Plantar Fasciitis

Plantar fasciitis is a common foot condition affecting the thick band of tissue, called the plantar fascia, that runs along the bottom of the foot.

What is Plantar Fasciitis?

Plantar fasciitis is a common foot condition affecting the thick band of tissue, called the plantar fascia, that runs along the bottom of the foot. This tissue stretches from the heel bone (calcaneus) to the base of the toes, helping to support the arch and absorb the impact of walking, running, and standing.

Despite the name, plantar fasciitis is not primarily an inflammatory condition. Instead, it is a degenerative disorder of the plantar fascia, meaning the tissue gradually weakens and develops tiny tears over time. This degeneration can cause persistent heel pain, especially during the first steps in the morning or after long periods of rest.

The condition tends to be chronic and can last for months, sometimes up to a year, affecting everyday activities like walking, standing, or exercising. Plantar fasciitis is often linked to overuse, repetitive strain, high-impact activities, poor foot mechanics, or prolonged standing.

Knee osteoarthritis is typically classified into four stages, based on the degree of joint damage:

Stage 1 (Early) — minor wear-and-tear in the knee joint, often without noticeable symptoms. X-rays may show small bone spurs, but the joint space remains normal.
Stage 2 (Mild) — more noticeable joint changes, including cartilage thinning and occasional discomfort after long periods of activity. Some stiffness may occur in the morning or after rest.
Stage 3 (Moderate) — clear loss of cartilage, joint space narrowing, and frequent pain during daily activities. Inflammation and swelling are more common.
Stage 4 (Severe) — most or all of the cartilage is gone. Bone-on-bone contact causes chronic pain, significant stiffness, and limited mobility. Joint deformity may also be present.

What causes Plantar Fasciitis?

The condition develops when the plantar fascia is subjected to repeated strain or injury, which over time leads to degeneration of the tissue. Small tears, known as microtears, form in the fascia, triggering a process called mechanotransduction. This is where mechanical stress is converted into biochemical signals, altering the structure of the tissue. The result is fragmentation of the plantar fascia and disorganisation of its collagen fibres, which contributes to pain and reduced function.

Several factors can increase the risk of developing plantar fasciitis:

Overuse injuries – repetitive stress on the plantar fascia can weaken the connective tissue over time. This is particularly common in runners, older adults, and people whose work involves long hours of standing.
Excess body weight – carrying extra weight increases pressure on the plantar fascia, accelerating tissue degeneration and contributing to heel pain.
Foot deformities – structural differences in the foot, such as high arches (pes cavus) or flat feet (pes planus), can alter the biomechanics of walking and standing. This uneven stress increases the likelihood of tissue strain and plantar fasciitis.

What are the symptoms of Plantar Fasciitis?

Symptoms usually present as pain in the heel, which can vary in intensity and timing depending on activity and foot stress.

Some of the common features include:

Sharp, stabbing pain – many people describe the discomfort as a sudden, piercing sensation in the heel, particularly with the first steps after rest.
Morning pain – pain is often most noticeable after long periods of rest, such as when getting out of bed, as the plantar fascia tightens overnight.
Discomfort after prolonged standing or sitting – remaining in one position for extended periods can trigger stiffness and aching in the heel.
Pain worsened by activity – walking, running, or other physical activity can increase stress on the fascia, intensifying the pain.
Pressure sensitivity – applying direct pressure to the heel, such as when wearing certain shoes or pressing on the sole, often triggers discomfort.

Who is at risk of Plantar Fasciitis?

Certain factors can make the plantar fascia more vulnerable to strain and degeneration, increasing the likelihood of developing plantar fasciitis:

Age – people between 40 and 60 years old are more prone to plantar fascia degeneration, as the tissue naturally loses elasticity and resilience over time.
Underlying conditions – connective tissue disorders, including rheumatoid arthritis and spondyloarthropathies, can weaken the fascia and surrounding structures, making them more susceptible to degeneration.
Obesity – excess body weight increases the load on the heel and arch, putting additional strain on the plantar fascia and accelerating tissue wear.
Foot deformities – structural differences, such as high arches (pes cavus) or flat feet (pes planus), alter normal foot biomechanics, concentrating stress on the fascia and increasing injury risk.
Activity level – athletes, particularly long-distance runners, place repeated stress on the plantar fascia, which can lead to microtears and overuse injuries.
Occupation – jobs that involve prolonged standing or walking, such as factory work, retail, or teaching, place continuous pressure on the heel and plantar fascia.

