What Is Plantar Fasciitis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

The American Academy of Orthopaedic Surgeons (AAOS) estimates that two million people are treated for plantar fasciitis every year. (1) At some point in their life, 1 in 10 people develops the condition. It accounts for between 11 and 15 percent of foot symptoms requiring treatment, past research shows. (2)

A simple definition: “It’s inflammation of the tissue on the bottom of the foot,” says Alan K. Mauser, a doctor of podiatric medicine at Louisville Podiatry Foot and Ankle Center in Louisville, Kentucky.

Here’s everything you need to know about what causes it, who’s at risk, how to manage it, and much more.

Plantar fasciitis is a foot condition characterized by sharp, stabbing heel pain that typically occurs when a person gets out of bed in the morning or stands up after sitting for a long period of time. While shooting pain is usually the most common symptom of plantar fasciitis, it can also cause some swelling in the heel. (1)

Even though the pain from plantar fasciitis can be extremely intense after rest, it usually eases during the day. The pain may reappear after exercise or long periods on your feet. (1)

Located on the bottom of the foot, the plantar fascia is a dense band of connective tissue, or ligament, connecting the heel to the front of the foot. This band of tissue, which supports the arch of the foot, acts like a bowstring on the bow, according to Dr. Mauser. It is meant to absorb any stresses and strains placed on the feet.

“When you're off your foot, it's not tight, but when you step down, it becomes tight,” Mauser says.

Over time you can strain or damage this tissue, which then usually becomes a chronic problem, he adds. “One never really rests their foot enough to heal and get better."

Plantar fasciitis occurs when the plantar fascia becomes tight from too much pressure on the tissue. That strain or damage causes inflammation, which results in your feeling pain and stiffness.

As tension in the plantar fascia increases, tiny tears form in the tissue. The more tension and tearing that occur in the plantar fascia, the more inflammation and irritation there will be. It’s this buildup of tension and tearing that cause the pain and stiffness associated with plantar fasciitis. (1)

Men and women between ages 40 and 60 are most likely to experience the condition, though it’s slightly more common among women, according to a June 2019 article in American Family Physician. (3)

It has a higher incidence among athletes — particularly runners. It is sometimes referred to as “runner’s heel.” A retrospective study of running injuries found that 7.8 percent of the injuries were plantar fasciitis, and the condition ranked as one of the five most common running injuries. (4)

Plantar fasciitis usually develops over time, rather than being triggered by any one specific injury. (1) There are a number of risk factors that can increase your risk for plantar fasciitis, including:

• Obesity or Sudden Weight Gain Excess weight can damage the plantar fascia, making it less able to absorb shock, which can lead to heel pain. There also appears to be a strong association between increased body mass index (BMI) and plantar fasciitis in nonathletes. (2) Pregnancy also raises your risk by increasing weight placed on the feet.
• Too Much Pressure on the Heels People who walk frequently, run, or have to stand all day at work tend to be at higher risk. Spending most of your workday walking or standing, such as is the case for occupations like factory worker and teacher, can damage the plantar fascia, notes the Mayo Clinic. (5) Research has shown that excessive stretching and tightness of the Achilles tendon can lead to overstraining of the plantar fascia. (6)
• Foot Shape and Gait People with overpronation (rolling inward on your arches when you walk or run) or flat feet (also known as low or fallen arches) are at an increased risk for plantar fasciitis because the entire soles of their feet are more likely to touch the ground when standing, per past research. (7) Similarly, very high arches (cavus foot) raise your risk because an excessive amount of pressure is placed on the heel and the ball of the foot when standing or walking. (7) An unusual running or walking gait can also increase pressure and tension on the plantar fascia.
• Diabetes Research has found that people with type 2 diabetes may be more likely to have thicker plantar fascia, particularly among those with a higher BMI. (8) A review published in April 2020 in the journal Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy concluded that common comorbidities, including obesity and sedentary lifestyle, are likely the factors that increase plantar fasciitis risk for people with diabetes. (9)
• Arthritis While there’s no direct link between plantar fasciitis and arthritis, people who develop limitations in foot and ankle mobility as a result of arthritis may face a greater risk of developing conditions like plantar fasciitis, according to Michelle Steege, a doctor of physical therapy and orthopedic physical therapist at Motion Minnesota in Minnetonka, Minnesota.
• Wearing the Wrong Shoes If shoes don't fit well, they won't support the foot. Inadequate footwear can impair walking and put additional stress on the plantar fascia. Running shoes, for example, lose a significant amount of their shock absorption with age. Simply swapping out old, worn shoes for a new pair may help decrease pain. (7) “Shoes can make the difference between good health and potential foot, leg, low-back, or general health problems,” says Neil M. Scheffler, a doctor of podiatric medicine with the Baltimore Podiatry Group in Maryland. “Shoe choice is especially important for people with diabetes or circulatory problems."

