Plantar Fasciitis Ultimate Guide

Plantar Fasciitis 101: The Ultimate Guide To Your Heel Pain

Sharp pain on the bottom of the feet, especially around the heel?

First few steps out of the bed in the morning are a nightmare?

There is a good chance you're suffering from Plantar Fasciitis.

  • Plantar Fasciitis is the most common cause of foot & heel pain
  • ​The plantar fascia is the largest ligament in the human body
  • ​About 10% of the people will suffer from plantar fasciitis in their lifetime
  • ​Plantar fasciitis AKA policeman’s heel, jogger’s heel, tennis heel and plantar fasciosis
  • ​Pain in the bottom of the heel during the first few steps of the day is a symptom
  • ​Causes of PF is not entirely clear but risk factors involve obesity, poor footwear, poor foot structure
  • ​Initial treatments are Rest, Ice, Pain Relievers and Stretching

What Is Plantar Fasciitis?

Anatomy Plantar Fasciitis

​Image Credit: totalhealth.co.uk

Plantar fasciitis is the most common foot disorder that results in pain in the heel and bottom of the foot. Plantar Fasciitis is the Latin term for “Inflammation of the plantar fascia”.

Plantar refers to the bottom of the foot and fascia is the fibrous band of tissue that connects the heel bone to your toes. The plantar fascia ligament helps maintain the arch of your foot and acts as a shock absorber.

The condition is brought on by repetitive stress injury to the plantar fascia ligament. The overstretching of the ligament weakens the fascia and causes micro-tears to the plantar fascia resulting in inflammation and pain.

The pain is most severe during the first few steps of the day or after a period of rest. The pain usually decreases as you start moving around with your daily activities.

However, the pain may be triggered by bending your foot and toes and may get worse for patients with tight Achilles tendon. Roughly 10% of the people will suffer from PF in their lifetime and about ⅓ will suffer in both the feet.

Various terms have been used to describe plantar fasciitis including policeman’s heel, jogger’s heel, tennis heel and plantar fasciosis. Plantar fasciitis is sometimes misunderstood to be heel spur by the general population.

What Are The Signs & Symptoms Of Plantar Fasciitis?

The symptoms of plantar fasciitis may take days or even weeks to get noticed. The pain comes on slowly in the beginning but increases in frequency and intensity over time.

Most people feel pain in the first few steps of the day or after a period of rest. The pain and stiffness may diminish as you start walking around but may return as the day goes by.

Additionally, the pain may be felt with activities like climbing stairs, walking barefoot or after a long period of standing.

The pain may quickly steal your ability to be on your foot if the symptoms are unnoticed.

Let's look at the most common signs and symptoms of plantar fasciitis.

Sharp Heel Pain:

A sharp pain in the bottom of your heel, usually unilateral (rarely bilateral) is a trademark sign of plantar fasciitis.

Pain After A Period Of Rest:

The plantar fasciitis pain is significant when bearing weight on your foot after a prolonged period of rest. This is because the plantar fascia ligament shortens as your footrest and putting weight stretches the ligament thus causing pain.

The pain usually reduces or goes away after begin on foot for some time.

Pain After A Period Of Activity:

Just as prolonged rest shortens the fascia, long period of standing, walking or physical exercises can stretch and stress the fascia ligament resulting in inflammation and pain.

A good balance of physical activity and rest is crucial.

Pain When Flexing Your Foot:

Stabbing pain when flexing your foot and toe upwards towards your shin (dorsiflexion) is a sign of plantar fasciitis.

The symptoms may be worse for patients with tight Achilles tendon.

Numbness, Burning & Tingling:

Rare but occasionally patients have reported the feeling of numbness, burning, tingling and radiating pain from the affected foot.

The pain forces the patient to put less weight on the affected foot which results in limping when walking.

The plantar fascia ligament may rupture when overused and over-stressed. Typical signs and symptoms of plantar fascia rupture are clicking or snapping sound, arch collapse, acute pain & swelling on the bottom of the foot.

Foot pain that continues at night can be caused due to different reasons such as arthritis or nerve damage like tarsal tunnel syndrome.

