Plantar Fasciitis: causes, symptoms and treatments

Updated 5/15/2024

What is plantar fasciitis?

The plantar fascia is a thick ligament that connects your heel to the front part of your foot and supports your arch. When these ligaments become inflamed, it causes heel pain and stiffness. That is plantar fasciitis.

 

Plantar fasciitis is so common and has so many causes it often takes an experienced doctor to work through the true underlying cause. Too often, we see patients who have not received satisfactory relief because previous doctors didn’t seek out the root cause of their plantar fasciitis.

 

Table of Contents

What are plantar fasciitis causes and risk factors?

On NBC's "The Doctor's" we explain plantar fasciitis and perform three advanced procedures for pain relief before a live audience.

Plantar fasciitis is generally a chronic condition and rarely caused by a single trauma to the foot. 

 

The most common causes of heel pain include:

 

  • Tight calf muscles and tight Achilles tendons
  • If you are a long-distance runner or spend extended periods of time on your feet
  • Wearing shoes with soft soles or poor arch support
  • High arches
  • Flat feet

 

What are the symptoms of plantar fasciitis?

  • Morning heel pain.
  • Sharp or stabbing pain on the bottom of the foot with the first few steps after getting out of bed or after sitting for an extended period of time. The pain may decrease as the tendon loosens up but almost always returns.
  • Heel pain when climbing stairs, participating in high-impact activities, or standing for long periods

 

How do doctors diagnose plantar fasciitis? 

There are many sources of heel pain, and not all cases are plantar fasciitis. It’s vital to determine the source of your heel pain so your doctor can treat the true cause of your pain, not just the symptoms. To that end, UFAI offers the most advanced technologies to properly diagnose plantar fasciitis, including:

 

  • Advanced Digital X-Ray
  • Diagnostic Ultrasound
  • Advanced Extremity MRI
  • Neurosensory testing

 

What are conservative treatments for plantar fasciitis? 

Conservative care, usually our first line of care, when properly matched to the patient, has a very high success rate. Over 70% of our heel pain patients find relief with physical therapy, orthotics, and shoe change. Less than 5% need advanced treatments, and less than 2% require surgery.

 

The goal of conservative treatments is to make the fascia and Achilles tendon more limber and stretched, which decreases stress on the arch and lessens pressure through the plantar fascia. These treatments are used when symptoms have been present for less than six months. They include:

 

Orthotics

Adding support to the arch of the foot with a custom orthotic insole device (which provides more accurate support than over-the-counter insoles) will greatly help support the foot and decrease stress on the arch.

 

Physical Therapy and Stretching Exercises

Stretching plays a crucial role in the treatment of plantar fasciitis, primarily because it aids in alleviating tension and tightness in the plantar fascia, the thick band of tissue that runs along the bottom of your foot. By engaging in specific stretch routines, individuals can see significant improvements in reducing inflammation and mitigating pain.

 

Stretching your lower leg muscles and plantar fasciitis will relax the tight muscles, reducing heel pain, especially when done before getting out of bed in the morning. In addition, a physical therapist can determine the correct stretches for you that will strengthen muscles, improve foot mechanics, and reduce stress on the foot. At UFAI, our physicians work closely with our on-site physical therapists, offering the advanced protocol for successful physical therapy treatment.

 

Steroid Injections for Heel Pain

One, maybe two cortisone steroid injections may be used to calm the severe swelling and pain. We usually try to avoid these injections, as cortisone is known not only to reduce inflammation (a good thing) but also to damage and weaken the tissue (a bad thing), making it more prone to tearing. In some cases, we have seen this to be effective and contribute to total recovery, but its effectiveness is usually temporary.

 

Icing for Heel Pain

Icing is important in the treatment of plantar fasciitis, especially after activity. Icing will reduce swelling and pain, allowing the tissue to heal faster. Combining ice and massage (rolling the bottom of your foot on a frozen water bottle) is very helpful. It not only brings some pain relief and a reduction in inflammation, but it also helps stretch the plantar fascia. This too should be done several times each day.

 

 

 

Proper Foot Gear

We recommend stiffer-soled shoes. The upper can be soft but the sole needs to be stiff and a little lift is okay. Women do well with wedges and men do better with stiff running shoes or a cowboy boot or a work boot. Active footwear should have flexible soles, and provide plenty of support to the arch. This helps to distribute your weight across the bottom of the shoe, mitigating the impact of shock to your inflamed fascia.

 

Massage

Massaging the heel region will break up scar tissue and increase blood to the area to help with healing.

