Plantar Fasciitis

Plantar fasciitis is pain at the bottom of the heel caused by irritation of the plantar fascia, the thick band of tissue that runs from the heel bone to the base of the toes and supports the arch. It is the most common reason adults seek care for heel pain. It is an overuse problem, where the fascia is loaded faster than it heals, often after a jump in activity, with a tight calf, with extra body weight, or from long hours standing on hard floors. The tissue thickens rather than staying truly inflamed. The condition is not cured in the sense of reversing the tissue changes, but most people recover with consistent nonsurgical care.

Common symptoms include:

• Sharp, stabbing pain with the first steps out of bed in the morning
• Pain that eases after a few minutes of walking
• A dull ache that returns with prolonged standing
• The morning pain again after standing up from sitting
• Pain on the inside and underside of the heel, usually in one foot

Plantar fasciitis is a clinical diagnosis. The history and a focused exam of the foot are usually enough, and most people need no scan. Imaging is ordered only when the picture does not fit: ultrasound to confirm fascia thickening or guide an injection, X-ray to look for other bony causes of heel pain, and MRI for atypical or stubborn cases.

The large majority of people recover without surgery:

• Daily plantar-fascia and calf stretching, the most effective treatment
• A night splint to keep the fascia from shortening overnight
• A gel heel cup or supportive insole in everyday shoes
• Physical therapy, and well-cushioned shoes in place of worn or flat ones
• A guided steroid injection in selected cases to break a stubborn flare

Surgery is reserved for people who remain significantly limited after a sustained course of nonsurgical care. The most common procedure, a plantar fascia release, partially divides the fascia at its heel attachment to relieve the tension driving the pain.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Plantar Fasciitis and Bone Spurs — AAOS OrthoInfo