Most cases of plantar fasciitis can be treated with rest and applying ice. Over-the-counter pain relievers like ibuprofen (Advil, Motrin B) and  Aleve (naproxen) can help reduce some of the pain and inflammation associated with the condition. (7) Orthotics, or shoe inserts that provide support and relieve pressure on the foot, can also alleviate pain in the short term. (13)

Stretching and strengthening exercises can also speed recovery and help avoid other complications, such as tightness or weakness of other foot muscles. A physical therapist can show you effective stretches to loosen the plantar fascia, as well as exercises to strengthen your lower-leg muscles. (7)

Stretches for Plantar Fasciitis

One of the best stretches you can do to facilitate recovery and help prevent plantar fasciitis from coming back is a standing calf stretch with your toes on the wall. “It’s almost like you’re stretching [the plantar fascia] from both ends,” Steege says.

To do it, prop your toes against a wall so your legs are straight, and step one foot back. Keeping both legs straight, gently push your body toward the wall so you feel a stretch in your front foot and calf. Hold for 30 to 60 seconds. Switch sides, performing two or three times per side.

Another effective calf stretch is known as the runner’s stretch, according to Quirolgico. To do it, begin standing in front of a wall at arm’s length from it with your feet hip-width apart. Place both hands flat against the wall and bend one knee. Step the other foot back so your leg is straight, heel flat on the ground. Keep both feet pointed forward and gently press into the wall until you feel a stretch in your back calf and heel. Hold for 30 to 60 seconds and perform two or three times per side.

Stretch out your calves both before and after exercise.

Plantar fasciitis is usually more painful after you’ve been immobile for a period of time (as when sleeping or sitting at your desk). To ease pain and loosen up the plantar fascia, roll your foot over a lacrosse, tennis, or small massage ball for a few minutes before you stand up. “You’re giving input to those tissues to try and calm them down before you start moving,” Steege says.

You can also roll your foot over a frozen water bottle to ice and massage the plantar fascia at the same time. (1) “Having that icing component helps decrease inflammation locally in some patients,” Quirolgico says. Ice baths and applying ice via an ice pack are also recommended to help manage pain. (7)

Other Treatment Options for Plantar Fasciitis

Another option to help you recover is to wear a dorsal night splint. Designed for nighttime use, a dorsal night splint keeps your ankle propped up, stretching out the plantar fascia while you sleep. “But some patients don’t like wearing anything on their feet at night, so they end up taking it off,” Quirolgico says. For those patients, she recommends wearing the splint for a couple of hours in the evening. “It functions in the same way as doing calf stretches,” she says.

Nutrition may play a tangential role in triggering and managing plantar fasciitis.

A 2014 case report noted a patient whose plantar fasciitis went into remission when she maintained a gluten-free diet, but it did not establish a direct cause-and-effect relationship. (14) Dietary intake of certain types of foods such as dairy, sugar, and trans fatty acids may contribute to inflammatory conditions like plantar fasciitis, but this link has not been clearly established in the medical literature.

Obesity is a known risk factor for plantar fasciitis, and research shows that people who are obese are more likely to experience recurring plantar fasciitis. (15) It is unclear if diet is a factor, but losing weight has many health benefits and at a minimum would reduce the pressure on the heels.

