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Consider for a second all the punishment our feet endure. Running, walking, jumping—it’s a wonder they don’t quit after their first day on the job. It should come as no surprise, then, that something in the foot eventually can go wrong. In most people, the plantar fascia—the tough band of fibers along the bottom of your foot—is the first to go. Unfortunately, once plantar fasciitis kicks in, it can be frustratingly hard to shake off. Time, though, is the best cure, so be prepared for a bit of a wait.
What is plantar fasciitis?
Plantar fasciitis is painful inflammation of the plantar fascia ligament, a tough, fibrous band that supports the bottom of the foot. Plantar fasciitis is often associated with plantar fasciopathy, a degenerative disorder of the plantar fascia. Connected to the heel bone (calcaneus) on one end and the toes (phalanges) on the other, the plantar fascia supports the foot’s arch and serves as the foot’s shock absorber.
Plantar fasciitis can develop from excessive running or jumping, poor arch support, or other problems that can cause microscopic tears in the plantar fascia near the heel bone. Over time, these tiny injuries can worsen and lead to the breakdown of the plantar fascia tissues, causing pain and inflammation. The strain on the plantar fascia can also cause the formation of heel spurs. These hook-shaped bony outgrowths can form where the plantar fascia connects to the heel bone and cause significant heel pain.
Plantar fasciitis is the most common cause of heel pain, affecting about one in ten people during their lifetimes. People most at risk for developing plantar fasciitis are athletes, recreational runners, and people in occupations that involve working on their feet for extended periods of time. Overpronation—rolling the foot inwards with each step—can also damage the plantar fascia over time. Other risk factors for developing plantar fasciitis include excess body weight, high arches, flat arches, muscle tightness in the calves, and limited ankle dorsiflexion (or a limited range of motion when flexing the foot upwards toward the shin).
Plantar fasciitis is not always easy to treat. In most cases, however, the pain subsides after several months of rest, pain relievers, stretching, massage therapy, or other conservative treatments. Surgery and a variety of other medical treatments can help in the most severe or debilitating cases.
How is plantar fasciitis diagnosed?
Plantar fasciitis is diagnosed after evaluating a patient’s medical history and conducting a physical examination. Most people will be diagnosed and treated by a general practitioner, but more severe cases may require the expertise of an orthopedist, podiatrist, orthopedic surgeon, or podiatric surgeon.
Sharp, stabbing heel pain is the defining symptom of plantar fasciitis. The pain is at its worst when taking the first few steps in the morning. However, the pain may go away temporarily while walking. Standing or getting up after sitting for long periods of time can also trigger the pain.
A doctor will thoroughly examine the foot to make a definitive diagnosis. They will likely try and locate the source of the pain or tenderness in your foot to determine whether the discomfort is caused by plantar fasciitis. The healthcare professional will also look for other foot problems such as fallen arches, tightness of the Achilles tendon, stress fractures, or overpronation.
Blood tests and urine tests are not required. Unless the healthcare provider suspects other foot problems, an X-ray, ultrasound, or MRI will not be needed.
Plantar fasciitis treatment options
In four out of five patients, plantar fasciitis resolves within a year with or without treatment. Some healthcare providers will recommend using conservative, nonsurgical methods such as —stretching, massages, over-the-counter pain relievers, orthotics, braces, or taping—to treat plantar fasciitis. Surgery may be recommended in severe cases where conservative treatment does not relieve pain after six to 12 months. Some people with severe plantar fasciitis may also be treated with steroid injections, platelet-rich plasma injections, or extracorporeal shock wave therapy.
Activity modification
Plantar fasciitis often requires significant lifestyle changes to help the foot heal. Athletic activities and long periods of standing or walking may need to be limited or stopped temporarily. Low-impact exercises, rest, and supportive orthopedic shoes can help reduce pain from an injured plantar fascia.
Stretching and strengthening
Stretching and strengthening the plantar fascia and calf muscles are essential parts of treatment and physical therapy for plantar fasciitis. A healthcare professional or physical therapist can help guide you on the most effective plantar fascia stretches and calf muscle exercises.
Orthotics
Shoe inserts such as arch supports or heel cups can help restore a natural gait. Inserts and pads can also distribute the shock of walking or running, reducing stress on the plantar fascia.
Bracing
Night splints and taping are other possible treatment options for plantar fasciitis. Night splints can help reduce heel pain in the morning, while taping can help support the arch, correct overpronation, and reduce strain on the plantar fascia throughout the day.
Pain relief
Ice massages and over-the-counter pain relievers can be used to reduce discomfort and pain from plantar fasciitis.
