Plantar Fasciitis

Overview

What is plantar fasciitis?

An inflamed plantar fascia — the rubber band-like ligament that stretches from your heel to your toes — is very painful. Imagine walking around with a strong ache in your heel, a tender bruise on the bottom of your foot, or a stabbing pain that hits you the moment your feet hit the ground in the morning. Now, if you already have it, imagine your pain beginning to go away or disappearing altogether — this too can happen.

The normal foot has 28 bones, 33 joints and more than 100 muscles, tendons and ligaments. It does so much! The plantar fascia itself supports the arch of your foot. It absorbs pressure — think of the shock absorbers of your car. It bears your weight. Pain is inevitable when the tissues are inflamed, or partially or completely torn.

The word “fasciitis” means “inflammation of the fascia of a muscle or organ” while “plantar” relates to the sole of the foot. Two million patients get treatment for plantar fasciitis, annually. That makes it the most common cause of heel pain. It’s common especially for athletes — specifically, runners. The repetitive motion of pushing off with your feet can injure the tissues.

How common is plantar fasciitis? Who gets it?

About one in 10 people will develop plantar fasciitis sometime in their lives. Young male athletes and middle-aged obese females get it most often.

Symptoms and Causes

What causes plantar fasciitis?

Too much pressure and stretching damages, inflames or tears your plantar fascia.

Unfortunately, there’s no discernable cause for some cases. However, you’re more likely to get plantar fasciitis if:

  • You have high-arched feet or flat feet.
  • You wear shoes that don’t support your feet (especially for a long time on a hard surface).
  • You’re obese. (70% of patients with plantar fasciitis are also obese.)
  • You’re an athlete.
  • You’re a runner or jumper.
  • You work or exercise on a hard surface.
  • You stand for prolonged periods of time.
  • You exercise without stretching your calves.

What are the symptoms of plantar fasciitis?

Both a dull pain and a stabbing pain have been reported by patients with plantar fasciitis. The symptoms of plantar fasciitis include:

  • Pain on the bottom of the heel, or nearby.
  • Increased pain after exercise (not during).
  • Pain in the arch of the foot.
  • Pain that is worse in the morning or when you stand after sitting for a long time.
  • A swollen heel.
  • Pain that continues for months.
  • A tight Achilles tendon. (80% of people report this symptom.) Your Achilles tendon connects your calf muscles to your heel.

Can plantar fasciitis cause pain in the toes?

Occasionally. This is not a usual symptom.

Can plantar fasciitis cause pain in the calf?

Pain in the calf usually comes from muscles that are too tight. If those muscles are tight, that contributes to additional stress on the plantar fasciitis. Plantar fasciitis itself does not cause calf muscle pain.

Can plantar fasciitis cause ankle pain?

Plantar fasciitis pain is in the foot but sometimes, if it irritated a nerve, the pain can radiate up to your ankle.

Can plantar fasciitis cause back pain?

People with plantar fasciitis can experience back pain. It’s unclear what causes what. Perhaps your back pain actually results from a change in your posture and walk as you try to avoid pain by not putting full pressure on your foot. Any shift in how your body weight is distributed shifts how your muscles around your hip and leg are used and could cause muscle strain and ache in your back.

Can plantar fasciitis cause arthritis?

You can get arthritis in the bones of your foot, but it is not caused by plantar fasciitis.

Diagnosis and Tests

How is plantar fasciitis diagnosed?

Your healthcare provider will, after noting your medical history, perform a physical examination of your foot. If putting pressure on the plantar fascia causes pain, then plantar fasciitis is the likely culprit. If it’s difficult to raise your toes, or if you have tingling or loss of feeling in your foot, those are big red flags.

They will ask questions like “is the pain worse in the morning?” and “does the pain typically decrease throughout the day and with use?” These and other affirmative answers to questions help your healthcare provider determine if it’s plantar fasciitis.

Part of diagnosing plantar fasciitis is a process of elimination. Many conditions are considered when you report foot pain: a fracture, stress fracture, tendinitis, arthritis, nerve entrapment or a cyst in the heel. To determine other possible causes, your healthcare provider may order imaging tests including:

Are plantar fasciitis and heels spurs the same thing?

No. Heel spurs and plantar fasciitis are not the same thing, and heel spurs do not cause plantar fasciitis. A heel spur is an extra piece of bone that sticks out from the heel while plantar fasciitis is pain from an inflamed or microscopically torn plantar fascia. Removing a heel spur will not cure plantar fasciitis.

Management and Treatment

How is plantar fasciitis treated?

Over 90% of those who have plantar fasciitis will improve within 10 months with the following at-home remedies. They include:

  • Stretching your calf muscles.
  • Wearing supportive, sturdy, well-cushioned shoes. Don’t wear sandals or flip flops that do not have a built in arch support. Don’t walk with bare feet.
  • Using appropriate shoe inserts, arch supports or custom-made foot orthotics.
  • Using a night splint to reduce tightness in the calf muscle.
  • Massaging the area.
  • Putting ice on the area three to four times per day for 10 to 15 minutes.
  • Limiting physical activity including prolonged standing.
  • Taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil®, Motrin®) or naproxen (Aleve®).
  • Losing weight.
  • Using crutches.