There are other foot conditions with similar symptoms like reactive arthritis, osteoarthritis, and heel pad syndrome.

What Are The Causes Of Plantar Fasciitis?

The plantar fascia ligament is a shock absorber that supports the arch of your foot and the impact of your daily activities. When tension and stress on the ligament increases, tiny tears form on the band.

This overstretching and tearing of the ligament can make the fascia weak and inflamed resulting in heel pain.

Though the causes of plantar fasciitis are not entirely clear​, however, you're at risk of developing plantar fasciitis if you are:

Who Is At Risk Of Developing Plantar Fasciitis?

Plantar fasciitis can arise without any notable cause, but you’re at greater risk of developing plantar fasciitis if you have:

Unusual Foot Bio-mechanics: Having high arch, flat foot, over-pronation or abnormal walking or running pattern is a red signal.

These conditions affect the way weight is distributed on the foot while performing your day to day activities thus adding stress on the ligament.

Age: Increasing age can reduce plantar ligament flexibility and makes the heel’s protective fat pad thin which weakens the fascia resulting in heel pain.

PF is most common between ages 40 and 60.

High Body Mass Index: Studies have found a strong relationship between high Body Mass Index and development of plantar fasciitis.

A significant increase in weight due to pregnancy or obesity can put extra pressure on your foot and extra stress on the fascia.

Physical Activities: A frequent short burst of time and intensity of your physical activities like running, weight lifting, ballet dancing etc. can overwork the ligament increasing the chances of early PF.

Moreover, too little physical exercises can cause plantar fasciitis just as too much can. Your plantar fascia ligament shortens when you rest your feet too much.

Regular exercises can help keep the fascia flexible, increase blood flow and strengthen it.

A study reported​, PF is the #1 foot injury in runners and athletes.

Occupational Hazards: You’re at higher risk if your work requires you to be on your feet all day long (especially on a hard surface).

Teachers, factory workers or cooks who are on their feet most of the hours are at risk of developing plantar fasciitis.

Diabetes & Arthritis: According to NCBI, plantar fasciitis and Achilles tendon thickening are associated with diabetes. The exact reason PF is common in diabetes patients is not exactly clear.

Arthritis is also known to cause inflammation associated with plantar fasciitis.

Tight Achilles Tendon: The Achilles tendon is a band of muscle that connects your calf to the heel. A tight Achilles tendon limits your foot’s ability to move and flex completely thus stressing your plantar fascia.

A study found 4 out of 5 patients with tight heel cord suffer from plantar fasciitis.

Unequal Leg Length: Different leg lengths can pose a lot of foot problems including plantar fasciitis. The difference in your leg length can put added stress on your plantar fascia and other soft tissues when you’re on your foot.

Improper Footwear: Improper or worn out footwear can cause a lot of foot problems including plantar fasciitis. This is especially true if you’re an athlete, run marathons or into some other type of outdoor sports.

Weak Foot Muscles: The muscles on the bottom of your foot that runs along the plantar fascia ligament are important for proper foot functionality. Weak foot muscles can lead to excess strain on the plantar fascia soft tissue.

It was often believed that plantar fasciitis is caused due to a heel spur. However, recent studies have shown that heel spur may develop due to PF.

How Is Plantar Fasciitis Diagnosed?

Diagnosis of plantar fasciitis is pretty straightforward if you have pain on the bottom of your heel, you’re probably suffering from PF.

However, your doctor will ask you few questions to rule out other causes of heel pain such as arthritis, heel spur, broken heel or Achilles tendon.

Questions such as:

Your medical history to find out about any illness or injuries you may have had. Symptoms, frequency, time and location of the pain. Your lifestyle and your daily activities.

Additionally, your doctor may do an X-Ray or an MRI of your foot if he/she suspects a bone fracture to ensure an accurate diagnosis.

What Are The Treatment Options For Plantar Fasciitis?

There are many proven pain management options available to heal plantar fasciitis pain, from natural home remedies to medical to surgical procedures.

But no single treatment can be considered as the best for everyone with plantar fasciitis.

