Plantar fasciitis
The plantar fascia is the thick tissue on the bottom of the foot. It connects the heel bone to the toes and creates the arch of the foot. When this tissue becomes swollen or inflamed, it is called plantar fasciitis.
The plantar fascia is a very thick band of tissue that covers the bones on the bottom of the foot. It extends from the heel to the bones of the ball of the foot and acts like a rubber band to create tension which maintains the arch of the foot. If the band is long it allows the arch of the foot to be low, which is most commonly known as having a flat foot. A short band of tissue causes a high arch. This fascia can become inflamed and painful in some people, making walking more difficult.
Inflammation (irritation and swelling with presence of extra immune cells) of the plantar fascia can cause heel pain and make walking difficult. Some risk factors for development of this problem include foot arch problems (both flat foot and high arches), obesity, sudden weight gain, running and a tight Achilles tendon.
Causes
Swelling occurs when the thick band of tissue on the bottom of the foot (fascia) is overstretched or overused. This can be painful and make walking more difficult.
You are more likely to get plantar fasciitis if you:
- Have foot arch problems (both flat feet and high arches)
- Run long distances, downhill or on uneven surfaces
- Are obese or gain weight suddenly
- Have a tight Achilles tendon (the tendon connecting the calf muscles to the heel)
- Wear shoes with poor arch support or soft soles
- Change your activity level
Plantar fasciitis is seen in both men and women. It is one of the most common orthopedic foot complaints.
Plantar fasciitis was commonly thought to be caused by a heel spur. However, research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis.
Symptoms
The most common symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn.
The pain is often worse:
- In the morning when you take your first steps
- After standing or sitting for awhile
- When climbing stairs
- After intense activity
- During walking, running, and jumping sports
The pain may develop slowly over time, or come on suddenly after intense activity.
If you have pain and stiffness in the bottom of your feet and heel, you may have a problem called plantar fasciitis. Plantar fasciitis is irritation and swelling of the thick tissue on the bottom of your foot. The tissue is called plantar fascia. It connects your heel bone to your toes, creating the arch of your foot. Plantar fasciitis occurs when you overstretch or overuse this thick band of tissue. It can be painful and make it hard to walk. So, how do you know if you have plantar fasciitis? You will probably have pain and stiffness in the bottom of your foot or heel. The pain may be dull or sharp. The bottom of your foot may ache or burn. The pain is usually worse in the morning when you take your first steps, after standing or sitting for a while, when you climb stairs, or after you exercise. To treat this condition, your doctor will check the bottom of your foot for tenderness, swelling, redness, and stiffness or tightness in your arch. The doctor may first recommend that you try ibuprofen (Advil, Motrin) to reduce your pain and swelling. You can also try heel stretching exercises, resting as much as possible for at least a week, and wearing shoes with good support. You can also try applying ice to the painful area at least twice a day, ten to 15 minutes each time. You might try wearing a heel cup, felt pads in your heel area, or shoe inserts. Wearing splints at night can stretch the injured fascia and allow it to heal. This can be particularly helpful. If these treatments don't work, your doctor may recommend you wear a boot cast for three to six weeks, or wear custom-made shoe inserts called orthotics, or have steroid shots in your heel. Some people even need surgery to release the tight tissue in your foot. The good news is that non-surgical treatments usually improve the pain. However, treatment may last from several months to two years before the symptoms get better. But most people will feel considerably better within nine months.
Exams and Tests
The health care provider will perform a physical exam. This may show:
- Pain on the bottom of your foot.
- Pain along the sole of the foot.
- Flat feet or high arches.
- Mild foot swelling or redness.
- Stiffness or tightness of the arch in the bottom of your foot.
- Stiffness or tightness with your Achilles tendon.
X-rays may be taken to rule out other problems.
Treatment
Your provider will often recommend these steps first:
- Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation.
- Physical therapy with emphasis on heel and foot stretching exercises.
- Night splints to wear while sleeping to stretch the foot.
- Resting as much as possible for at least a week.
- Wearing shoes with good support and cushions.
You can also apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes, more often in the first couple of days.
If these treatments do not work, your provider may recommend:
- Wearing a boot cast, which looks like a ski boot, for 3 to 6 weeks. It can be removed for bathing.
- Custom-made shoe inserts (orthotics).
- Steroid shots or injections into the heel.
Sometimes, foot surgery is needed.
Outlook (Prognosis)
Nonsurgical treatments almost always improve the pain. Treatment can last from several months to 2 years before symptoms get better. Most people feel better within 6 to 18 months. Rarely, surgery may be needed to relieve the pain.
When to Contact a Medical Professional
Contact your provider if you have symptoms of plantar fasciitis.
Prevention
Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis. Stretch your plantar fascia in the morning before you get out of bed. Doing activities in moderation can also help.
References
Grear BJ. Disorders of tendons and fascia and adolescent and adult pes planus. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 83.
Kadakia AR, Aiyer AA. Heel pain and plantar fasciitis: hindfoot conditions. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 120.
McGee DL. Podiatric procedures. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 51.
Silverstein JA, Moeller JL, Hutchinson MR. Common issues in orthopedics. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 30.
Version Info
Last reviewed on: 6/8/2022
Reviewed by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
