Plantar Fasciitis

Symptoms

• Sharp heel pain with the first steps in the morning
• Pain after getting up from sitting
• Pain on the inner bottom of the heel
• Pain that may ease with walking, then worsen after long periods on the feet

Causes and who gets it

Increased running or standing, a tight calf, unsupportive footwear, and higher body weight are common contributors. It is most common between ages 40 and 60 and in runners.

How it is diagnosed

Diagnosis is clinical. Imaging is not needed for most people. Ultrasound can show thickening of the plantar fascia and guide treatment if symptoms persist.

Treatment

• Plantar fascia and calf stretching, especially before the first steps in the morning
• Supportive shoes; avoid going barefoot on hard floors
• Over-the-counter heel cups or arch supports
• A night splint may help morning pain
• Corticosteroid injections can help short term but carry a small risk of fascia rupture and fat pad thinning
• Shock wave therapy is an option for stubborn cases

Recovery time

Most people improve within 6 to 12 months with conservative care. Surgery is rarely needed.

When to see a doctor

• Heel pain after a fall or a pop
• Numbness, tingling, or burning in the foot
• Swelling or pain at rest
• Pain in both heels with other joint problems

Clinical pearls

• Classic presentation: first-step pain with medial calcaneal tubercle tenderness; Windlass test may reproduce symptoms
• Consider calcaneal stress fracture (squeeze test), Baxter nerve entrapment, tarsal tunnel syndrome, and fat pad atrophy
• Plantar fascia-specific stretching and calf stretching are first-line
• Limit repeated corticosteroid injections because of rupture and fat pad atrophy risk; ultrasound guidance improves accuracy
• Extracorporeal shock wave therapy is supported for chronic cases