Definition

Plantar fasciitis is inflammation of the plantar fascia in the foot. The plantar fascia is a band of tissue located at the bottom of the foot, extending from the heel to the toes. Its function is to act as a shock absorber and provide support to the foot during walking.

Although the plantar fascia can stretch like rubber, overstretching can cause small tears in the tissue. Activities that put excessive pressure on the feet may also result in injury or tears to the tissue. As a result, the plantar fascia becomes inflamed, leading to heel pain.

Plantar fasciitis is a common condition that can affect one or both feet at the same time. Approximately 1 in 10 people will experience plantar fasciitis at some point in their lives.

Causes

Pressure and stretching of the plantar fascia tissue can cause small tears, which may lead to inflammation if this happens repeatedly. In some cases, the exact cause is unknown. Here are some factors that can cause plantar fasciitis:

• Standing for long periods
• Sports activities
• Working or exercising on hard surfaces (e.g., warehouse floors, pavements)
• Exercising without proper warm-up or cool-down
• Wearing shoes that don’t provide proper foot support (e.g., flip-flops, flat shoes, sneakers)
• Walking or standing barefoot at home
• Medical conditions
  • High arches of the feet
  • Flat feet
  • Obesity

Read more: Flat Feet (Pes Planus)—Definition, Causes, Symptoms, and Treatment

Risk Factor

You are at higher risk for plantar fasciitis if you:

• Are between 40 and 60 years old
• Are overweight or obese
• This is caused by increased pressure on the feet, especially if there is a sudden increase in body weight
• Are a long-distance runner
• Have a job that requires prolonged standing (e.g., factory worker, restaurant server)
• Have structural foot problems like flat feet or high arches
• Wear shoes that do not provide adequate foot support

Symptoms

The primary symptom of plantar fasciitis is heel pain, or sometimes pain in the mid-bottom part of the foot. It usually affects one foot but can also impact both feet. Common symptoms include:

• Heel pain
• Pain in the sole of the foot
• Stiffness
• Swelling around the heel
• Tightness around the Achilles tendon

Plantar fasciitis typically causes pain in the heel or sole, which can vary based on activity. You may experience:

• Pain when standing after waking up or sitting. This pain usually subsides after walking for a few minutes.
• Dull, constant pain
• Sharp, stabbing pain when using the affected foot
• Relief during activity, but worsening pain after stopping
• Increased pain in the morning or when standing after sitting or sleeping

Diagnosis

A diagnosis of plantar fasciitis can be made through a medical interview (history taking), a physical examination, and, if necessary, additional tests.

The doctor will ask about your symptoms and determine whether they suggest a diagnosis of plantar fasciitis. Tell your doctor if you experience pain during daily activities, including the location and timing of the pain.

After conducting a medical interview, the doctor will then perform a physical examination. During the physical examination, the doctor may apply light pressure to the soles of your feet to feel for inflammation and assess the level of pain you are experiencing.

The doctor will also assess muscle strength and nerve health by checking your reflexes, muscle tone, coordination, and balance.

Your doctor may recommend additional examinations, such as radiological tests, such as an X-ray or MRI. Radiological tests can help your doctor see the structures and tissues of your foot more clearly.

In addition, your doctor may be able to identify the cause of your heel pain, such as a fracture. An ultrasound may also be performed to check for swelling, brittle bones, and other problems.

Management

Plantar fasciitis treatment can involve home care and over-the-counter medication. The doctor will provide options to reduce symptoms, offer effective treatment, and prevent future plantar fasciitis. Common treatments include:

• NSAIDs
• Over-the-counter NSAIDs such as ibuprofen, aspirin, and naproxen can reduce pain and inflammation. These medications should not be taken for more than 10 days without consulting a doctor.
• Rest
• Total rest is recommended, avoiding activities or exercises that trigger plantar fasciitis for at least a week if possible.
• Cold Compress
• Apply a cold compress to the foot for 10-15 minutes, twice a day. Wrap a bottle of ice water in a thin towel and press it with your foot to massage the inflamed area.
• Special Footwear
• Use orthopedic shoes or supportive shoes, such as sturdy and cushioned ones, to provide better foot support.

Other treatments the doctor may offer include:

• Corticosteroid Injection
• An anti-inflammatory steroid injection into the plantar fascia if other treatments don’t relieve symptoms.
• Platelet-Rich Plasma (PRP)
• An injection that promotes healing and tissue repair.
• Extracorporeal Pulse Activation Technology (EPAT)
• A therapy using high-energy sound waves to improve blood flow and accelerate healing.
• Percutaneous Needle Tenotomy
• A procedure where a needle is inserted into the plantar fascia to stimulate healing through increased blood flow.

In severe cases, surgery may be necessary, such as:

• Gastrocnemius Recession: surgery to lengthen the calf muscle, reducing pressure on the plantar fascia.
• Plantar Fascial Release: a procedure to make small cuts in the plantar fascia to relieve tension.

Complications

You may experience chronic pain if you ignore the symptoms of plantar fasciitis. This can alter your gait and lead to injuries to your feet, knees, hips, and back.

Steroid injections and some medications can cause complications, such as weakening the plantar fascia tissue and potentially causing tears. Other complications can also arise during surgery, such as increased risk of bleeding, infection, and reactions to anesthesia.

Prevention

The best way to prevent plantar fasciitis is by avoiding excessive foot strain. General prevention tips include:

• Warming up before exercise and cooling down afterward
• Allowing your feet to rest after intense activities
• Wearing appropriate footwear
• Avoiding walking barefoot
• Replacing shoes every 6 to 9 months

However, prevention may not be entirely possible for individuals with underlying health conditions that increase the risk of plantar fasciitis.

When to See a Doctor?

See a doctor if you experience:

• Persistent heel or foot pain that doesn’t improve after a week
• Symptoms that don’t get better after two weeks of treatment

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