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Plantar fasciitis (say "PLAN-ter fash-ee-EYE-tus") is the most common cause of heel pain. The plantar fascia is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk.
Plantar fasciitis is common in middle-aged people. It also occurs in younger people who are on their feet a lot, like athletes or soldiers. It can happen in one foot or both feet.
Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen if:
Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.
If you have foot pain at night, you may have a different problem, such as arthritis, or a nerve problem such as tarsal tunnel syndrome.
Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about:
Your doctor may take an X-ray of your foot if he or she suspects a problem with the bones of your foot, such as a stress fracture.
No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better:
If these treatments do not help, your doctor may recommend splints that you wear at night, shots of medicine (such as a steroid) in your heel, or other treatments. You probably will not need surgery. Doctors only suggest it for people who still have pain after trying other treatments for 6 to 12 months.
Plantar fasciitis most often occurs because of injuries that have happened over time. With treatment, you will have less pain within a few weeks. But it may take time for the pain to go away completely. It may take a few months to a year.
Stay with your treatment. If you don't, you may have constant pain when you stand or walk. The sooner you start treatment, the sooner your feet will stop hurting.
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Exactly what causes plantar fasciitis is not well understood. But it probably develops as the result of repeated small tears in the plantar fascia. Normally when you walk, your plantar fascia stretches as your foot strikes the ground. If the plantar fascia is strained by the way you walk or by repeated stress, it can become weak, swollen, and irritated (inflamed), and it can hurt when you stand or walk.
Conditions or activities that may lead to plantar fasciitis include:
The classic symptom of plantar fasciitis is heel pain when you take your first steps after getting out of bed or after sitting for a long period of time. You may also have:
Plantar fasciitis may be mistaken for other conditions with similar symptoms, such as arthritis or a nerve problem such as tarsal tunnel syndrome.
Plantar fasciitis usually develops gradually. You may have heel pain only when you take your first steps after getting out of bed or after sitting for a long period of time. If you do not rest your feet, the pain will get worse. Other things, such as the repetitive stress of walking, standing, running, or jumping, will add to the injury, inflammation, and pain. The injured ligament may never heal completely if you are not able to stop the activity or change the condition that caused it.
As plantar fasciitis progresses:
If the condition is not treated, plantar fasciitis can cause constant heel pain when you stand or walk.
You have a greater chance of developing plantar fasciitis if you:
If you are a runner, you increase your chance of developing plantar fasciitis if you:
If you think you might have plantar fasciitis, call your doctor. The earlier a doctor diagnoses and treats your problem, the sooner you will have relief from pain.
Call your doctor immediately if you have heel pain with fever, with redness or warmth in your heel, or with numbness or tingling in your heel.
Call your doctor if you have:
Call your doctor if you have been diagnosed with plantar fasciitis and the home treatment you agreed on is not helping to control your heel pain.
If you have heel pain:
The following health professionals can evaluate and diagnose plantar fasciitis and recommend nonsurgical treatment:
If nonsurgical treatments fail to relieve your pain, your doctor may refer you to a specialist such as an orthopedist or podiatrist. If you are an athlete, your doctor may refer you to a sports medicine specialist to look for problems with how your feet strike the ground, how your feet are shaped, or your training routine.
The following health professionals can do surgery:
To diagnose plantar fasciitis, your doctor will ask questions about your symptoms and your past health. He or she will also do a physical exam of your feet that includes watching you stand and walk.
X-rays aren't helpful in diagnosing plantar fasciitis, because they do not show ligaments clearly. But your doctor might take X-rays if he or she suspects a stress fracture, bone cyst, or other foot or ankle bone problems. X-rays may show whether a heel spur is present, but a bone spur does not necessarily mean that a person has plantar fasciitis.
If the diagnosis is not clear, you may have other tests. Tests that are done in rare cases include ultrasound, MRI, blood tests, bone scans, and vascular testing, which can evaluate blood flow in the foot and lower leg. If your doctor suspects nerve entrapment, you may have neurological testing.
The goals of treatment for plantar fasciitis are to:
Most people recover completely within a year. Out of 100 people with plantar fasciitis, about 95 are able to relieve their heel pain with nonsurgical treatments. Only about 5 out of 100 need surgery.footnote 1
Treatment that you start when you first notice symptoms is more successful and takes less time than treatment that is delayed.
There are many methods you can try to relieve the heel pain of plantar fasciitis. Even though their effectiveness has not been proved in scientific studies, these methods, used alone or in combination, work for most people.footnote 2
Avoid using only heat on your foot, such as from a heating pad or a heat pack for at least the first 2 or 3 days. Heat tends to make symptoms worse for some people. If you use contrast baths, which alternate hot and cold water, make sure you end with a soak in cold water. If you try a heating pad, use a low setting.
If your weight is putting extra stress on your feet, your doctor may encourage you to try a weight-loss program.
If nonsurgical methods such as rest, ice, and stretching exercises help relieve your plantar fasciitis symptoms, continue using them. If you have not improved after 6 weeks, your doctor may recommend that you continue those methods but add other nonsurgical treatments, such as:
Formal physical therapy instruction can help make sure you properly stretch your Achilles tendon and plantar fascia ligament. Doctors usually consider surgery only for severe cases that do not improve.
Your doctor may suggest corticosteroid shots if you have tried nonsurgical treatment for several weeks without success.footnote 1 Shots can relieve pain, but the relief is often short-term. Also, the shots themselves can be painful, and repeated shots can damage the heel pad and the plantar fascia.