Surgery Options for Plantar Fasciitis

If the pain hasn’t resolved after several months of limiting activity, increasing stretching, and other behavior changes, your doctor may recommend more invasive procedures like surgery, steroid injections, extracorporeal shockwave therapy, or ultrasonic tissue repair. (7)

Alternative and Complementary Therapy Options for Plantar Fasciitis

In addition to conventional care methods, acupuncture, a treatment modality commonly used in traditional Chinese medicine, may also be a safe and effective treatment option for plantar fasciitis. (16)

Acupuncture is often used to treat pain and involves the insertion of thin needles through the skin at specific points in the body to redirect the flow of energy. The evidence suggests that stimulating the nerves, muscles, and connective tissue in specific areas helps boost your body’s natural pain-relieving abilities. (17,18)

According to one review of eight studies published in the journal Acupuncture in Medicine in 2018, acupuncture was shown to be an effective treatment for heel pain and function in people with plantar fasciitis and is comparable to conventional interventions like stretching, night splints, or dexamethasone (an anti-inflammatory medication). (16)

Another review, published in 2017 in the Singapore Medical Journal, found that acupuncture led to a significant reduction in plantar fasciitis pain during four to eight weeks of therapy, which suggests that it may be effective for short-term pain management. More research is needed to determine if acupuncture is effective for long-term pain management. (19)

Acupuncture is generally considered to be safe, so long as the treatment is performed by a qualified practitioner. Most states require a license, certification, or registration to practice acupuncture. (17)

“Acupuncture is low risk and many patients get pain relief from it,” Quirolgico says. However, some patients don’t respond to acupuncture. “In that case I tell patients not to continue if it’s not helping them.”

Learn More About Treatment for Plantar Fasciitis: Medication, Surgery Options, and More

Prevention of Plantar Fasciitis

There are many steps you can take to help prevent plantar fasciitis.

First, try to limit the factors that increase your risk of heel pain, Steege says: (20)

• Maintain a healthy weight to ease the load on your heels.
• Warm up before exercise, including calf stretches.
• Increase running and other forms of high-impact exercise gradually.
• Choose shoes that support your arch and cushion your heel.

Also, if you’re a runner, update your running shoes regularly. “I encourage runners to change their sneakers every 300 to 400 miles, or every three to four months, whichever comes sooner,” Quirolgico says. Over time, the materials in your shoes wear down, which lowers their shock absorption and increases the pressure on your plantar fascia.

Tight calf muscles can also make you prone to plantar fasciitis. One of the best things you can do to prevent plantar fasciitis is to stretch out your calves regularly, Steege says. It’s especially helpful to stretch them out before and/or after exercise. If stretching before exercise, do it after warming up.

If you’ve had plantar fasciitis in the past, consider working with a physical therapist to find out if you have any muscle weaknesses or mobility issues that could cause a recurrence. Weakness and immobility in areas such as the hip and ankle can create changes in the foot, Steege says.

RELATED: Everything You Need to Know About Flexibility and Stretching

Plantar fasciitis requires treatment to prevent it from becoming persistent or growing worse. If untreated, plantar fasciitis can impair mobility and keep you from getting much-needed exercise. It can also lead to back problems, knee and hip problems, and other foot conditions because of how it affects the way you walk. (7)

If conservative, nonsurgical, and nondrug plantar fasciitis treatments don’t resolve the issue, some doctors may recommend a corticosteroid injection. Research shows that corticosteroid injections greatly reduce pain, but their effects are usually short-term, lasting from 4 to 12 weeks. (21) In addition, this treatment option can cause plantar fascia tears, so doctors have to weigh the potential benefits against this risk. “Most patients don’t get tears, but because of the risk, I’ve moved away from [corticosteroid injections],” Quirolgico says.

Surgery performed to treat plantar fasciitis, known as a plantar fasciotomy, can also lead to complications. Some patients continue to experience heel pain even after surgery, whereas others feel discomfort because of the scar tissue that forms as a result of the surgery. (22) Studies that used cadavers suggest a plantar fasciotomy may limit the ability of the plantar fascia to provide arch support, which may change the way a patient stands and walks. (22) However, more research is needed to determine if this finding applies to living patients. (22) Other possible complications of surgery include nerve problems, infection, delayed healing, and neuroma, a benign (not harmful) tumor made of nerve cells and fibers. (23)

Plantar fasciitis is the most common cause of heel pain in adults, with about 10 percent of the population experiencing it in their lifetime. (3)

Researchers keep looking to improve minimally invasive treatments for plantar fasciitis when symptoms don’t improve from rest, icing, and physical therapy. Although a corticosteroid injection is the most common treatment in these cases, newer treatment options may be just as effective, with a lower risk of complications.

