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Plantar Fasciitis: What Causes It & Treatment

If you have heel pain, you may need to stop high-impact activities until it gets better.
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Written by
Benjamin Schwartz, MD, FAAOS.
Orthopedic Surgeon, Sports Medicine North
Last updated April 1, 2021

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What is plantar fasciitis?

Plantar fasciitis is an inflammation of the tissue, called fascia, that runs along the arch of the foot. You experience intense pain in the sole of your foot by the heel, where the plantar fascia attaches to the bone.

It mostly affects adults and can occur in people who are active or sedentary. Several lifestyle factors may put you at increased risk of plantar fasciitis. It usually resolves with rest, ice, and other home remedies, but may take months to get better.

Most common symptoms

Pro Tip

Have you ever gotten out of bed first thing in the morning only to experience a sharp, stabbing pain in your heel that takes your breath away? If so, you are not alone. More than 3 million Americans suffer from plantar fasciitis each year. Usually women and people ages 45 to 64. —Dr. Benjamin Schwartz

The main symptom is pain at the bottom of the foot near the heel. It often occurs first thing in the morning or when getting up after being in the same sitting position for a long time (such as during a car ride or sitting at a desk).

The first few steps are typically the most painful. Symptoms lessen with walking, although they may not completely disappear. Pain may be felt in both feet. And is worse after, but not during, activity.

Main symptoms

  • Sharp pain on the bottom of the foot.
  • Heel pain.
  • Pain when stepping down first thing in the morning.
  • Pain after sitting for a long time (e.g. riding in a car, sitting at a desk).
  • Pain improves with walking.
  • Tenderness on the bottom of the foot at the heel bone.

Other symptoms

  • Tight calf muscles or heel cords.
  • More pain after (not during) exercise.
  • Bone spurs (seen during x-rays).

Next steps

At least 90% of plantar fasciitis cases improve with minor lifestyle changes. Although it may take almost a year for symptoms to disappear.

Most people can be treated by not doing what is aggravating it, such as not running. Other treatments include rest, ice, anti-inflammatories (NSAIDs), and stretching.

If you still have symptoms after 6 to 8 weeks of treating yourself or if pain becomes so severe that you are unable to walk, see a doctor. They may be able to evaluate and treat mild to moderate cases of plantar fasciitis.

In severe cases or if the treatment is not helping, you may be referred to a podiatrist or orthopedic surgeon that specializes in foot and ankle problems.

What causes plantar fasciitis?

Pro Tip

In the past, it was thought that bone spurs in the heel were the cause of plantar fasciitis. Research has shown that the bone spurs are more likely a result of chronic inflammation caused by plantar fasciitis. Removing bone spurs does not seem to stop the pain from plantar fasciitis. —Dr. Schwartz

Plantar fasciitis occurs when the plantar fascia running along the bottom of your foot gets inflamed. Too much pressure on the fascia can damage it, causing inflammation and tightness. It tends to hurt when the tissue tightens, such as after sleeping or sitting for a long time.

Factors that can make you more prone to plantar fasciitis include:

  • Being obese, which puts extra load on your feet.
  • Repeatedly pounding feet on hard surfaces such as runners or those who do other high-impact exercises.
  • Tight calf muscles/heel cords.
  • High foot arch.
  • Sudden increase or change in activity level.
  • Prolonged standing, especially on concrete floors.
  • Abnormal foot position while walking (pronation or turning out of the foot at the ankle).

Plantar fasciitis treatment

Plantar fasciitis can usually be treated with home care. Though symptoms tend to linger and it can take months before it completely heals. Treatment includes:

  • Avoid offending activities: Repetitive pounding (running or jumping on hard surfaces), prolonged standing on hard surfaces should be minimized.
  • Night splints: These are special braces that are worn at night to help keep the plantar fascia stretched while you are sleeping. Night splints are generally inexpensive and are sold by many online retailers. In some cases, simple off-the-shelf heel cushions can be effective in relieving symptoms.
  • Anti-inflammatories (NSAIDS): Plantar fasciitis may be relieved by regular use of over-the-counter NSAIDs such as ibuprofen (Motrin, Advil) or naproxen (Aleve). The key is to take them on a schedule for at least 2-3 weeks. Many patients give up too quickly on these medications. Prescription NSAIDs can be used when these are not helping.   Check with your doctor if you take these for more than a month or have been told not to take them in the past, as people with certain conditions should not take NSAIDs regularly.
  • Ice: Applying ice to the bottom of the foot/heel can help relieve symptoms. Ice can be applied for 20 minutes at a time 3 to 4 times a day.
  • Stretching: Exercises for plantar fasciitis try to stretch the fascia on the bottom of the foot as well as the calf muscle and heel cord. Here is a simple stretching routine to do on your own.
  • Corticosteroid (“cortisone”) injections: These can help relieve the pain. In some cases, cortisone injections can weaken and cause the plantar fascia tissue to completely tear or can cause atrophy (wasting) of the fatty tissue that cushions your heel bone.
  • Surgery: The procedure, called plantar fascia release, is very uncommon. It may be suggested for the small number of people who do not respond to other treatments. It involves cutting a small portion of the plantar fascia to relieve tension. It is not recommended to cut the entire fascia as this may lead to a fallen arch.

Follow up

It can take as long as 9 months of consistent treatment to improve symptoms. It is best not to return to high-impact activities until the pain is gone. It risks aggravating the condition and slowing the healing process.

Dr. Rx

While many people might get frustrated by their slow progress and not doing activities they enjoy, sticking to a routine of stretching and night splinting will eventually pay dividends. Returning too quickly can result in setbacks and prolong the healing process. When dealing with plantar fasciitis, patience is a virtue! —Dr. Schwartz

Prevention

Prevention of plantar fasciitis involves weight loss for obese patients, avoiding repetitive pounding such as running on hard surfaces, and doing stretching exercises of calf muscles and heel cords.

If plantar fasciitis comes back, it is important to consider maintaining a regular stretching program and/or wearing night splints on a regular basis.

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Orthopedic Surgeon, Sports Medicine North

Dr. Schwartz is a board-certified Orthopedic Surgeon and Member of the Buoy Medical Advisory Board. He graduated Magna Cum Laude from the College of William and Mary (1998) with a B.S. in Biology, then obtained his medical degree from the Medical College of Virginia (2002) where he was elected to the Alpha Omega Alpha Medical Honor Society. After completing his Orthopedic Surgery Residency at Boston Medical Center (2007), Dr. Schwartz performed a fellowship in Adult Reconstruction at the Anderson Orthopedic Clinic in Alexandria, VA (2008). As a private practice surgeon, Dr. Schwartz specializes in the treatment of hip and knee arthritis including joint replacement surgery.

On a national level Dr. Schwartz serves several leadership positions including as an Editorial Board Member of the Journal of Arthroplasty, a member of the Practice Management Committee of the American Association of Hip and Knee Surgeons, and a member of the Hip and Knee Content Committee for the American Academy of Orthopedic Surgeons. With a keen interest in healthcare technology, Dr. Schwartz has served as a mentor for several digital health incubators and as an advisor for health tech startups. He joined Buoy as a content writer in 2019 and became a member of the Medical Advisory Board in 2020.

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