Plantar Fasciitis

Plantar fasciitis is a common cause of heel pain. Learn about symptoms, causes, risk factors, home remedies, and treatment options

The fibrous tissue that surrounds muscle and separates various tissues of the body is referred to as the fascia. The bottom, or plantar, surface of the foot has a strip of this tough tissue, referred to as the plantar fascia, stretching from the heel to the front of the bottom of the foot.

This bowstring-like plantar fascia stretches underneath the sole of the foot and attaches at the heel. This fascia can become inflamed by disease or injury. Inflammation of the plantar fascia is referred to as plantar fasciitis.

Symptoms of plantar fasciitis include the following:

• Heel pain and tenderness of the bottom (sole) of the foot
• Heel pain is described as a burning pain, is often sharp, and can be severe
• Difficulty in weight-bearing on the affected foot, making it hard to walk, especially the first few steps after waking from sleep
• Swelling, warmth, and tenderness at the insertion of the plantar fascia to the heel, on the bottom of the foot

The symptoms may come on gradually or appear acutely following an athletic activity.

• Treatment may involve ibuprofen or injections of cortisone in the foot, which are often helpful for pain relief.
• Orthotic devices or shoe inserts are used to take pressure off plantar spurs (donut-shaped insert), and heel lifts can reduce stress on the Achilles tendon to relieve painful spurs at the back of the heel.
• Similarly, sports running shoes with their soft, cushioned insoles can be helpful in reducing irritation of inflamed tissues from both plantar fasciitis and heel spurs.
• Stressful athletic activities should be avoided.
• Physical therapy is sometimes used as an additional treatment.
• Infrequently, surgery is performed on chronically inflamed spurs.

• Plantar fasciitis is a condition that most commonly occurs in people between 40 and 60 years of age.
• Plantar fasciitis can occur alone from injury or may be related to underlying diseases that cause arthritis (inflammation of the joints) such as:
  • reactive arthritis (formerly called Reiter's disease),
  • ankylosing spondylitis, and
  • diffuse idiopathic skeletal hyperostosis.
• Sometimes plantar fasciitis occurs for unknown reasons.

Risk factors for plantar fasciitis include:

• female gender
• being overweight
• occupations requiring walking or standing on hard surfaces
• running for exercise

Someone who has a foot with a very high or flat arch is also more likely to develop plantar fasciitis.

Anyone with persistent foot pain or heel pain should seek medical evaluation.

• Chronic heel or foot pain may be due to arthritis or a bone fracture.
• With treatment, function can be restored.

The key to proper diagnosis of plantar fasciitis is examination by a doctor. Typically, there is tenderness of the bottom of the inner heel at the point of attachment of the plantar fascia. X-rays may be obtained to rule out bone fracture in the foot or arthritis. Moreover, some patients with chronic plantar fasciitis can develop bone spurs on the bottom of the heel bone that can be visualized with X-ray testing.

• Primary-care providers such as family medicine doctors, internists, and general practitioners frequently treat plantar fasciitis.
• Physical medicine and rehabilitation specialists, sports-medicine doctors, podiatrists, general orthopedists, and orthopedic surgeons specializing in the foot and ankle have further training and expertise in the treatment of plantar fasciitis.

• Stretching the foot can be very effective in the treatment of plantar fasciitis.
• It may help to rest the affected foot by keeping weight off it until the initial inflammation resolves.
• Home exercises may be done to gently stretch the Achilles tendon and plantar fascia.
• Massaging the plantar fascia by rolling the bottom of the foot on a tennis ball can be helpful.
• Over-the-counter NSAIDs (nonsteroidal anti-inflammatory medications) such as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) can be used if there is no medical contraindication to taking these drugs. These medications should always be taken with food as they can be hard on the stomach.

As described above, anti-inflammatory medications are frequently used in the treatment of plantar fasciitis.

• Common nonsteroidal anti-inflammatory medications include ibuprofen, naproxen, diclofenac, and many others.
• Occasionally, oral cortisone medications such as prednisone and prednisolone are given during treatment.
• Injections of cortisone medication, such as kenalog, depomedrol, or celestone, provided by the physician directly into the plantar fascia, can be very helpful.

On return visits to the health care professional, the intensity and frequency of symptoms can be monitored in order to optimally adjust the treatment plan.

• Recurrent plantar fasciitis can be prevented only if a specific activity is known that caused the injury of the plantar fascia.
• Additionally, the use of an arch support, shoe orthotics, and stretching exercises for the foot can be helpful. These measures may improve the prognosis by preventing recurrent plantar fasciitis.

• Plantar fasciitis typically responds to medications and conservative treatment measures.
• Resistant plantar fasciitis can indicate underlying rheumatic disease or complications such as a tear of the plantar fascia.

Arthritis Foundation