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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.
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.
have foot pain at night, you may have a different problem, such as arthritis, or a nerve problem such as
tarsal tunnel syndrome.
will check your feet and watch you stand and walk. He or she will also ask
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
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
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.
Learning about plantar fasciitis:
Living with plantar fasciitis:
Health Tools help you make wise health decisions or take action to improve your health.
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
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
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
Call your doctor if you have been diagnosed with plantar
fasciitis and the home treatment you agreed on is not helping to control your
If you have heel pain:
The following health professionals can
evaluate and diagnose plantar fasciitis and recommend nonsurgical
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 prepare for your appointment, see the topic Making the Most of Your Appointment.
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.
diagnosis is not clear, you may have other tests. Tests that are done in rare
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.1
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.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
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:
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.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
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.1 If 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
If you exercise frequently, ask your doctor
whether physical therapy or referral to a sports medicine
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
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
If your weight is putting extra stress on your feet,
your doctor may encourage you to try a weight-loss program.
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
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
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
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
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.3, 4 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
The American College of Foot and Ankle Surgeons provides
information on surgery and shoe selection as well as the care and treatment of
heel, toe, ankle, nerve, tendon, nail, and skin conditions. You can also look up and learn about sports injuries, diabetic foot problems, arthritis, and resources in your local area.
The American Orthopaedic Foot and Ankle Society (AOFAS)
provides information on a variety of topics, including foot care for adults,
children, and people who have diabetes; proper shoe fit; and how to select
children's shoes and sports shoes. Some information is available in several
languages besides English.
The American Podiatric Medical Association (APMA)
provides information about foot and ankle injuries, sports-related foot
concerns, surgical and nonsurgical treatment of foot problems, special medical
issues such as diabetes, and resources in your local area. Some information is
available in Spanish.
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.
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, Foster LS (2008). Plantar fasciitis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation, 2nd ed., pp. 469–473. Philadelphia: Saunders Elsevier.
July 9, 2013
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Gavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery
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