How is Plantar Fasciitis diagnosed?

Diagnosing plantar fasciitis usually begins with a thorough evaluation of your symptoms and a physical examination of the foot. Our doctor will assess the heel and arch, check for tenderness, and perform specific tests to pinpoint the source of pain.

Imaging studies may also be used to confirm the diagnosis or rule out other causes of heel pain.

Physical examination – our doctor will review your medical history and recent foot injuries, then examine your feet for abnormalities. Tests such as the Windlass test may be performed to evaluate foot movement and identify areas of pain.
Ultrasonography – ultrasound imaging can detect thickening of the plantar fascia, a common sign of plantar fasciitis. It also helps rule out other disorders, such as plantar fibroma.
Magnetic resonance imaging (MRI) – MRI scans are usually reserved for persistent or severe cases that do not respond to initial treatment. They provide detailed images to rule out other conditions that may mimic plantar fasciitis.
X-ray radiography – X-rays are primarily used to exclude other causes of heel pain, such as bone spurs or calcifications, rather than to diagnose plantar fasciitis itself.

How is Plantar Fasciitis treated?

Many cases of plantar fasciitis improve with rest and time, but a variety of treatments are available to relieve pain, support healing, and restore foot function.

Non-steroidal anti-inflammatory drugs (NSAIDs) – medications like ibuprofen or naproxen can help relieve heel pain, especially during flare-ups. While plantar fasciitis is not primarily inflammatory, these drugs may still ease discomfort.
Heel supports – cushioned inserts or custom orthotics provide support to the heel and arch, reducing pressure on the plantar fascia and improving comfort while walking or standing.
Immobilisation – night splints or braces hold the foot in a neutral position during rest, preventing the fascia from tightening overnight and reducing morning pain..
Physical therapy – targeted exercises and gentle stretches help improve flexibility, strengthen the foot and calf muscles, and relieve tension on the plantar fascia, promoting long-term recovery.
Steroid injections – though plantar fasciitis is degenerative rather than inflammatory, corticosteroid injections can reduce local swelling and provide temporary pain relief in stubborn cases.
Platelet-rich plasma (PRP) injections – PRP uses concentrated growth factors from the patient’s own blood to stimulate healing of the damaged fascia, supporting tissue repair and regeneration.
Botulinum toxin injections – injecting botulinum toxin into the plantar fascia or calf muscles can relax tight tissues, reducing tension and alleviating heel pain.
Extracorporeal shockwave therapy (ESWT) – ESWT delivers focused shockwaves to the fascia, promoting tissue regeneration, new blood vessel formation, and improved blood flow. Results vary, but some patients experience significant pain relief.
Intense ultrasound therapy – High-energy ultrasound targets the plantar fascia to enhance healing and reduce discomfort by stimulating tissue repair.
Surgery – surgery is considered only after 6 to 12 months of unsuccessful conservative treatment. The most common procedure, endoscopic plantar fasciotomy, involves a small incision to release tension in the fascia and relieve pressure on the heel.

Summary

Plantar fasciitis is a common cause of heel pain, often affecting athletes, older adults, and individuals carrying excess weight. While the condition can sometimes improve with rest, chronic plantar fasciitis may lead to persistent pain and affect daily activities. The good news is that most cases respond well to non-surgical treatments, and in rare cases where conservative methods are insufficient, surgical options are available to relieve discomfort and restore foot function.

Contact us today to explore the most suitable treatment options for plantar fasciitis and get back to comfortable, pain-free movement.

Frequently Asked Questions (FAQs)

Will plantar fasciitis go away on its own?

When should I see a doctor for heel pain?

How do I know if my heel pain is caused by plantar fasciitis?

Can plantar fasciitis return after treatment?

What can I do at home to relieve heel pain?

Is surgery always necessary for plantar fasciitis?