Injections
In severe cases of plantar fasciitis, an orthopedist or podiatrist may inject corticosteroids, platelet-rich plasma, or botulinum toxin in the plantar fascia to provide weeks or months of pain relief.
Extracorporeal shock wave therapy (ESWT)
For chronic plantar fasciitis that does not improve with conservative treatment, extracorporeal shock wave therapy is often used as an alternative to surgery. Using a device placed against the heel, high energy sound waves are directed at the plantar fascia to kick-start the healing process. Unfortunately, there may be mixed results when using ESWT for plantar fasciitis
Platelet-rich plasma
Platelets are blood cells responsible for blood clotting. They also release growth factors that stimulate injured tissues to heal. Platelet-rich plasma (PRP) involves removing blood from a patient and removing everything except plasma (liquid part of blood) and platelets. The platelet-rich plasma is injected into plantar fascia tissues where growth factors may help speed up the healing process. Platelet-rich plasma is a less invasive alternative to surgery, but results are mixed.
Surgery
When all other treatments have been exhausted, an orthopedic surgeon may perform an endoscopic plantar fasciotomy, or plantar fascia release. Through a small incision, the surgeon will insert a flexible tube with a camera into the heel and cut part of the plantar fascia near the heel. This can help relieve stress on the plantar fascia, allowing it to loosen and relax. Reserved for patients with debilitating pain, a plantar fasciotomy produces significant pain relief in nearly all patients. The surgery will require several weeks of recovery, including at least two weeks when weight-bearing on the foot must be strictly avoided. Most patients can return to normal activities after approximately 10 weeks of recovery.
Plantar fasciitis medications
Medications can only treat the pain symptoms of plantar fasciitis. In the majority of cases, over-the-counter pain relievers or ice packs will keep pain at bay. More severe or debilitating pain may require corticosteroid or botulinum toxin injections.
Pain relievers
Both nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, or naproxen) and acetaminophen are equally capable of controlling plantar fasciitis pain.
Corticosteroids
When plantar fasciitis pain is severe enough to impair daily living, an orthopedist or podiatrist may inject a corticosteroid, such as methylprednisolone, dexamethasone, or triamcinolone into the plantar fascia tissues near the heel bone. Steroid injections are made by either palpating the heel or guiding the injection using ultrasound. Corticosteroids can provide rapid pain relief that can last for a few weeks, but they do interfere with the healing process.
Botulinum toxin
Botulinum toxin A, better known as Botox, injected directly into the plantar fascia paralyzes nerves that transmit pain signals and weakens the foot muscles pulling on the plantar fascia. A doctor will use an ultrasound device to guide the injection. Botulinum toxin does not interfere with the healing process and can effectively relieve plantar fasciitis pain for several months.
What is the best medication for plantar fasciitis?
Medications can only relieve the pain symptoms caused by plantar fasciitis. Healing the injury is something only time can do. For this reason, there is no “best” medication for plantar fasciitis.
| Best medications for plantar fasciitis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Aspirin | NSAID | Oral | 325 to 650 mg every four hours. Maximum of 4,000 mg per 24 hours | Upset stomach, heartburn, nausea |
| Advil (ibuprofen) | NSAID | Oral | 200 to 400 mg every four to six hours as needed. Maximum of 1,200 mg per day | Nausea, upset stomach, heartburn |
| Aleve (naproxen) | NSAID | Oral | 220 mg every eight to 12 hours as needed. Maximum of 660 mg per day | Nausea, upset stomach, heartburn |
| Tylenol (acetaminophen) | Analgesic | Oral | 650 mg every four to six hours as needed. Maximum of 3,250 mg per day | Nausea, headache, itching |
| Dexamethasone | Corticosteroid | Injection | 1 mL of 4 mg/mL solution. Dosage may vary | Injection site reactions such as swelling, redness, or tenderness |
| Depo-Medrol (methylprednisolone acetate) | Corticosteroid | Injection | 1 mL of 40 mg/mL solution. Dosage may vary | Injection site reactions such as swelling, redness, or tenderness |
| Botox (botulinum toxin A) | Neurotoxin | Injection | 200 units injected directly into the plantar fasciitis | Injection site reactions such as swelling, redness, or tenderness |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are common side effects of plantar fasciitis medications?
Side effects are possible with all medications. Different drugs will have different side effects, so this is not a complete list of side effects. A healthcare professional can answer your questions about possible side effects and drug interactions.
Over-the-counter pain relievers are safe and effective. NSAIDs such as ibuprofen or aspirin can cause side effects such as stomach pain, heartburn, and nausea. Acetaminophen can cause side effects such as nausea, headache, and stomach pain. Acetaminophen can be toxic to the liver when taken in large quantities, so always take the dose recommended by the packaging or by a healthcare professional.