 

Plantar Fasciitis Night Splints

A night splint may be used in cases that do not respond to physical therapy, stretching, and insole modifications. The goal of the night splint is to keep the calf and Achilles stretched during sleep and rest and allows for less tension and stretching of the fascia for the first steps in the morning or after a period of rest.

 

Anti-inflammatory Medications

Nonsteroidal anti-inflammatory drugs like Advil can reduce inflammation in the heel and arch of your foot, helping to ease foot pain.

 

Get Some Rest

Unlike a sprained ankle or a broken bone, plantar fasciitis is not an acute injury. But that doesn’t mean you shouldn’t treat it like one. Your fascia needs rest in order to heal. Give yourself a break from your normal exercise routine for just a few days. Even minor injuries can turn major if you irritate the area over and over again.

 

 

What are advanced treatment options for plantar fasciitis?

While approximately 80% of our patients respond to simple conservative care, heel pain may continue to be a problem for some. This is often due to a lack of blood flow to the damaged tissue, resulting in chronic plantar fascia pain and scar formation. To correct such issues, the body must be alerted to the injury region to treat the damaged tissue and help resolve the problem.

 

These treatment options are typically used in chronic cases where plantar fasciitis symptoms have lasted more than six months. They include:

 

Cryotherapy (cryoablation with ultrasound)

Using extreme cold temperatures, we destroy targeted nerves so they can no longer send pain signals to the brain. Through a rapid and limited deep-freezing of the affected area, the chronic pain that fascia pain causes is resolved with a simple and comfortable office procedure. Cryosurgery is minimally invasive and relatively painless.

 

Platelet rich plasma therapy (PRP)  for plantar fasciitis

Dr. Baravarian discusses regenerative medicine therapy for the treatment of plantar fasciitis.

 

Platelet-rich plasma (PRP) injections allow growth factors in the blood to cause inflammation of the injured tissue. This increases the healing response of the body.

 

With PRP, the blood is drawn and spun down with a centrifuge. Under ultrasound guidance and local anesthesia, an injection of PRP is placed in the damaged tissue. This sparks an increased growth-factor release in the area, which increases the blood supply to the damaged heel region to facilitate a healing process.

 

Amniotic stem cell therapy for plantar fasciitis

During stem cell therapy, the patient's stem cells are taken from a simple blood sample. Using a special procedure, unhelpful cells are removed, leaving behind just the strong healing stem cells. Those cells are injected into the injured area and begin to replicate themselves, making healing possible.

 

Topaz technology

Topaz, a minimally invasive procedure, uses high-frequency energy to speed healing.

 

Topaz coblation technology combines bipolar high-frequency energy with a saline-based medium to remove damaged tissue with little, if any, damage to surrounding healthy tissue. Removing tissue irritates the fascia enough to turn a chronic problem into an acute problem by increasing circulation to the damaged area. The patient's body then increases the natural healing properties, which begin to repair the newly injured ligament.

 

TenJet and Tenex procedure

Doctors use diagnostic ultrasound to identify the exact site(s) of scar tissue. Using the TenJet probe, the scar tissue is broken up using high-pressure streams of water, whereas Tenex uses radio waves. The procedures usually take only 15 minutes, and there is usually just some minor swelling after the procedure.

 

Shockwave therapy

Extracorporeal shockwave therapy is a non-invasive, in-office procedure that permits new blood flow into the area of fascia damage. It is a long-term solution that offers slow improvement. Maximum pain relief is usually felt at three months, however, patients usually see improvement at the start of the third week of treatment.

 

Endoscopic plantar fasciotomy surgery

Surgery is reserved for chronic cases of plantar fasciitis that do not respond to conservative or advanced therapies. In these cases, fascia release surgery is used to, as the name implies, release the tight fascia. 

 

The fascia is cut to relieve tension or pressure. The surgeons at UFAI have perfected the approach for fascia release. Our endoscopic and minimally invasive fascia release procedure promotes rapid healing with the quickest surgical recovery.

 

 

UFAI, the right choice for your plantar fasciitis treatment

Our physicians are nationally recognized as experts in the treatment of plantar fasciitis. Our results are revolutionary and unmatched in the community; less than 5% of all UFAI patients we see for plantar fascia need surgery and less than 2% need a fascia release.

 

Internationally recognized as experts in the field of plantar fasciitis and heel pain, the specialists at our podiatry group instruct worldwide on the latest techniques and the most innovative products on the market. They are often asked to share their expertise in various medical publications and to participate in clinical trials, including a new technology that uses high-frequency ultrasound to treat heel muscle injuries.

 

For more information or to schedule a consultation, please call (877) 736-6001 or make an appointment online now.

