Plantar Fasciitis

How plantar fasciitis develops

The plantar fascia acts like a bowstring supporting the arch, stretching with each step. Repeated strain causes tiny tears and degenerative changes at its attachment to the heel bone (calcaneus). Despite the name, there is usually little inflammation; it is more a wear-and-repair problem, which is why some call it plantar fasciopathy.

Causes and risk factors

• Age 40 to 60
• Excess body weight
• Standing or walking on hard surfaces for long periods at work
• Running, especially increasing distance quickly or running on hills
• Tight calf muscles and Achilles tendon (calf tightness), which limit ankle bending and increase fascia strain
• Foot shape: flat feet or high arches
• Unsupportive footwear: worn-out shoes, flip-flops, walking barefoot on hard floors
• Stiff big toe joint (hallux rigidus), which alters how the foot rolls off and loads the fascia

Symptoms

• sharp or stabbing pain under the heel, sometimes along the arch
• worst with the first steps after getting out of bed or after sitting
• eases after a few minutes of walking, then aches again after long standing or at the end of the day
• tenderness when pressing the inner front of the heel
• pain often worse after, rather than during, exercise

Heel spurs

Many people with plantar fasciitis have a heel spur, a small bony growth on the heel bone seen on X-ray. But many people with spurs have no pain, and many people with plantar fasciitis have no spur. The spur is not usually the cause of pain and rarely needs removal.

Other causes of heel pain

Diagnosis

A doctor, podiatrist or physical therapist diagnoses plantar fasciitis by history and examination, checking for tenderness at the heel, calf tightness and foot posture. X-rays or ultrasound are only needed if symptoms are atypical, persistent, or a fracture is suspected. Ultrasound may show a thickened fascia.

Treatment

First-line (most people)

• Stretching: - Plantar fascia stretch: sit, cross the affected foot over the other knee, pull the toes back toward the shin until you feel a stretch in the arch; hold 10 to 30 seconds, repeat 10 times, especially before the first steps in the morning. - Calf stretches: wall stretches with the knee straight and bent, holding 30 seconds.
• Supportive shoes: cushioned, with good arch support and a slightly raised heel; avoid going barefoot on hard floors.
• Insoles and heel cups: off-the-shelf arch supports often work as well as custom ones.
• Activity changes: reduce running and long standing; switch to cycling or swimming temporarily.
• Ice: roll the foot over a frozen water bottle for 10 to 15 minutes.
• Pain relief: acetaminophen (paracetamol) or anti-inflammatory medicines at the label dose for short periods, if safe for you.
• Weight loss if overweight.

If symptoms persist

• Night splints that hold the foot flexed overnight to reduce morning pain.
• Physical therapy: stretching, strengthening (including high-load calf raises with toes extended), taping and manual therapy.
• Taping to support the arch.
• Extracorporeal shockwave therapy for chronic cases lasting more than 6 months.
• Corticosteroid injection: short-term relief; small risks of fascia rupture and fat pad thinning, so used sparingly.

Surgery

Reserved for the small number of people with severe pain after 6 to 12 months of good non-surgical care. Options include partial release of the plantar fascia or lengthening of the calf muscle (gastrocnemius recession).

Recovery

Most people improve within several months and about 80 to 90 percent are better within a year. Recovery is faster when stretching and footwear changes are started early and continued consistently. Return to running gradually.

Prevention

• Replace running shoes every 500 to 800 km (300 to 500 miles).
• Increase training gradually.
• Stretch calves regularly.
• Wear supportive shoes, especially on hard surfaces.
• Maintain a healthy weight.

Frequently asked questions

What does plantar fasciitis feel like?

It usually feels like a sharp, stabbing or bruised pain under the heel, worst with the first steps in the morning or after sitting. The pain often eases after a few minutes of walking, then returns as a dull ache after long periods of standing.

How long does plantar fasciitis last?

Most cases improve within a few months with stretching, good shoes and activity changes, and about 80 to 90 percent resolve within a year. Some people have symptoms for longer, especially if treatment starts late or triggers continue.

What is the fastest way to cure plantar fasciitis?

There is no instant cure, but combining daily plantar fascia and calf stretches, supportive shoes with insoles, avoiding barefoot walking on hard floors, icing and reducing high-impact activity gives the quickest recovery. A night splint helps severe morning pain.

Can a stiff big toe cause plantar fasciitis?

It can contribute. The big toe joint bends upward as you push off, tightening the plantar fascia (the windlass mechanism). A stiff big toe (hallux rigidus) changes how the foot moves and can increase strain on the fascia. Treating both together often helps.

Should I walk or rest with plantar fasciitis?

Relative rest is best: keep walking for daily activities in supportive shoes, but cut back on running, long walks and prolonged standing until pain settles. Complete rest is not necessary and can make stiffness worse.