Plantar Fasciitis

Plantar fasciitis is diagnosed and treated by the Podiatry Division of Premier Medical Group.

What is plantar fasciitis?

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Plantar fasciitis is inflammation and microtears in the sole of the foot primarily affecting the plantar fascia, the ligament which connects the heel bone to the rest of the foot. The plantar fascia is the largest ligament in the body—and for good reason. Connecting at the medial point of the calcaneus (heel bone) and running forward along the foot to the metatarsals in the ball of the feet, the plantar fascia plays a huge role in absorbing the force exerted on the foot when standing, walking, and running. As thick and fibrous as this connective tissue is, it is still vulnerable to the microtears and inflammation known as plantar fasciitis.


What causes plantar fasciitis?

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Plantar fasciitis is caused by excessive strain on the plantar fascia, which results in potentially painful microtears and inflammation in the surrounding areas of the foot. Weight-bearing stress over prolonged periods and on a repeated basis is a big risk factor for plantar fasciitis. It is a common health condition for runners and hikers. Running creates an enormous force that must be absorbed primarily by the feet and knees. Hiking, especially over uneven ground and when going downhill, will also put more stress on the foot and plantar fascia. Repeatedly jumping and landing on the feet is another high-risk activity.
There are also occupational risks that can cause plantar fasciitis. If you must sit or stand for long periods of time at work, this can be contributing to your foot and heel pain. For similar reasons, wearing high-heeled shoes can be another cause of plantar fasciitis.
Plantar fasciitis is more common in people who are overweight and in people who have tight calves/Achilles tendons. Plantar fasciitis can also be caused by and related to medical conditions which make the plantar fascia more vulnerable to tearing and inflammation. The most common of these is collapsed arches, which occurs when the posterior tibial tendon which supports the arch of the foot becomes weakened or injured. Other notable examples include ankylosing spondylitis and reactive arthritis.

What are the symptoms of plantar fasciitis?

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The most common symptom of plantar fasciitis is a pain in the sole of the foot. The pain may be centered on the heel bone or more in the arch of the foot. The pain may be described as stabbing or more like a bruise or ache. The pain typically worsens when the foot has become tight with inactivity. Many people find the pain is worst when taking their first steps in the morning. The pain may also flare up after a high-impact exercise routine or during long periods of sitting or standing in one position. When the foot has been stretched out, the pain is usually reduced.
Mild symptoms of plantar fasciitis can often be managed with home remedies, but the condition may also get worse, especially when neglected. Moderate to severe symptoms of plantar fasciitis may include difficulty or an inability to stand and walk on the affected foot.

How is plantar fasciitis diagnosed?

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Most often, plantar fasciitis is diagnosed on a patient’s medical history and physical examination. The exact location and type of pain will vary depending on the nature of the microtears and the constitution of your feet. Nevertheless, by applying pressure to your foot and having a short conversation about your foot pain and daily routine, a doctor can usually make a confident diagnosis. Try to be as honest and forthright as you can when responding to your doctor’s questions. Sometimes, diagnostic imaging in the form of an X-ray or MRI may be necessary to rule out other causes of foot pain, such as a stress fracture or pinched nerve. This type of imaging may also be necessary to diagnose more severe cases of plantar fasciitis and to determine whether surgery is required.

How is plantar fasciitis treated?

