What is it?
The plantar fascia is a thick band of tissue running from the heel bone to the base of the toes. It supports the arch every time you stand or walk. When it is overloaded, the attachment at the heel develops small tears and degenerative change, and it becomes painful.
What causes it?
- Tight calf muscles or Achilles tendon
- A sudden increase in walking, running, or standing
- Long hours on hard floors
- Worn-out or unsupportive shoes
- High arches or flat feet
- Weight gain
What does it feel like?
- Sharp pain at the bottom of the heel with the first steps out of bed
- Pain after sitting that eases once you get moving
- An ache at the end of a long day on your feet
- Tenderness when pressing the inside of the heel
How is it diagnosed?
Diagnosis is usually made from the history and a hands-on exam. We take X-rays in the office to look at the heel bone and rule out a stress fracture, and diagnostic ultrasound can show thickening of the fascia and help confirm the diagnosis.
When should you see a podiatrist?
- Heel pain that has not improved after two to three weeks of rest and supportive shoes
- Pain that is changing how you walk
- Swelling, numbness, or pain that began after an injury
- Heel pain with diabetes
Nonsurgical treatment
- Stretching
- Targeted calf and plantar fascia stretching is the foundation of treatment.
- Footwear and inserts
- Supportive shoes and over-the-counter or custom orthotics reduce strain on the fascia.
- Night splints
- Keep the fascia gently stretched overnight, which reduces morning pain.
- Corticosteroid injection
- Can calm severe inflammation; used selectively because repeated injections carry risks.
- Physical therapy
- Strengthening and manual therapy for pain that is slow to respond.
- Activity changes
- Temporarily swapping high-impact exercise for cycling or swimming.
When is surgery considered?
Surgery is uncommon. It is considered only when pain has persisted for many months despite consistent, well-directed conservative care.
Options include a gastrocnemius recession (lengthening a tight calf muscle) or a partial release of the plantar fascia, sometimes performed through small incisions. Your surgeon will explain whether either is appropriate for you.
What is recovery like?
Most people improve within several months of consistent conservative treatment. After surgery, recovery typically involves a period of protected weight-bearing followed by a gradual return to normal shoes and activity over a few months.
Frequently asked questions
Why does plantar fasciitis hurt most in the morning?
Overnight the fascia tightens and shortens. The first steps stretch it suddenly, which is why pain is sharpest then and eases as you move.
Is a heel spur the same as plantar fasciitis?
No. A heel spur is a bony growth seen on X-ray. Many people have spurs without pain, and the pain of plantar fasciitis comes from the soft tissue, not the spur.
How long does plantar fasciitis last?
With consistent treatment most cases improve within a few months. Without treatment it can linger for a year or longer.
Can I keep running with plantar fasciitis?
Often you can continue at reduced volume while it is treated, but pain that worsens during or after running is a signal to cut back and get evaluated.