Condition Center: Plantar Fasciitis

Photo Illustration by Michelle Alfonso
Photo Illustration by Michelle Alfonso

This informational guide, part of POPSUGAR's Condition Center, lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

If you feel a shot of pain in one heel when your feet hit the floor in the morning, it's likely you're one of the two million people in the US who are treated each year for plantar fasciitis, a condition that can make walking, running, standing, and even sleeping a painful ordeal. Fortunately, it's treatable — and the sooner you address it, the better.

What Is Plantar Fasciitis?

Plantar fasciitis occurs when there's age-related or overuse-related degeneration in the plantar fascia, the tough band of connective tissue that runs from your heel to the base of your toes and is designed to absorb the impact you put on your feet. The condition is not usually caused by an acute injury but rather by many minuscule tears that occur over time. As those tiny tears heal, scar tissue develops, which thickens and stiffens the plantar fascia, causing heel pain that ranges from a bruised feeling to a stabbing sensation, Bob Baravarian, MD, director of the University Foot and Ankle Institute of Santa Monica, says. It can be especially painful with your first steps in the morning or after long periods of sitting, because the plantar fascia tightens and shortens when you're not on your feet — and standing abruptly stretches the injured tissue.

Causes of Plantar Fasciitis

There's no single cause of plantar fasciitis, but a few factors play a role.

  • Age and gender are both contributing elements. The condition is most common in people between the ages of 40 and 60, but it's not rare in those who are younger. It's also more than twice as common in women as men.
  • Pregnancy may increase risk. The body changes that go along with pregnancy can put more stress on the plantar fascia, making that prime time for a flare up.
  • The physiology of your foot and lower leg may raise your odds of developing the condition as well. Flat feet, high arches, tight Achilles tendons or calf muscles, or unstable feet caused by loose tendons and ligaments (a common problem during pregnancy) are key culprits.
  • Lifestyle habits matter, too. Running and other high-impact activities put extra stress on your heel, as does walking or standing on hard surfaces for hours — so everyone from teachers to retail clerks are at increased risk. Wearing shoes with mushy soles or doing barefoot activities can also play a role in the development of plantar fasciitis. Footwear choices such as high heels and shoes with little arch support add to the risk.
  • Body size in general has an impact. People who weigh more are typically more prone to developing the condition, since the weight places a higher load on the ligaments of the lower body.

Most Effective Plantar Fasciitis Treatments

There's a range of options, starting with simple at-home treatments, Dr. Baravarian says. "The earlier you start treating it, the more likely it is to resolve fairly quickly — usually within a few months," he says.

First, stretch your foot and calf muscle in the morning, ideally before you get out of bed. Just loop a belt or band over the ball of your foot (usually the widest part under the toes), and gently pull the toes toward you for 20 seconds, flexing the foot. Repeat with the other foot, even if only one side is affected. Another option: invest in a slant board, and stand on it for five minutes right after you get up.

During the day, massage your arch to loosen the tight tissue, and roll your foot on a frozen water bottle for two minutes several times a day to reduce pain and inflammation, Dr. Baravarian suggests. Finally, wear shoes with a low to moderate heel, solid arch support, and a sturdy sole, adding a supportive insole (like Superfeet or Powerstep) if necessary. Avoid flimsy flats and walking barefoot, as these can further irritate the plantar fascia.

A physical therapist can help show you stretches, exercises, and lifestyle changes that will be most effective for your anatomy and symptoms. But if these steps don't resolve your pain, there's a range of more invasive treatment options that may help. The most effective, according to a 2021 systematic review of 139 previously published studies, is extracorporeal shockwave therapy, in which sound waves are directed at the area of heel pain to stimulate healing. Injections of plasma, derived from your own blood, can help as well, according to the study. The review indicated that acupuncture and dry needling might provide some relief but found that study results were mixed. Similarly, cortisone injections were found to offer some relief for short-term symptoms but not necessarily fix the problem. Surgery to detach the plantar fascia from the heel bone is also a treatment method, but it has limited evidence in its favor. "Fortunately, it's rare to require surgery," Dr. Baravarian says. Eighty percent of cases resolve on their own within a year.