Outpatient treatments include:

  • Cortisone (steroid) injections.
  • Physical therapy for stretching and exercises.
  • Extracorporeal shockwave therapy (ESWT). Shockwaves stimulate the healing process. This procedure is not commonly used.
  • Seeing a podiatrist (foot specialist) for recommendations regarding insoles and shoes.

Occasionally, if none of the above solutions are effective after 12 months, surgery may be considered. There are two types of surgeries:

  • Gastronemius recession. This surgery lengthens the calf muscles. Tight calf muscles put additional stress on the plantar fascia.
  • Plantar fascia release. The plantar fascia is cut, partially, to relieve some of the tension.

Prevention

How can I reduce my risk of future plantar fasciitis?

  • Tape your arches.
  • Stretch your feet, calves and Achilles tendon.
  • Ice your foot.
  • Get plenty of rest.
  • Do a low-impact exercise, like swimming, that doesn’t put pressure on your feet.
  • Change your shoes regularly if you’re a walker or a runner.

Outlook / Prognosis

What can I expect if I have plantar fasciitis?

Expect the worst pain when you first get out of bed in the morning and after you’ve been sitting for a long time. Expect that severe pain will be worsened by high-impact exercise, but remember that in most cases it’s not permanent as long as you follow your treatment plan. Expect to have to change some of your behaviors to decrease symptoms.

How long will I have plantar fasciitis?

More than 90% of plantar fasciitis patients improve within 10 months just by using at-home remedies.

If the underlying reason for your plantar fasciitis is something you can’t help, like the fact that your foot is flat, permanent recovery is difficult. Continue to fight the symptoms with at-home remedies and recommendations from your healthcare provider.

Living With

How do I take care of myself?

Avoid activities that put you at risk (see “Causes” above). Wear supportive shoes, avoid hard floors and experiment with other at-home remedies to figure out which ones work best for you. Don’t hesitate to contact your healthcare provider.

When should I see my healthcare provider about plantar fasciitis?

See your healthcare provider if the plantar fasciitis pain doesn’t improve in two weeks. See him/her again if your symptoms don’t improve after 6-8 weeks.

Can plantar fasciitis go away on its own?

Plantar fasciitis is unlikely to go away without some sort of behavioral change or treatment. Follow the at-home remedies and listen to your healthcare provider’s advice.

Will losing weight improve my plantar fasciitis?

Yes! Less weight means less pressure on your inflamed or microscopically torn plantar fascia.

What questions should I ask my healthcare provider about plantar fasciitis?

  • What do you think caused my plantar fasciitis?
  • Do I need to take any tests?
  • Do you predict that this will go away right away or will it be chronic?
  • How should I restrict my activities?
  • Is there a specific brand(s) of shoes that you recommend?
  • What brand(s) of shoes should I avoid?
  • What type of night splint should I purchase?
  • What low-impact exercises do you recommend?
  • What should I do if the pain becomes unbearable?
  • How often can I receive steroid shots?
  • Do you think I’ll need surgery for my plantar fasciitis?
  • Should I ask for reasonable accommodations at my job because of my plantar fasciitis?

A note from Cleveland Clinic

See your healthcare provider if you have heel pain. It might be plantar fasciitis, or it might be something else like a stress fracture or arthritis. You need to verify the proper diagnosis so that you use the most helpful at-home remedies. Remember that you don’t have to live with this pain! Educate yourself and access the right resources to improve your quality of life!

Last reviewed by a Cleveland Clinic medical professional on 06/29/2020.

References

  • McClinton S, Weber CF, Heiderscheit B. Low Back Pain and Disability in Individuals With Plantar Heel Pain. (https://www.sciencedirect.com/science/article/abs/pii/S0958259217300317?via%3Dihub) The Foot. 2018 Mar;34:18-22. Accessed 6/20/2020.
  • Cutts S, Obi N, Pasapula C, Chan W. Plantar Fasciitis. (https://publishing.rcseng.ac.uk/doi/10.1308/003588412X13171221592456) AnnRColl Surg Engl. 2012 Nov;94(8):539-542. Accessed 6/20/2020.
  • Tahririan MA, Motififard M, Tahmaesbi MN, Sisvashi B. Plantar Fasciitis. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687890/) JRes Med Sci. 2012 Aug;17(8):799-804. Accessed 6/20/2020.
  • Patient. Heel and Foot Pain. (https://patient.info/foot-care/heel-and-foot-pain-plantar-fasciitis) Accessed 6/20/2020.
  • NHS. Plantar Fasciitis. (https://www.nhs.uk/conditions/plantar-fasciitis/) Accessed 6/20/2020.
  • American Academy of Orthopedic Surgeons. Plantar Fasciitis and Bone Spurs. (https://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spurs) Accessed 6/20/2020.
  • American College of Foot and Ankle Surgeons. Foot Health Facts: Heel Pain (Plantar Fasciitis). (http://www.foothealthfacts.org/footankleinfo/heel-pain.htm) Accessed 6/20/2020.

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