Health A-Z

Plantar fasciitisEnlarge image

Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of each foot and connects the heel bone to the toes (plantar fascia).

Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move, the pain normally decreases, but it might return after long periods of standing or when you stand up after sitting.

The cause of plantar fasciitis is poorly understood. It is more common in runners and in people who are overweight.

Symptoms

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or when you get up from sitting.

Treatment

Most people who have plantar fasciitis recover in several months with conservative treatment, such as icing the painful area, stretching, and modifying or avoiding activities that cause pain.

Medications

Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) can ease the pain and inflammation of plantar fasciitis.

Therapies

Physical therapy or using special devices might relieve symptoms.

• Physical therapy. A physical therapist can show you exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles. A therapist might also teach you to apply athletic taping to support the bottom of your foot.
• Night splints. Your physical therapist or health care provider might recommend that you wear a splint that holds the plantar fascia and Achilles tendon in a lengthened position overnight to promote stretching while you sleep.
• Orthotics. Your health care provider might prescribe off-the-shelf or custom-fitted arch supports (orthotics) to distribute the pressure on your feet more evenly.
• Walking boot, canes or crutches. Your health care provider might recommend one of these for a brief period either to keep you from moving your foot or to keep you from placing your full weight on your foot.

Surgical or other procedures

If more-conservative measures aren't working after several months, your health care provider might recommend:

• Injections. Injecting steroid medication into the tender area can provide temporary pain relief. Multiple shots aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture. Platelet-rich plasma obtained from your own blood can be injected into the tender area to promote tissue healing. Ultrasound imaging during injections can assist in precise needle placement.
• Extracorporeal shock wave therapy. Sound waves are directed at the area of heel pain to stimulate healing. This is for chronic plantar fasciitis that hasn't responded to more-conservative treatments. Some studies show promising results, though this therapy hasn't been shown to be consistently effective.
• Ultrasonic tissue repair. This minimally invasive technology uses ultrasound imaging to guide a needlelike probe into the damaged plantar fascia tissue. The probe tip then vibrates rapidly to break up the damaged tissue, which is suctioned out.
• Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It is generally an option only when the pain is severe and other treatments have failed. It can be done as an open procedure or through a small incision with local anesthesia.

Diagnosis

Plantar fasciitis is diagnosed based on your medical history and physical examination. During the exam, your health care provider will check for areas of tenderness in your foot. The location of your pain can help determine its cause.

Imaging tests

Usually no tests are necessary. Your health care provider might suggest an X-ray or MRI to make sure another problem, such as a stress fracture, is not causing your pain.

Sometimes an X-ray shows a piece of bone sticking out (spur) from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.