The treatment for plantar fasciitis may vary depending on your goals. Main goals of treating plantar fasciitis are to:

  • Cure heel pain and reduce inflammation
  • ​Allow the micro-tears in the plantar fascia ligament to heal
  • ​Improve strength and flexibility of the foot
  • ​The ultimate goal is to get back to your daily life without having to worry about heel pain

Directing treatments according to your symptoms is the key to success. It is found that 95% of the people's pain respond to non-surgical treatments and the other 5% may require surgery.

Success rates are higher and take less time to cure with treatments that start with the initial symptoms then treatments that are delayed.

RELATED: Learn how to get rid of plantar fasciitis quickly and naturally

Initial Treatments For Plantar Fasciitis

Plantar fasciitis is typically a self-limiting condition and studies have shown a 90% patients improve the conditions with non-surgical measures.

Initial treatments can be started at home to ease the pain before seeking specialized medical treatment.

Foot Massages & Exercises

Foot Massage

​Photo Credit: LoosingWeightDone

Stretching and exercising your foot muscles is a great way to reduce heel pain.

Tight calf muscles and Achilles tendon prevents normal ankle movements resulting in improper walking patterns which stresses the plantar ligament.

Simple stretches and foot massages, especially in the morning can help increase blood flow and flexibility of the soft tissues, strengthen the fascia and reduce pain.

Proper foot massages and exercises are an important treatment option in reducing heel pain quickly.

Additionally, you can use a foot massager to get great results.

Icing & Anti-inflammatories

Icing Foot

​Photo Credit: InLifeHealthCare

Icing is the primary home treatment to reduce inflammation and swelling. After a stressful day, icing can help relieve pain almost instantly.

Place an ice pack on the floor and rest your foot on it for 2-3 minutes at a time. Repeat it 2-3 times a day.

Important: Ice therapy should only be used after exercises or daily activities and not before it. It should never be used first thing in the morning.

Non-Steroidal Anti-Inflammatory Drug (NSAID) like Ibuprofen can also be used for immediate pain relief and reduce inflammation. NSAIDs come in a pill (oral use)​ and cream form which you can use topically on the affected area.

Medicines are not the permanent cure for plantar fasciitis, they can only reduce pain temporarily. Medicines should only be used in conjunction with other treatments for an early pain relief.

It is important to consult a physician before taking any medicines.

Wear Supportive Footwear

Supportive Footwear

​Photo Credit: SportsDirect

Your footwear can play an important role in improving or hindering your heel pain condition. Fashionable footwear are usually just fashionable, they don't provide the needed foot support and may provoke the problem.

When you walk or run, a significant amount of tension is placed on the plantar fascia which causes micro-trauma (small tears in the tissues).

A good pair of shoes with arch support & heel cushion helps absorb most of the pressure generated on each step. In one study, 14% of the patient cited a good pair of shoe to be the best pain management option.

It is advisable not to go barefoot as it will enrage the pain. Put on your shoes as you get out of bed.

Additionally, you can use heel cups or shoe inserts (orthotics) to help cushion your heel.

Maintain Healthy Weight 

Lose Weight

​Photo Credit: Jmecc

The more weight you carry the more pressure is exerted on your plantar fascia. And losing those excess pounds can help reduce the extra pressure on your heel.

Regular exercises can be difficult as standing, running or walking may be tough with PF. Instead, you can try swimming, cycling or walking on a treadmill to shed those extra pounds.

Additionally, eating healthy can shed and keep you off those excess pounds. Avoid fried and processed food and cut down on added sugar. Instead, add fresh fruits and vegetables to your daily diet.

Avoid using heat during the initial period of your treatment as heat can make the symptoms worse in some patients.


If you're planning to use a heating pad or a heat pack, make sure to use it on low temperature. Additionally, end your heat therapy with a cold soak or cold massage.

Ongoing Treatments For Plantar Fasciitis

The plantar fasciitis symptoms usually go away with the non-surgical pain management options described above. And if your symptoms are getting better continue to use them.

However, if you don't see a considerable pain relieve in 6-8 weeks then add these treatments along with the ones described above.

Physical Therapy

Physical Therapy

​Photo Credit: TeamSelectHH

If rest, icing and painkillers don’t comfort you, you may want to see a physical therapist. A physical therapist will teach you exercises that will help you strengthen your plantar fascia, Achilles tendon, and other foot muscles.