Corticosteroids can cause side effects, but the dose used for plantar fasciitis is usually low and highly localized. When used to treat plantar fasciitis, corticosteroid injections can cause injection site reactions like swelling or tenderness around the area of injection.
Botulinum toxin injections may causeminor side effects such as bruising and pain around the injection site. Botulinum toxin may cause more serious damage if the drug spreads and starts affecting nerves in other parts of the body. Serious side effects are rare when botulinum toxin injections are used to treat plantar fasciitis.
What are the best plantar fasciitis home remedies?
An injured plantar fascia takes time to heal. Pain can be managed with ice and pain relievers, but the plantar fascia tissue may need up to a year to return to normal. Home treatments are effective for preventing further damage, giving the tissues time to heal, and promoting the healing process.
Modify activities
Treating plantar fasciitis requires rest and low-impact physical activity. Here are some ways you can support the healing process and lessen the pain:
- Limit how much time you spend standing or walking.
- Wear shoes with adequate arch support.
- If you have a job that requires standing, try to take sitting breaks to reduce stress on the plantar fascia.
- Limit high-impact exercises, such as running or jumping. Incorporate low-impact, non-standing activities such as swimming or cycling into your exercise routine.
Stretch the plantar fascia
Plantar fascia stretching is considered an effective form of treatment for plantar fasciitis. To be effective, plantar fascia stretches need to be performed every day. Good exercises include gently pulling the toes toward the shin, using a roller along the arch of the foot, grasping and lifting small objects with your toes, performing foot flexes, and doing calf stretches against a wall.
Massage the plantar fascia
Deep tissue massages on the heel and plantar fascia may help reduce plantar fasciitis pain. By loosening the fibrous tissue, deep tissue massages can help relieve the tension that causes plantar fasciitis pain.
Use ice massage
Place or roll ice over the heel for 10 to 20 minutes three to four times a day to reduce both pain and any soft tissue swelling.
Take over-the-counter pain relievers
Over-the-counter pain relievers can help reduce temporary pain. Consult a healthcare provider if you are having to take over-the-counter pain relievers for more than ten days at a time.
Lose weight
Excess body weight is a major risk factor for developing plantar fasciitis because the extra weight can put added stress on the plantar fascia. Losing weight will not only make the foot feel better, but it will also help you feel better overall.
Frequently asked questions about plantar fasciitis
What is the fastest way to cure plantar fasciitis?
There is no fast way to cure plantar fasciitis. Plantar fascia requires time to heal—anywhere from a few months to a year. Daily treatment may require some lifestyle changes, daily plantar fascia stretches, ice massages, shoe inserts, or foot taping, among other treatment options. The good news is that four out of five people with plantar fasciitis experience complete pain relief in about 12 months using simple home treatments or resting.
How can I treat plantar fasciitis at home?
Home treatment is essential to healing an injured plantar fascia, but the process may take months. Plantar fascia stretching exercises, deep tissue massages along the bottom of your feet, staying off your feet, and occasionally taking a pain reliever or icing the heel is a possible treatment strategy that can help your foot return to normal.
How long does it take for plantar fascia to heal?
In four out of five patients, plantar fasciitis heals in a few months to a year with or without treatment. Chronic plantar fasciitis that lasts longer than a year may require extracorporeal shock wave therapy, regenerative treatment, steroid injections, or surgery to resolve.
Is walking good for plantar fasciitis?
For plantar fasciitis, walking is not really the problem. Walking incorrectly is the problem. Overpronation—walking on the inside of the foot—puts undue strain on the plantar fascia and is a major cause of plantar fasciitis. Though not as serious, underpronation—walking on the outside of the foot—can also contribute to plantar fascia damage. For many people, learning to walk or run correctly is an important part of treatment for plantar fasciitis.
Can Plantar fasciitis go away on its own?
In most cases, plantar fasciitis will resolve in a few months without medications, surgery, or other medical interventions. However, recovery will require activity modification and other lifestyle changes to help the foot recover.
What is the medical treatment for plantar fasciitis?
For the vast majority of cases, the standard medical treatment for plantar fasciitis is adequate rest, plantar fascia stretches, calf stretches, pain relievers, ice massages, shoe inserts, and low-impact exercises for weight loss. For chronic and debilitating plantar fasciitis, other treatments such as extracorporeal shock wave therapy (ESWT), regenerative medicine, steroid injections, or surgery may be recommended.
Related resources for plantar fasciitis
- Managing Heel Pain. The Permanente Group
- Plantar Fasciitis. American Family Physician
- Plantar Fasciitis. StatPearls
- Plantar Heel Pain. StatPearls