What Is It?

Plantar fasciitis is a painful inflammation of the plantar fascia, a fibrous band of tissue on the sole of the foot that helps to support the arch. Plantar fasciitis occurs when this band of tissue is overloaded or overstretched. This produces small tears in the fibers of the fascia, especially where the fascia meets the heel bone. Plantar fasciitis is common in obese people and in pregnant women, perhaps because their extra body weight overloads the delicate plantar fascia. It is also more common in people with diabetes, though the exact reason for this is unknown. Plantar fasciitis also can be triggered by physical activities that overstretch the fascia, including sports (volleyball, running, tennis), other exercises (step aerobics, stair climbing) or household exertion (pushing furniture or a large appliance). Worn or poorly constructed shoes can contribute to the problem if they do not provide enough arch support, heel cushion or sole flexibility. In athletes, plantar fasciitis may follow intense training, especially in runners who push themselves too quickly to run longer distances.

Symptoms of plantar fasciitis can occur suddenly or gradually. When they occur suddenly, there is usually intense heel pain on taking the first morning steps, known as first-step pain. This heel pain often subsides as the patient begins to walk around, but it may return in the late afternoon or evening. When symptoms occur gradually, a more chronic form of heel pain causes patients to shorten their stride while running or walking. Patients also may shift the weight toward the front of the foot, away from the heel.

Your health-care provider will ask you whether you have the classic symptoms of first-step pain and about your activities, including whether you recently have intensified your training or changed your exercise pattern.

Your doctor often can diagnose plantar fasciitis based on your history and symptoms, together with a physical examination. If the diagnosis is in doubt, your doctor may order a foot X-ray, bone scan or nerve-conduction studies to rule out another condition, such as a stress fracture or nerve problem.

Once an appropriate treatment program begins, it may take six to eight weeks before the pain begins to be relieved. Total pain relief may not happen for several months.

You can help to prevent plantar fasciitis by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch and cushion the heel. In people who are prone to episodes of plantar fasciitis, exercises that stretch the heel cord (known as the Achilles tendon) and the plantar fascia may help to prevent plantar fasciitis from returning. Ice massage also can be used on the sole of the foot after stressful athletic activities. It is possible that strict control of blood sugar will prevent plantar fasciitis in people with diabetes, though this has not been proven.

Most doctors recommend an initial six- to eight-week program of conservative treatment, including:

• Stretching exercises to lengthen the heel cord and plantar fascia
• Ice massage to the sole of the foot after activities that trigger heel pain
• A temporary switch to swimming and/or bicycling instead of sports that involve running and jumping
• Shoes with soft heels and inner soles
• Taping the sole of the injured foot
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin and others) or acetaminophen (Tylenol) for pain
• Physical therapy using electrical stimulation with corticosteroids or massage techniques

If this initial conservative treatment does not help, your doctor may recommend that you wear a night splint for six to eight weeks. While you sleep, the night splint will keep your foot in a neutral or slightly flexed (bent) position to help maintain the normal stretch of the plantar fascia and heel cord. If the night splint doesn’t work, your doctor may inject corticosteroid medication into the painful area or place your foot in a short leg cast for one to three months. If all else fails, your doctor may suggest surgery, but this is rare, and surgery is not always successful.

Call your doctor whenever you have significant foot or heel pain, especially if this pain makes it difficult for you to walk normally.

The prognosis is excellent for most people with plantar fasciitis. At least 90 percent of patients respond either to the first six to eight weeks of conservative therapy or to conservative therapy followed by six to eight weeks of wearing night splints.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.