 

University Foot & Ankle Institute is conveniently located throughout Southern California and the Los Angeles area, as diabetic foot doctors near me are available at locations in or near Santa Monica (on Wilshire Blvd.), Beverly Hills, West Los Angeles, Manhattan Beach, Santa Barbara, Westlake Village, and Valencia California, to name a few.

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Plantar Fasciitis FAQs

 

Is plantar fasciitis the same thing as a heel spur?

Not technically. However, as heel spurs are a potential cause of plantar fasciitis, these conditions are related.

 

A heel spur is a calcium deposit that causes a build-up of bony tissue on the bottom of the heel bone. Sometimes, a heel spur is completely painless. But other times, it can get intertwined with and pull on the plantar fascia, which can be painful. If that is the case, you need to resolve the bone spur before you can get resolution of your plantar fasciitis.

 

A heel spur can form over time when a tight plantar fascia pulls on the bone, causing the bone to react by building a calcium deposit. In this case, we also need to resolve the heel spur first.

 

Is plantar fasciitis a tear in the plantar tendon?

No, it is not a true tear. With any form of injury, there is some mild, microscopic tearing that can occur which causes inflammation. But with plantar fasciitis, it's not a complete tear.

 

How long does plantar fasciitis take to heal? 

Healing usually takes two to six months. More than 95% of patients get better just by doing their exercises and managing their pain with over-the-counter drugs. Orthotic inserts are highly recommended, not only to support the plantar fascia and allow it to heal but to prevent the recurrence of pain once the fascia has healed. Very few patients require surgery to correct the problem.

 

Are there medications I can take for plantar fasciitis?

Over-the-counter anti-inflammatory medications (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve), are usually effective. Icing for 10-15 minutes throughout the day will also help to relieve the pain.

 

When should anti-inflammatory medications be used for plantar fasciitis?

These medications should be taken according to the instructions on the package. Typically, it is advisable to take them consistently for two weeks, ensuring you eat beforehand to minimize stomach upset. After two weeks, stop taking the medication for a week. If symptoms of plantar fasciitis persist or worsen, you can resume taking the medication for another two-week period followed by another break.

 

What is a night splint and should I use one?

A night splint can ease plantar fasciitis discomfort. It’s a partial boot that straps onto your foot and lower calf to hold the foot in a flexed position, keeping the plantar fascia and Achilles tendon stretched throughout the night.

 

What are some additional stretches recommended for plantar fasciitis relief?

Place the affected foot behind the other, with toes angled toward the heel of the front foot. Face a wall and lean forward gently. Progress the stretch by bending the knee of the front leg while keeping the rear leg straight and the heel down. Hold this stretch for about 10 seconds and repeat it 10 times per session. Aim to perform this routine at least three times daily for optimal relief and increased flexibility.

 

Can plantar fasciitis come back?

Yes. Our podiatrists will always do a thorough physical exam and review of your medical history to make sure we’re treating the exact cause of your plantar fasciitis. Correcting the root cause of a problem is always better than treating its symptoms. If your plantar fascia is inflamed due to another foot condition, we’ll tailor your treatment plan to reduce the risk of recurrence.

 

Can I still wear heels if I have plantar fasciitis?

Technically, yes you can. A lot of patients with plantar fasciitis actually feel better when they wear heels because it reduces the pull of the Achilles on the plantar fascia. However, wearing heels will shorten and tighten the Achilles over time, leading to worsening heel pain. If you’re a regular heel wearer, we recommend gradually switching from high heels to flats. Quitting your heels “cold turkey” might actually cause more harm.

 

When you’re back to wearing flats, make sure they have enough support, and if you can, get custom orthotics. 

 

If I have to have surgery for plantar fasciitis, what type of recovery can I expect?

Plantar fascia release surgery involves cutting part of the plantar fascia ligament to release tension and relieve inflammation of the ligament. At UFAI, we perform plantar fascia release endoscopically through a minimally invasive half-centimeter incision. This allows for a much shorter recovery period than is with traditional open surgery. Our patients are weight-bearing after one week and back in shoes in 3 weeks

 

I just had the Tenex procedure for my plantar fasciitis and I still have pain. When can I expect the pain to go away?

Heel pain should be gone approximately six weeks following the Tenex procedure.

 

What is a typical recovery for plantar fasciitis restorative procedures?

For restorative procedures such as PRP, amniotic cell therapy, and topaz, patients are in a boot for 2 weeks but immediately weight-bearing. Totally recovery time is about 6 weeks because, as with all restorative procedures, we need to give the body time to heal itself.

 

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