Plantar fasciitis

Key points about plantar fasciitis

  • Plantar fasciitis is inflammation of the thick band of tissue that connects your heel to your toes along the bottom of your foot.
  • It's the most common cause of heel pain.
  • You’re more likely to damage the plantar fascia tissue if you are middle-aged, overweight, pregnant, physically active, have a job that requires you to stand for long periods, or if you wear flat shoes, such as jandals.
  • There are things you can do to help relieve the pain and heal your foot.
  • You can also reduce your risk of plantar fasciitis by maintaining a healthy weight and wearing appropriate footwear.
Woman with sore heel while wearing sandals
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Plantar fasciitis is caused by bruising or overstretching the ligament (a short band of tough, flexible tissue) that runs under your foot. This is more likely to happen if you:

  • have flat feet
  • have an unusual way of walking, such as rolling your feet inwards
  • are overweight or obese
  • are middle-aged
  • wear ill-fitting or flat shoes
  • stand, run or jump on hard surfaces
  • get an injury, such as a stress fracture
  • have a medical condition such as diabetes or arthritis.

The main symptom is pain that develops gradually under your heel. The pain may be dull or sharp. You may also have an ache along the sole of your foot. The pain is usually worse first thing in the morning or if you have been sitting or standing for a long time, or after exercising. The pain improves with activity but worsens by the end of the day. 

Your doctor will ask you questions about your symptoms and will check for areas of tenderness in your foot. The location of the pain may help assist diagnosis. 

If they suspect your pain might be being caused by another problem, such as a stress fracture or a pinched nerve, your doctor might suggest an x-ray or magnetic resonance imaging (MRI).

Most people with plantar fasciitis recover with self-care treatments such as:

  • resting your foot with an ice pack on it for 20 minutes (especially if you get pain after being on your feet a lot)
  • icing and massaging your foot at the same time – to do this, fill a 600ml plastic bottle with water, put it in the freezer and when it’s solid, roll the bottle under your foot
  • massaging your foot by rolling a golf ball underneath it
  • losing weight if you are overweight or obese
  • wearing shoes with good support, or heel pads or arch supports in your shoes
  • using night splints or tape on your foot at night
  • stretching your calf muscles and the underside of your foot
  • avoiding running or walking on hard surface
  • taking pain relievers such as ibuprofen to help ease pain and inflammation.

If these simple measures don’t work, your doctor may give you a steroid injection, or in rare cases, recommend surgery. Another option, if other treatments haven't been successful, is extracorporeal shock wave therapy.(external link) This involves using a machine to pass high energy sound waves through the skin to treat the affected area. 

Your doctor may refer you to a podiatrist or physiotherapist. They can teach you exercises or give you ideas for how to change the way you exercise and do other regular activities. You can also self-refer to a podiatrist and physiotherapist. 

Find a podiatrist or a physiotherapist here. 

  • Maintain a healthy weight.
  • Wear appropriate footwear, especially shoes that support and cushion your arches and heels and that have a low-to-moderate heel.
  • Warm up and cool down after exercise.
  • Avoid running or walking on hard surfaces.
  • If you feel pain in your foot, follow the RICE procedure of rest, ice, compression and elevation.

Clinical resources

Management of plantar fasciitis 
  • Take a history of pain, location and recent activities.
  • Recommend self-care strategies (stretching exercises, appropriate footwear or orthoses, painkillers, weight loss if necessary).
  • If recurring, consider corticosteroid injections, although there is only low-quality evidence that this improves pain up to one month, but not beyond that time. See Steroid injections for painful soles of heels in adults(external link) Cochrane Review, 2017
  • Consider other causes for symptoms such as calcaneal stress fracture, fat pad atrophy (common in older adults), calcaneal apophysitis (8–14 years), nerve compression of tarsal tunnel on lateral plantar nerve or posterior tibial nerve (Tinel’s test positive) or Achille's tendonitis or tendinosis, and in rare cases, plantar fasciitis may be a symptom of spondyloarthritis. See Spondyloarthritis(external link) BPAC, NZ, 2016
Comparing treatments

A 2018 study compared the effectiveness of (1) extracorporeal shock wave therapy (ESWT) plus usual care, (2) low-level laser therapy (LLLT) plus usual care and (3) usual care (exercises and orthotic supports). When LLLT and ESWT were combined with usual care, LLLT was found to be more effective than ESWT in reducing pain in plantar fasciitis at short-term follow-up. Cinar E, Saxena S, Uygur F. Combination therapy versus exercise and orthotic support in the management of pain in plantar fasciitis – a randomized controlled trial(external link) Foot Ankle Int. 2018 Jan 1:1071100717747590. doi: 10.1177/1071100717747590.

What works for plantar fasciitis?(external link) Book-length tutorial.

Continuing professional development


Rupesh Puna discusses foot pain throughout the lifespan. He uses a case-based approach highlighting 4 common conditions: Sever’s disease, Morton’s neuroma, plantar fasciitis and osteoarthritis of the foot.

(external link) 
(Goodfellow Podcast, NZ, 2020)

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Sharon Leitch, GP and Senior Lecturer, University of Otago

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