Foot and heel
Plantar fasciitis
The plantar fascia is a thick band of connective tissue running along the sole from the heel bone to the toes, supporting the arch of the foot. Plantar fasciitis is irritation and degenerative change where the fascia attaches to the heel. It is among the most common causes of heel pain in adults, and despite the name the tissue changes are more degenerative than inflammatory, which is reflected in how it is treated.
Symptoms
The pattern is characteristic enough that it does much of the diagnostic work on its own.
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Pain on the first steps
Sharpest when getting out of bed in the morning or standing after a period of sitting, then easing within several minutes of walking and often returning later in the day.
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Located under the heel
Typically a precise point on the underside of the heel where the fascia attaches, rather than diffuse pain across the whole foot.
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Worse after prolonged standing
Extended time on hard surfaces, or a sudden increase in walking or running, commonly aggravates it.
Causes and risk factors
The common factor is load on the fascia that exceeds what it has adapted to tolerate.
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Sudden increases in activity
A rapid rise in running distance, a new job spent standing, or a change in training surface are frequent precipitants.
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Foot mechanics
High arches, flat feet and limited ankle dorsiflexion — often from a tight calf complex — each change how the fascia is loaded during walking.
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Footwear and surfaces
Unsupportive footwear and prolonged standing on hard surfaces are commonly associated.
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Body weight and age
Higher body weight increases load through the fascia, and the condition is most common in middle age.
Diagnosis and differential
Heel pain has several causes that behave differently and are not treated the same way, so the first task is to establish which one is present.
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Clinical examination
Point tenderness at the fascial origin, pain reproduced by stretching the fascia, and assessment of calf flexibility and foot mechanics.
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Ultrasound
Images the fascia directly and allows thickness to be compared with the other foot. It is used where the diagnosis is unclear or symptoms have not responded as expected.
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Other causes of heel pain
Achilles tendinopathy affects the back of the heel rather than the underside; calcaneal stress fracture, fat pad atrophy and nerve entrapment at the ankle each produce distinguishable patterns.
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The role of heel spurs
Bone spurs appear on X-rays of many people with no heel pain and are absent in many who have it. Their presence does not establish the cause.
Common questions
How long does it take to get better?
Improvement is usually gradual and often takes several months of consistent treatment. Most people recover without surgery, but the timescale is a common source of frustration and is worth knowing at the outset.
Do I have a heel spur, and does it matter?
Heel spurs are common findings on X-rays in people both with and without heel pain, and removing one is not the treatment for plantar fasciitis. The condition of the fascia itself is more informative.
Should I stop running or walking?
Complete rest is not usually necessary or advisable. Volume and surface are typically reduced temporarily while the fascia is loaded progressively through rehabilitation.
Are insoles worth using?
Supportive footwear and insoles help many people by reducing load on the fascia. Prefabricated insoles perform comparably to custom orthoses for most people in the studies that have compared them.
General reference information, and not advice about your own case. It may not reflect the most recent guidance or what is offered on a given day — call (201) 408-5151 to check.
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Dr. Yoo Rehab Clinic welcomes new patients from across Northern New Jersey and New York City, including Englewood, Teaneck, Fort Lee, Palisades Park and Ridgefield. Call today to learn more about insurance, scheduling, and how we can help.