Contrast baths, deep tissue massage, or ultra-sonography may be recommended by your physical therapist for ongoing healing.

Night Splints 

Night Splints

When you sleep at night your feet are at the plantar-flexed position, allowing the plantar fascia to relax and shorten. And this is one of the reasons for the stabbing pain in the morning.

A night splint helps maintain 90-degree foot-leg angle while putting a passive stretch on the Achilles tendon and the fascia while you sleep.

However, it may be difficult to sleep with a night-splint on, but it is an effective method for improving the condition.

Custom-Made Orthotics

Custom Orthotics

Orthotics are designed to help support the arch and provide extra cushion for your foot and heel.

Custom made orthotics are specially designed according to the shape and structure of the bottom of your foot. If you have an unusual foot structure, a custom shoe insert is your best option.

However, unlike over the counter orthotics, custom-made orthotics require a prescription. You'll need to consult your podiatrist before you opt for one.

Plantar Fasciitis Treatment Options: If Condition Becomes Worst

You may have to higher the stakes if the non-medical treatments discussed above doesn't bring a noticeable relieve in pain.

With the pain becoming chronic, your doctor may recommend injections,  prolotherapy, or a shockwave treatment.

Let's discuss each briefly:

Steroid Injections

Injection

If your pain is severe and doesn’t respond to prescribed NSAIDs, you’ll need to get steroid shot. Cortisone is a powerful anti-inflammatory drug which gives instant pain relief when injected directly on the plantar fascia ligament.

However, steroid injections are not the solution to heel pain and inflammation. Steroid injections act as a temporary pain reliever and have to be repeated every few months.

Moreover, the steroid injections are very painful and multiple shots can weaken and cause your plantar fascia to rupture. Additionally, a steroid injection may lead to fat pad atrophy which can result in chronic heel pain.

Extracorporeal Shock Wave Therapy (ESWT)

Extracorporeal Shock Wave Therapy

​Photo Credit: myankle.co.uk

In this procedure, sound waves are sent to the area of pain through a handheld device. Shock waves help improve blood circulation and metabolic responses in the area of pain which accelerates the healing process.

Shock Wave Therapy is used for patients suffering from chronic plantar fasciitis that don’t seem to respond to the traditional treatments. This procedure doesn’t require any incision or injections but may cause side effects like bruising, swelling, pain, numbness or tingling.

Shockwave therapy is a proven procedure with promising results for treating plantar fasciitis.

Tenex Procedure

This procedure aims to remove the dead or scar tissues of plantar fasciitis by using ultrasonic sound waves. This minimally invasive procedure requires a local anesthetic injection and a small incision.

Surgery

Plantar Fasciitis Surgery

​Photo Credit: HeelThatPain

Surgery is the last line of cure if all the treatment options discussed above fails. About 95% people suffering from PF will recover with conservative and home remedies.

According to experts, you should consider traditional remedies for at least 6 months before moving on to any surgical procedures.

The main goal of plantar fasciitis surgery is to release tension off from the plantar fascia and reduce inflammation. Additionally, surgeries to remove heel spurs or loosen specific foot nerves in combination with plantar fascia release are done to ease the pain.

Heel spur was often thought of as the cause of plantar fasciitis. Research today shows that heel spurs are the result of PF and not the cause.

Surgical procedures are safe and success rates are impressive but they come with there own side effects such as flattening of foot and nerve damage. Therefore, surgeries are suggested to patients suffering from chronic heel pain for an extended period of time and don't respond to traditional approaches.

When To See A Doctor for Plantar Fasciitis?

Plantar fasciitis is a manageable condition that can be treated at home. However, in some cases, the pain doesn’t respond to traditional treatments.


It is advisable to call a doctor if you have:

  • Fever alongside redness, swelling, warmth or tingling in your affected heel
  • ​Continuous pain even when you’re not on your foot
  • ​A recent heel injury that’s limiting you from bearing weight
  • ​Heel pain doesn't respond to home remedies (Rest, Ice, Painkillers, and Exercises) for more than 2 weeks

The sooner you get your condition diagnosed and treated, the sooner you’ll have relief from the pain and be back on your foot.