Out of 100 people with plantar fasciitis, about 95 are able to relieve their heel pain with nonsurgical treatments. Only about 5 out of 100 need surgery. footnote 1If you are one of the few people whose symptoms don't improve in 6 to 12 months with other treatments, your doctor may recommend plantar fascia release surgery. Plantar fascia release involves cutting part of the plantar fascia ligament in order to release the tension and relieve the inflammation of the ligament.
If you are trying to lose weight and you develop plantar fasciitis when you begin exercising, especially jogging, talk with your doctor about other types of activity that will support your weight-loss efforts without making your heel pain worse. An activity like swimming that doesn't put stress on your feet may be a good choice.
If your plantar fasciitis is related to sports or your job, you may have trouble stopping or reducing your activity to allow your feet to heal. But resting your feet is very important to avoid long-lasting heel pain. Your doctor or a sports medicine specialist may be able to suggest a plan for alternating your regular activities with ones that do not make your pain worse.
If you exercise frequently, ask your doctor whether physical therapy or referral to a sports medicine specialist, podiatrist, or orthopedist is appropriate.
Some questions you may want to ask about exercise include:
The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it:
If you feel that work activities caused your heel pain, ask your human resources department for information about different ways of doing your job that will not make your heel pain worse. If you are involved in sports, you may want to consult a sports training specialist for training and conditioning programs to prevent plantar fasciitis from recurring.
The first steps your doctor will recommend to treat plantar fasciitis are ones you can take yourself. Different people find that one method or a combination of methods works best for them.
Try the following methods:
Often athletes develop foot problems because they train in shoes that are worn out or don't fit properly. Replace your shoes every few months, because the padding wears out. Also, replace shoes if the tread or heels are worn down. While replacing shoes is expensive, it is less expensive—and less painful—than a long-lasting heel problem. Other sensible training techniques, such as avoiding uneven or hard surfaces, can help prevent plantar fasciitis from occurring or returning.
To be successful at treating plantar fasciitis, you will need to:
The healing process takes time—from a few months to a year. But you should begin to have less pain within weeks of starting treatment. If you have not improved after trying these methods for 6 weeks, your doctor will suggest other treatments.
Your doctor may recommend medicine to relieve the pain and inflammation caused by plantar fasciitis. Drug treatment does not cure plantar fasciitis. But by reducing pain, medicine may make it easier for you to follow other treatment steps, such as stretching. You should not use medicine as a way to continue the activities that are causing heel pain.
Medicine options include:
Injections of botulinum toxin are being studied for use in plantar fasciitis.
Surgery is usually not needed for plantar fasciitis. About 95 out of 100 people who have plantar fasciitis are able to relieve heel pain without surgery. Your doctor may consider surgery if nonsurgical treatment has not helped and heel pain is restricting your daily activities. Some doctors feel that you should try nonsurgical treatment for at least 6 months before you consider surgery.footnote 3
The main types of surgery for plantar fasciitis are:
Experts in the past thought that heel spurs caused plantar fasciitis. Now experts generally believe that heel spurs are the result, not the cause, of plantar fasciitis. Many people with large heel spurs never have heel pain or plantar fasciitis. So surgery to remove heel spurs is rarely done.
Physical therapy may be helpful for some people who have plantar fasciitis. It can be especially useful for people who have problems with foot mechanics (biomechanical problems), such as tight Achilles tendons.
A technique called extracorporeal shock wave therapy (ESWT) uses pulsed sound waves to treat plantar fasciitis. Research is still being done, but some studies show that ESWT can help reduce symptoms in plantar fasciitis that has not responded to other treatment.footnote 4, footnote 5 New shock wave treatments are being studied. Most types of shock wave therapy, sometimes called "focused" ESWT, require anesthetic. Another type, called radial ESWT, can be done without anesthetic, because the shock wave is more spread out.
American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Plantar fasciitis. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 839–844. Rosemont, IL: American Academy of Orthopaedic Surgeons. Thomas JL, et al. (2010). The diagnosis and treatment of heel pain: A clinical practice guideline-revision 2010. Journal of Foot and Ankle Surgery, 49(3, Suppl): S1–S19. American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Plantar fasciitis. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 839–844. Rosemont, IL: American Academy of Orthopaedic Surgeons. Malay DS, et al. (2006). Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: Results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial. Journal of Foot and Ankle Surgery, 45(4): 196–210. Gerdesmeyer L, et al. (2008). Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: Results of a confirmatory randomized placebo-controlled multicenter study. American Journal of Sports Medicine. Published online October 1, 2008.
Other Works Consulted
Basford JR, Baxter GD (2010). Therapeutic physical agents. In WR Frontera et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 5th ed., vol. 2, pp. 1691–1712. Philadelphia: Lippincott Williams and Wilkins. Digiovanni BF, et al. (2006). Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. Journal of Bone and Joint Surgery, 88(6): 1775–1781. Orchard J (2012). Clinical review: Plantar fasciitis. BMJ. Published online October 10, 2012 (doi:10.1136/bmj.e6603). Pasquina PF, et al. (2015). Plantar fasciitis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 3rd ed., pp. 463–467. Philadelphia: Saunders.
ByHealthwise Staff Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine E. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Kathleen Romito, MD - Family Medicine Gavin W. G. Chalmers, DPM, FACFAS - Podiatry and Podiatric Surgery
Current as ofNovember 29, 2017
Current as of:
November 29, 2017
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Gavin W. G. Chalmers, DPM, FACFAS - Podiatry and Podiatric Surgery
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