A 2019 review of studies for the treatment of plantar fasciitis reveals that autologous platelet-rich plasma therapy (PRP), which uses injections of a patient’s own platelets (cells in the blood that form blood clots and prevent bleeding) to speed healing, may be safer and more effective than corticosteroid injections. (24)

The same review found that dry needling, a treatment that involves inserting thin needles through the skin to stimulate muscle tissue in specific areas to relieve tightness and pain (which is similar to acupuncture), also shows promising results with minimal side effects, but more research is needed. (18,25)

Another review found that acupuncture may help reduce plantar fasciitis pain in the short term (between four and eight weeks) with few side effects. However, more research is needed to determine if it’s effective in the long term. (26,18)

Currently, trials are planned that will compare the effectiveness of dry needling versus various types of acupuncture for the treatment of plantar fasciitis. (27,28,29,30)

Plantar fasciitis is the most common cause of heel pain, but it is not the only one. Among these other causes of heel pain are:

Bursitis Bursas are fluid-filled sacs that cushion bones and muscles near large joints in the body. They’re found in the hips, shoulders, and elbows, as well as places like the heel of the foot. Bursas in the foot can become inflamed and painful due to excessive walking, running, or jumping. (31)

Calcaneal Apophysitis The growth plate, or epiphyseal plate, in the heel can become inflamed. The condition, also known as Sever’s disease, usually occurs in children during growth spurts. (32)

Inflammatory Diseases People with systemic inflammatory conditions, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and reactive arthritis, may experience heel pain.

Lateral Plantar Nerve Entrapment Nerves along the central part of the arch can become compressed between bone and tissue, resulting in pain around the heel and ankle area of the foot. (33)

Plantar Fascia Rupture In rare cases, the plantar fascia can rupture, according to Quirolgico. This painful injury usually occurs during high-impact exercise, such as sudden jumping, running, and sprinting. (34)

Sciatica Injury or pressure on your sciatic nerve, which controls muscles in the knees and lower legs, can cause lower-back and leg pain. The pain can sometimes be felt in the foot, but it might be more of a tingling or numbness than the pain typically associated with plantar fasciitis. (35)

Stress Fracture A hairline crack or fracture can develop in the heel bone, also known as the calcaneus. It’s usually the result of overuse or an event in which the heel is crushed under the weight of the body (like a fall from a height). Calcaneal stress fractures are rare and account for only about 2 percent of all fractures in adults. (36)

Tarsal Tunnel Syndrome The tarsal tunnel is a space inside the ankle containing nerves, arteries, and tendons. One of these is the tibial nerve, which allows feeling and movement to parts of the foot. Tarsal tunnel syndrome refers to a compression of the tibial nerve that can be caused by an ankle sprain, inflammatory disease, and flat or fallen arches. The possible symptoms include pain and a tingling sensation around the heel. (37)

As previously noted, plantar fasciitis can also exist alongside other chronic health conditions, including obesity and diabetes. (38)

Favorite Orgs for Essential Plantar Fasciitis Information

American College of Foot and Ankle Surgeons (ACFAS)

This professional society offers resources to help you identify and resolve your foot and ankle issues. Search its encyclopedia of foot and ankle conditions, use its interactive “Where do you hurt?” foot and ankle diagram to pinpoint your pain, and find an ACFAS physician through its database.

American Family Physician

The journal of the American Academy of Family Physicians (AAFP) offers a searchable archive of articles and research about a wide range of conditions. Search to learn specifically about the causes, diagnosis, and treatment of plantar fasciitis.

American Orthopaedic Foot and Ankle Society (AOFAS)

This society is made up of orthopedic surgeons who specialize in foot and ankle conditions. While its website is primarily geared toward the organization’s members, you’ll find up-to-date information about orthopedic care advances in the news section.

American Podiatric Medical Association (APMA)

Here, you’ll find general and condition-specific information on muscle and tendon problems, foot and ankle injuries (like plantar fasciitis), and treatment options. Use the website’s search tool to find a local podiatrist, if needed.

Favorite Podiatry Websites and Journals

OrthoInfo

This site features articles and videos that offer in-depth information about bone and muscle problems, broken down by body part. You’ll find helpful guides for treatment options, recovery from surgery, pain management, and sports injury prevention, all developed and reviewed by experts at the American Academy of Orthopaedic Surgeons.

Podiatry Today

Learn about plantar fasciitis, as well as related topics like heel pain, orthotics, neuropathy, and sports medicine by searching this journal’s topic center.