What is plantar fasciitis?
The plantar fascia is a ligament that connects the heel bone (calcaneus) to the toes and provides support for the foot's arch. Every step engages this ligament. When the plantar fascia becomes inflamed, it's called plantar fasciitis. This painful condition can be caused by overuse, too much stress on the foot, or a pre-existing anatomy issue.
Plantar fasciitis is one of the most common causes of heel and foot pain. It is often felt as a shooting pain in the bottom of the foot or stabbing pain in the back of the heel. Conservative treatments are often enough to alleviate plantar fasciitis symptoms.
What are plantar fasciitis symptoms?
Throbbing pain in the foot or stabbing pain in the bottom of the foot are the most common plantar fasciitis symptoms. Patients typically report that the pain is most intense with the first few steps of the day or after periods of inactivity. While the pain may decrease with use, it doesn't typically fully subside. Commonly, the pain returns stronger after an activity.
Pain sensations differ for each patient, with some reporting that the more they use the foot, the stronger the pain becomes. Others may experience intermittent moments of sharp pain. The common thread of plantar fasciitis symptoms is bottom of the foot pain and heel pain, often sharp and typically most intense immediately following periods of inactivity.
What causes plantar fasciitis?
Plantar fasciitis can be caused by anatomy like flat feet or by overuse and stress on the foot.
In some cases, an abnormally high arch or a flat arch can lead to undue stress on the plantar fascia, causing irritation and inflammation. A unique foot shape or structure can also place additional tension on the ligament. A tight calf muscle can limit range of motion, stressing the plantar fascia.
Other than foot anatomy, other causes and risk factors for plantar fasciitis include:
- Highly repetitive activities, such as running and jumping
- A sudden increase in activity level
- Improper footwear for the activity
- Continued activity on hard surfaces
- Being overweight
- Age (plantar fasciitis is more common in those over age 40)
How to diagnose plantar fasciitis
A physical exam diagnosing plantar fasciitis often includes:
- Questions about the location of the pain and the timing of the pain
- An inspection of the height of the arch
- Testing to check range of motion of the foot and ankle and how pain responds to different motions
Your doctor will determine the pain's location, the foot's structure, and how the pain differs based on the foot's movements. If necessary, imaging technology can further evaluate the foot and rule out other issues.
Request an appointment with a Mass General Brigham sports medicine specialist to learn more.
Plantar fasciitis treatment
Nonsurgical treatment usually clears up most plantar fasciitis cases. Surgery is reserved for only the most extreme cases that don't clear up after more than a year of treatment.
Treatment of plantar fasciitis includes:
- Rest: Limiting painful activities can ease the stress on the plantar fascia
- Ice: Rolling the bottom of the foot over a frozen water bottle or frozen golf ball provides anti-inflammatory treatment while massaging the ligament
- Stretching: Calf and plantar fascia stretches can relieve pain and loosen muscles that limit range of motion
- Anti-inflammatory medication: Medicines that relieve pain and inflammation may be recommended by a doctor and, in some cases, a cortisone injection may be prescribed
- Proper footwear: Supportive shoes and orthotics can help reduce stress on the heel and plantar fascia
- Night splints: A physical therapist or specialist may prescribe wearing a splint at night to stretch the plantar fascia and Achilles tendon during sleep
- Regenerative medicine: Injections, platelet rich plasma (PRP), or extracorporeal shockwave therapy
Patients typically recover from plantar fasciitis symptoms in six months, although mild cases can see a speedier recovery. More extreme cases may take up to a full year.
Patients typically recover from plantar fasciitis symptoms in six months, although mild cases can see a speedier recovery. More extreme cases may take up to a full year.
Preventing plantar fasciitis
Many of the risk factors of plantar fasciitis should be avoided to ensure the plantar fascia remains free of stress. A prevention strategy includes:
- Stretching and exercising the foot and calf muscles
- Varying activity types and surfaces
- Wearing proper footwear or orthotics
- Maintaining a proper weight
- Properly warming up before activity and easing into new exercises
FAQs
With the proper treatment, most cases of plantar fasciitis will clear up on their own.
Plantar fasciitis symptoms may be present all day but are usually most intense after long periods of inactivity. Often hurts most with the first few steps of the day.
Doctors recommend ice for plantar fasciitis.
Patients experiencing plantar fasciitis should select supportive shoes that reduce the stress on the plantar fascia ligament. Focus on shoes with quality arch support and cushioning.
Plantar fasciitis is not a form of arthritis. Still, the two are linked, as forms of arthritis can make a person more likely to develop plantar fasciitis, and someone with plantar fasciitis may experience arthritis.
When the plantar fascia is not properly warmed up, plantar fasciitis pain may be more severe. The morning is often the worst time for plantar fasciitis symptoms because of poor blood supply to the foot during the night.
