Plantar Fasciitis
What Is Plantar Fasciitis?
Plantar fasciitis, sometimes referred to as heel spur syndrome, is a condition that causes pain on the bottom of the heel when putting weight on the foot. This is one of the most common causes of heel pain in adults, affecting millions of people each year. The condition results from inflammation, irritation, and microtears of the plantar fascia, a thick band of tissue that runs along the bottom of the foot from the heel bone to the toes. While there can be many underlying causes of heel pain, plantar fasciitis is the leading diagnosis, and several effective treatment options are available.
The plantar fascia helps support the arch of the foot and acts as a shock absorber during walking and running. When the foot is on the ground, the full weight of the body is concentrated on the plantar fascia. This force stretches the tissue as the arch of the foot tries to flatten from the body's weight, leading to stress on the plantar fascia where it attaches to the heel bone. With each step, the fascia experiences tension and must absorb significant force.
During normal daily activities, small tears can develop in the fascia. The body normally repairs these microtears through its natural healing processes. However, when the rate of damage exceeds the rate of repair—often due to overuse, excessive stress, or other contributing factors—chronic inflammation develops. As this process of injury and repair repeats itself over and over again, a bone spur (a pointed outgrowth of the bone) sometimes forms as the body's response to firmly attach the fascia to the heel bone. While bone spurs are often present on X-rays of patients with plantar fasciitis, the spur itself is rarely the actual source of pain.
Several factors can contribute to the development of plantar fasciitis. The chronic inflammation of the fascia itself is typically the primary source of pain. As we age, the fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates, leading to inadequate padding on the heel and chronic pain in this area. The small nerves that travel under the plantar fascia on their way to the forefoot can also become irritated and may contribute to the pain. Activities that place excessive stress on the heel and attached fascia—such as long-distance running, sudden increases in activity level, or standing for prolonged periods on hard surfaces—significantly increase risk. Biomechanical factors including flat feet, high arches, abnormal walking patterns, and tight calf muscles can place additional stress on the plantar fascia. Being overweight or obese increases the force transmitted through the fascia with each step. Wearing shoes with poor arch support or thin soles provides inadequate cushioning and support.
The hallmark symptom of plantar fasciitis is sharp, stabbing pain on the bottom of the heel, typically near the inside edge. This pain is characteristically worse with the first steps in the morning or after periods of rest, as the fascia tightens during inactivity. The pain often improves somewhat with activity as the fascia stretches and warms up, but it may worsen again after prolonged standing or walking. Some patients experience pain throughout the day, particularly during weight-bearing activities. The pain may be localized to a specific point on the heel or may radiate along the arch of the foot. Symptoms typically develop gradually over weeks to months rather than appearing suddenly.
Nonsurgical Treatments
The vast majority of plantar fasciitis cases—more than 90 percent—can be successfully treated without surgery. Treatment typically focuses on reducing inflammation, stretching the plantar fascia and calf muscles, and addressing contributing factors. Our doctors offer comprehensive nonsurgical treatments to relieve pain and restore function.
Lifestyle Modifications
Activity modification is often the first step in treatment. Avoiding or reducing activities that aggravate symptoms—such as running, jumping, or prolonged standing—allows the fascia to heal. Switching to low-impact activities like swimming or cycling can maintain fitness without stressing the heel. Maintaining a healthy weight reduces stress on the plantar fascia. Proper footwear with good arch support and cushioning is essential. Shoes should have adequate heel cushioning and should not be worn beyond their useful life. Walking barefoot or in unsupportive footwear should be avoided, particularly on hard surfaces.
Medications & Injections
Anti-inflammatory medications can help decrease inflammation in the fascia and reduce heel pain. Over-the-counter options may be sufficient for mild cases, while prescription-strength medications may be necessary for more severe inflammation. A cortisone injection into the heel may be effective in reducing pain and inflammation in some cases. However, cortisone should be used judiciously since repeated injections may contribute to fat pad degeneration or even rupture of the plantar fascia, potentially making the problem worse. Most doctors limit cortisone injections to one or two per year at most.
Physical & Occupational Therapy
Physical therapy is a cornerstone of plantar fasciitis treatment. Stretching exercises for the plantar fascia and Achilles tendon are particularly important. Calf stretches help reduce tension on the plantar fascia by improving ankle flexibility. Plantar fascia–specific stretches involve pulling the toes back toward the shin, creating a stretch along the bottom of the foot. These stretches should be performed multiple times daily, particularly first thing in the morning before taking the first steps. Strengthening exercises for the intrinsic foot muscles and lower leg can improve foot mechanics and reduce stress on the fascia. Night splints or dorsiflexion braces hold the foot in a stretched position during sleep, preventing the fascia from tightening overnight and reducing morning pain.
Supportive & Assistive Devices
Orthotic devices play a central role in managing plantar fasciitis. A heel cup can reduce pressure on the sore area and add padding to cushion the heel. Supporting the arch with a well-fitted arch support or custom orthotic helps reduce pressure on the plantar fascia by supporting the foot's natural arch and preventing excessive flattening. These inserts redistribute forces more evenly across the foot. Taping techniques can provide temporary support to the arch and reduce stress on the fascia. Ice massage or ice packs applied to the heel for 15 to 20 minutes several times daily can reduce inflammation and provide pain relief. Some patients benefit from using a frozen water bottle, rolling it under the foot to combine stretching with icing.
Surgical Treatments
Surgery is considered a last resort in the treatment of heel pain and is only recommended when conservative treatments have failed to provide relief after at least 6 to 12 months of consistent conservative care. Doctors have developed several surgical procedures to address plantar fasciitis, typically performed on an outpatient basis.
Plantar Fascia Release
This procedure involves partially cutting the plantar fascia to release tension and reduce inflammation. The surgeon identifies the area where the plantar fascia attaches to the heel and releases approximately half of the fascia from the bone. This reduces the tension in the fascia while maintaining some structural support for the arch. Some surgeons perform this procedure using an endoscope—a small camera that can be inserted through a tiny incision, allowing the surgeon to complete the surgery with minimal tissue damage. However, there is ongoing debate about whether endoscopic release offers significant advantages over traditional open release through a small incision.
Heel Spur Removal
If a bone spur is present and appears to be contributing to symptoms, it may be removed during surgery. The spur is trimmed away from the heel bone. However, since the spur itself is rarely the primary source of pain, removal is typically performed in conjunction with plantar fascia release rather than as a standalone procedure.
Nerve Release
The small nerves that travel under the plantar fascia can become compressed or irritated, contributing to heel pain. During surgery, these nerves are identified and released from any structures causing pressure. This nerve decompression can provide significant relief when nerve involvement is contributing to symptoms.
Recovery from plantar fascia surgery typically takes several weeks. A bandage or dressing is worn for about a week following the procedure, and stitches are usually removed 10 to 14 days post-surgery (dissolvable sutures may be used instead). Crutches are often needed briefly to protect the foot during initial healing. Physical therapy helps restore strength and flexibility. Most patients can gradually return to normal activities over 6 to 12 weeks, though full recovery may take several months. While surgery can be effective, it carries risks including nerve damage, incomplete pain relief, and changes in foot mechanics that may lead to other problems. Therefore, exhausting all conservative treatment options before considering surgery is essential.