Plantar fasciitis

Key points

1. Plantar fasciitis is the most common cause of heel pain.
2. You’re more likely to damage the plantar fascia tissue if you are middle-aged, overweight, pregnant, physically active, have a job that requires you to stand for long periods, or if you wear flat shoes, such as jandals.
3. There are things you can do to help relieve the pain and heal your foot.
   
4. You can also reduce your risk of plantar fasciitis by maintaining a healthy weight and wearing appropriate footwear.

What causes plantar fasciitis?

Plantar fasciitis is caused by bruising or overstretching the ligament (a short band of tough, flexible tissue) that runs under your foot. This is more likely to happen if you:

• have flat feet
• have an unusual way of walking, such as rolling your feet inwards
• are overweight or obese
• are middle-aged
• wear ill-fitting or flat shoes
• stand, run or jump on hard surfaces
• get an injury, such as a stress fracture
• have a medical condition such as diabetes or arthritis.

What are the symptoms of plantar fasciitis?

The main symptom is pain that develops gradually under your heel. The pain may be dull or sharp. You may also have an ache along the sole of your foot. The pain is usually worse first thing in the morning or if you have been sitting or standing for a long time, or after exercising. The pain improves with activity but worsens by the end of the day. 

How is plantar fasciitis diagnosed?

Your doctor will ask you questions about your symptoms and will check for areas of tenderness in your foot. The location of the pain may help assist diagnosis. 

If they suspect your pain might be being caused by another problem, such as a stress fracture or a pinched nerve, your doctor might suggest an x-ray or magnetic resonance imaging (MRI).

How is plantar fasciitis treated?

Most people with plantar fasciitis recover with self-care treatments such as:

• resting your foot with an ice pack on it for 20 minutes (especially if you get pain after being on your feet a lot)
• icing and massaging your foot at the same time – to do this, fill a 600ml plastic bottle with water, put it in the freezer and when it’s solid, roll the bottle under your foot
• massaging your foot by rolling a golf ball underneath it
• losing weight if you are overweight or obese
• wearing shoes with good support, or heel pads or arch supports in your shoes
• using night splints or tape on your foot at night
• stretching your calf muscles and the underside of your foot
• avoiding running or walking on hard surface
• taking pain relievers such as ibuprofen to help ease pain and inflammation.

If these simple measures don’t work, your doctor may give you a steroid injection, or in rare cases, recommend surgery. Another option, if other treatments haven't been successful, is extracorporeal shock wave therapy. This involves using a machine to pass high energy sound waves through the skin to treat the affected area. 

Your doctor may refer you to a podiatrist or physiotherapist. They can teach you exercises or give you ideas for how to change the way you exercise and do other regular activities. You can also self-refer to a podiatrist and physiotherapist. 

Find a podiatrist or a physiotherapist here. 

How can plantar fasciitis be prevented?

• Maintain a healthy weight.
• Wear appropriate footwear, especially shoes that support and cushion your arches and heels and that have a low-to-moderate heel.
• Warm up and cool down after exercise.
• Avoid running or walking on hard surfaces.
• If you feel pain in your foot, follow the RICE procedure of rest, ice, compression and elevation.

Learn more

Plantar fasciitis and heel pain Podiatry NZ
Heel and foot pain Health Info, NZ
Plantar fasciitis a patient’s guide Family Doctor, NZ
Treatment options, including stretches NHS Choices, UK
Choosing sports shoes and trainers NHS Choices, UK

References

1. Plantar fasciitis Auckland Health Pathways, NZ
2. Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis – a randomized trial Arch Intern Med. 2006
3. Uden H, Boesch E, Kumar S. Plantar fasciitis – to jab or to support? A systematic review of the current best evidence J Multidiscip Healthc. 2011
4. Extracorporeal shock wave therapy for plantar fasciitis NHS, UK, 2019

Reviewed by

	Dr Sharon Leitch is a general practitioner and Senior Lecturer in the Department of General Practice and Rural Health at the University of Otago. Her area of research is patient safety in primary care and safe medicine use.