Last Updated: October 26, 2017

Plantar Fasciitis

Overview

If you hop out of bed in the morning only to be greeted by a stabbing pain in your heel, plantar fasciitis might be the culprit.

picture of plantar fascia

Plantar fasciitis is an overuse injury of a ligament called the plantar fascia. This tough band of connective tissue runs the length of your foot, linking your heel bone with your toes. Like the string of a bow, it exerts tension that pulls your foot into a slightly arched shape. This allows the foot to give a little with every step, absorbing shock that would otherwise be transmitted upward through your body.

The plantar fascia can take quite a beating, but when it’s overused, tiny tears begin to form. Over time, this can lead to pain, irritation and swelling of the ligament.

Left untreated, plantar fasciitis may turn into a persistent, long-term condition that keeps you from your normal activities. And the problems don’t stop with your foot. People with heel pain often change the way they step to relieve the discomfort. Over time, this abnormal movement can injure other parts of the foot as well as the knees, hips, and back.

If you are coping with plantar fasciitis, you’re in good company. About 2 million people are treated for this condition every year, making it one of the most common causes of foot pain.

Causes

The biggest risk factors for developing plantar fasciitis are mechanical issues of the legs and feet. These include high arches, low arches, tight calf muscles or tight Achilles tendons. Risk also increases with age, peaking between 40 and 70 years.

Many people associate plantar fasciitis with runners, and these athletes do tend to be more at risk. This is especially true of those who spend a lot of time running downhill or over uneven surfaces. Other sports that stress the heel include ballet, and aerobic dancing.

Footwear also plays a role. Wearing shoes with poor arch support and cushioning can aggravate the fascia. This is especially true for people like teachers or factory workers, who spend a lot of time standing on hard surfaces.

Finally, obesity likely increases the risk of plantar fasciitis by raising the pressure on the ligaments.

Many people with plantar fasciitis also have a heel spur - a bony overgrowth of the heel bone. In the past, this was believed to be a major contributor to the condition. However, research suggests that heel spurs are often painless, and that many people who have them never develop plantar fasciitis.

Symptoms

The first sign of plantar fasciitis is usually mild heel pain (also called a “stone bruise”) that flares up after exercise. In most cases, pain increases slowly over a period of months. However, it can also come on suddenly, especially after a period of intense activity.

Plantar fasciitis pain usually affects the underside of the heel or arch. You might describe it as stabbing, aching, burning and stiff in character. The pain is often most intense in the morning when you first get out of bed. It may also flare up when you’re standing around, climbing stairs, or getting up after a long sit. Walking or exercise may provide temporary relief, but may lead to even worse pain afterward.

Diagnosis

Heel pain has many causes, including stress fractures, tendonitis, arthritis, nerve irritation, and cysts. For this reason, it’s important to get a proper diagnosis of any pain that is bad enough to keep you from your daily activities for more than a week or two. Your primary care physician will likely refer you to a foot specialist (podiatrist) or sports physician for diagnosis and treatment.

In most cases, plantar fasciitis can be diagnosed by a simple history and physical exam. Your doctor will want to know:

During the physical exam, your doctor will feel your foot to determine the location of the pain and may also check the flexibility of your calf and Achilles tendon. Sometimes imaging tests (MRI or X-rays) are ordered to rule out other conditions.

Treatment

Treatment of plantar fasciitis usually begins with conservative measures, including:

If your plantar fasciitis doesn’t improve after several months of conservative treatment, your doctor may recommend:

About 90 percent of plantar fasciitis cases heal within 10 months with conservative treatment only. Most people feel a lot better within two months. However, a complete recovery may take months to years.

People with a history of plantar fasciitis can prevent a recurrence by stretching their feet regularly, exercising wisely, and wearing supportive shoes.

Prevention

Not all cases of plantar fasciitis are preventable. However, there are a few things you can do to promote good foot health:

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Authored by: Sarah Maurer