So, who to see for plantar fasciitis?

A general medical practitioner or a medicine doctor can diagnose and recommend the non-surgical treatments.

Your doctor can refer you to a specialist like physical medicine & rehabilitation specialists, general orthopedists, orthopedist surgeon, sports-medicine doctors and a podiatrist who can further assist you in treating plantar fasciitis.

How To Prevent Plantar Fasciitis From Coming Back?

Recurrent plantar fasciitis can be prevented by finding out the cause(s) that is responsible for weakening your plantar fascia.

However, not all causes of plantar fasciitis are preventable.

Here below you’ll find a few lifestyle changes to keep PF from coming back:

Shed Those Extra Pounds:

Being overweight or obese can pose a lot of health problems including plantar fasciitis. The extra weight you carry can really stretch and stress the ligament resulting in heel pain.

Consider losing some weight to get relief from your heel pain and prevent it from coming back.

Do Stretching Exercises Regularly:

Stretching your plantar fascia ligament and your Achilles tendon can help reduce and prevent the pain. Proper exercises can help strengthen the muscles, improve blood flow and reduce inflammation.

Stretching your foot right before getting out of bed or before sports can really help with plantar fasciitis.

However, it is important to keep the intensity of exercises to the minimum and gradually work your way up.

Wear Supportive Footwear:

A good pair of supportive shoes is important when preventing plantar fasciitis is the goal. A good pair of shoes for plantar fasciitis is designed for proper arch support and comfort your heel.

Athletes should consider replacing their shoes every 6 months as most shoes lose their cushioning in about 400 miles. Ladies should avoid high heel as they can cause a lot of problems including plantar fasciitis.

Avoid being barefoot even for a minute and wear a supportive shoe as soon as you get out of your bed. You may also consider a good pair of insoles (orthotics) for more support and comfort.

Avoid High-Impact Activities:

High impact activities can really hinder your recovery and increase your risk. Activities like running, jumping, skipping or weight lifting should be avoided to prevent PF.

Instead, try low impact activities like swimming, cycling or walking/running on a treadmill to get the benefits of exercises and prevent PF.

Activity modification is mandatory if your work requires you to be on your foot or your sports training needs long hours of intense practice. You need to talk to your employer or your trainer before the pain becomes worse.

You’re well aware of the symptoms if you just recovered from PF. Thus it will be easy for you to identify if it comes back.

However, the key is to identify the symptoms and act quickly on treating the symptoms. The sooner you take measures, the sooner your pain will diminish.

What Is the Outlook (Prognosis) for Plantar Fasciitis?

Most people suffering from plantar fasciitis respond to the home and non-surgical treatments discussed above. These remedies do a great job of speeding up the recovery process.

In some cases, however, PF can take quite a long time to cure. This is an indication that there are some other underlying problems that are causing the pain.

Are There Any Complications Associated With Plantar Fasciitis?

Your heel pain may turn into a wildfire if the symptoms are ignored. There are many complications associated with plantar fasciitis if left untreated.

Our body is connected by a network of connective tissues called “fascia” and they work together to maintain a balance. When the balance is disrupted in one part of the body, it soon affects the other closely connected parts.

..And the same is true for your foot..

When you compromise your walking style to ease your pain, the other closely connected parts like your foot, leg, hips, keen, neck and or back comes under stress.

..And the pain spreads.

A study found that repetitive steroid injections can weaken your plantar fascia ligament and rupture it.

Plantar Fasciotomy AKA Plantar Fasciitis Surgery also brings about a few complications. Risk such as bleeding, infection, and reactions to anesthesia. After surgery, a degree of foot support and comfort are lost.

How long will it take for the pain to go away?

The time taken for your plantar fasciitis pain to diminish will greatly depend on the severity of your heel pain.

Generally, PF at its early stages can take about a month to go away, given you take care of your foot (described above in the initial treatments).

However, chronic cases of plantar fasciitis may take about 6-12 months to go away depending on how sincere you’re with your treatment.

The quicker you identify your symptoms the quicker you’ll get rid of the condition.

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