold for 30 seconds.

Toe Spreading

1. Sit in a chair with your feet flat on the floor.
2. Spread all your toes out and apart as far as you can, holding for 5 seconds.
3. Repeat 10 times.

Calf Raises

1. Sit in a chair with your feet flat on the floor.
2. Lift your right heel as high as possible, keeping the toes on the floor and engaging the calf muscle.
3. Hold briefly, then the lower heel to the floor.
4. Repeat 10 times with the right foot.
5. Perform the same movement with the left foot, again repeating 10 times.

A Word From Verywell

Plantar fasciitis is extremely common, affecting about 2 million patients per year. While it can be a frustrating and painful condition, with the right treatment and a good amount of patience, you should be able to resume your normal activities within a matter of months, if not sooner.

If you're experiencing persistent foot and/or heel pain, remember that it's important to receive a proper diagnosis. A physician is the best judge of what might be causing your heel pain and can help determine the right treatment plan to help get you back on your feet.