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The treatment for plantar fasciitis is dependent on the severity of the microtears, inflammation, and resulting pain. Mild cases may be effectively treated with some combination of home remedies and lifestyle changes. These remedies also serve as preventative treatment for those with a history of plantar fasciitis. More serious cases will require a doctor’s visit and medical treatment such as steroid injections or surgery.
Often, some combination of treatments works best to relieve pain and allow the foot to heal itself. We’ve organized the different types of treatment for plantar fasciitis from less serious to more serious options.
• Rest + Stretching: While it’s important to get plenty of rest and minimize or eliminate certain types of high-impact exercising and occupational hazards stresses, the best calisthenic treatment for plantar fasciitis includes plenty of stretching, yoga, physical therapy, and/or massage. Simple stretches can help the plantar fascia recover. This includes pulling straps under your foot, using a foot roller, or even something as simple as pulling your toes back. Calf and Achilles stretches are also important. This includes lunges, dropping your feet off the edge of stairs, and certain yoga poses like downward-facing dog.
• Ice/Cold Compress: A cold compress can be very helpful in reducing the inflammation of plantar fasciitis. This can be an ice pack or a frozen water bottle that can be rolled under the foot. There are also cold compress products that can be kept in the freezer and then used to massage your feet. Along with anti-inflammatory effects, a compress cold with massage will keep the foot stretched out and promote healing. Applying heat before exercise to stretch the foot out is a good idea, though this can also be accomplished by stretching or with light walking as well.
• Orthotics: These include boots, sole inserts, compression socks, and other aids that can keep your foot stretched out and provide support to the arch, heel, and mid-foot. Orthotic boots and other bulky foot braces may be impractical to wear during the day, but wearing this type of boot or brace overnight can make a big difference. Sole inserts are helpful in almost every case but can be especially important for plantar fasciitis related to flat feet or a collapsed arch. Don’t overlook compression socks, either. These socks can provide support and reduce inflammation at the same time.
• Anti-inflammatory medication: This could be ibuprofen, aspirin, or other over-the-counter medications. If the pain and inflammation is bad enough to see a doctor, stronger anti-inflammatories may be prescribed. In most cases, these anti-inflammatory medications are a short-term treatment for plantar fasciitis, providing enough relief to implement an effective regimen of stretching, cold compress, and orthotics that can provide permanent relief without the need for ongoing medication.
• Steroids and/or PRP injections: Steroids are a more powerful type of anti-inflammatory medication that can help muscles as well as tendons and ligaments. Platelet-rich plasma (PRP) injections use a patient’s own platelets, in a concentrated form, to accelerate the healing of injured tendons and ligaments including the plantar fascia. When one of these injection treatments fail to make a permanent difference, the other type of injection is still an option, or your doctor may recommend proceeding to surgery. Both treatment options may be considered when first-line treatments fail to show improvement.
• Shock-wave therapy: This relatively new therapy uses pressurized air, or sonic waves, to “shock” the foot. This has the effect of temporarily relieving pain by stunning the nerves in the foot. It also stimulates blood flow and healing of microtears. A typical course of shock-wave therapy might involve three weekly sessions. This is an increasingly recommended treatment for plantar fasciitis and is considered less intrusive than surgery.
• Surgery: Diagnostic imaging can confirm a severe case of plantar fasciitis as well as the preferred surgical treatment. Endoscopic surgery, sometimes called a Tenex procedure, is a minimally invasive surgery for treating plantar fasciitis. This procedure involves making a small incision and using a scope to access the plantar fascia. Using this scope, the damaged portions of the plantar fascia can be removed, relieving the pain and allowing the body to more fully heal itself over time. Open plantar fasciitis surgery, also known as plantar fascia release surgery, involves targeted cutting of the ligament and removal of damaged tissue to release the tension in the plantar fascia and allow the feet to heal.

What is the prognosis for plantar fasciitis treatments?

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Some plantar fasciitis treatments have more definitive timelines than others. Home remedies can take days, weeks, or even months to completely heal.
What’s most important is that the foot pain and tightness are trending in the right direction. If neglected, a mild case of plantar fasciitis can deteriorate into severe, even debilitating pain. Microtears and inflammation, especially over prolonged periods of time, can make the plantar fascia more susceptible to partial thickness tears as well as complete ruptures of the ligament.
Anti-inflammatory treatments typically start working within hours and should make a substantial difference over the first couple days. Steroid injections usually provide anti-inflammatory benefits for as long as three to six months. It’s important to keep stretching out the ligament during this time to encourage a full recovery and not experience a relapse once the steroids wear off.
Plantar fasciitis surgery can provide immediate relief in the tension-based pain, but fully recovering from the surgery itself usually takes about 2-3 months. A course of shockwave treatment may take three weeks but with ongoing recovery and stretching required for additional weeks or months.

What else causes heel pain, or pain in the soles of the feet?

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There are countless causes of foot pain. Rather than try to list every single one, we wanted to focus on conditions that have a realistic chance of mimicking the pain and discomfort caused by plantar fasciitis. Even many of these conditions can be easily distinguished from plantar fasciitis, some or most of the time. Nevertheless, before assuming that foot pain is plantar fasciitis, here are some of the other causes that may need to be ruled out.
• Osteoarthritis
• Septic arthritis
• Reactive arthritis
• Gout
• Collapsed arches
• Stress fractures
• Avulsion fractures
• Broken foot or toe
• Bone spurs
• Haglund’s deformity
• Pinched nerve
• Achilles Tendinitis
• Ruptured Achilles tendon
• Retrocalcaneal bursitis
• Peripheral neuropathy
• Diabetic neuropathy
• Osteomyelitis
• Metatarsalgia
• Morton’s neuroma
• Tarsal tunnel syndrome
• Tumors (usually benign)