Plantar Fasciitis

Pain on the underside of the heel is the main symptom of Plantar Fasciitis. Usually, one spot is found as the main area of pain and may be tender to touch.

The other main symptoms of plantar fasciitis include:

• Pain or tenderness in the arch of the foot
• Pain with initial steps in the morning or after a period of rest
• Walking short distances may improve pain but longer distances may increase the symptoms again
• Pain with sudden stretching of the sole of the foot. This could include going up on your toes or upstairs
• Pain with prolonged standing or when wearing flat or unsupportive footwear

It’s more likely to be plantar fasciitis if:

• The pain is much worse when you start walking after sleeping or resting
• The pain feels better during exercise, but returns after resting
• It’s difficult to raise your toes off the floor

Plantar fasciitis results from the plantar fascia becoming irritated, after repetitive use or due to poor foot posture. The pain comes from microscopic tears within the fascia, these micro tears repair with scar tissue, which is less flexible than the fascia and can cause the problem to persist for many months. It can occur suddenly but more often it develops gradually over time and in most people, there is no specific cause. It can affect both athletic and non-athletic people.

Risk factors include:

• Age – it is more common between the age of 40 & 60 years
• Gender – it is more common in women than men
• Weight – excessive weight, especially sudden weight increases, puts more stress on your foot.
• Diabetes – people with diabetes are more likely to develop plantar fasciitis
• Faulty foot mechanics – poor mechanics at the foot, knee and/or hip (e.g., pronated (flat) feet, supinated (high arched) feet or inward pointing knees) causes an abnormal walking pattern and adversely affects the weight distribution on the foot.
• Tight calf muscles and Achilles’ tendon – does not allow the calcaneus (heel bone) to move freely, putting more stress on the plantar fascia.
• Unsuitable footwear – shoes that are too worn, thin-soled, loose, lack arch support, or lack of shock absorption provide inadequate protection for the foot (e.g., flip flop type shoes). Frequent use of high-heeled shoes shortens the Achilles tendon which stresses the plantar fascia.
• Physical activity overload – advancing too quickly in your sport or activity can put too much stress on your foot. Occupations that require constantly being on your feet, especially on hard surfaces can also play a part (e.g., those that work shifts of eight hours or more).

It is a common belief that heel pain is due to a “spur” or bony growth from the heel bone (calcaneum). This is incorrect as many people have a bony heel spur but not everybody with this gets the symptoms of plantar fasciitis.

Diagnosis is usually made from the typical symptom history +/- examination without the need for further investigations.

Occasionally, if your symptoms have persisted for a long time or to rule out other causes of foot pain other tests may be used. These can include X-ray, ultrasound scan or MRI scan.

Plantar Fasciitis is regarded as a self-limiting condition, meaning that it will eventually get better by itself in time, but this may take up to 18 months (or occasionally even longer). In many people it may only last a few weeks.

It is impossible to predict how long it will last for each person however, treatment may speed up recovery.

Most treatments can be done at home without the need to contact a healthcare professional.

Treatment is primarily aimed at resting the plantar fascia. The problem is that you still need to walk and carry out your daily activities.

Remember to be patient with some of these treatments as they can take a few weeks before an effect is seen.

Listed below are some of the most useful treatments for Plantar Fasciitis:

Inflammation and pain management

• Anti-inflammatory medications may help. If you are already taking medication prescribed by your doctor for other conditions, please check with a pharmacist prior to taking over the counter medicines (e.g., asthma, stomach ulcers, or if you are taking warfarin).
• Heat: some people find this beneficial. Heat the sole of your foot first thing in the morning (e.g., rub the sole of your foot or put the plug in the bath whilst you are showering).
• Cold/ice: some people find cold more helpful. Applying ice wrapped in a damp cloth to your heel for 10-15 minutes once or twice a day and after periods of activity may help to relieve your symptoms. Alternatively, fill a 500 ml drinks bottle with water and freeze it. Apply the ice by rolling your foot over the bottle with a layer of towel between the bottle and your foot to prevent an ice burn. Do not use ice if you have any circulatory problems or poor skin sensation.
• Rolling your foot over a small hard ball e.g., a golf or tennis ball may also help.

There is some evidence to suggest that acupuncture can be beneficial in the treatment of plantar fasciitis.

Stretching and strengthening

Stretching the Achilles tendon / calf muscles and plantar fascia and strengthening the intrinsic muscles of the foot can improve foot biomechanics and reduce stress on the foot (see downloads below).

Taping techniques

Certain taping techniques can help the pain experienced on the first few steps of walking. It can be helpful in more short-term flare ups. This is something that may be taught to you by a physiotherapist if they feel it would be beneficial. Taping should not be used if you have poor skin sensation or poor skin condition.

Rest / activity modification

• Avoid walking on hard surfaces for extended periods of time.
• Try to avoid walking bare foot. A shoe or slipper with a small heel will help especially first thing in the morning.

Support of the arch of the foot

• Avoid wearing flat, unsupportive shoes.
• Wear comfortable supportive shoes such as trainers and wear insoles.
• Use insoles and orthotics to correct any foot faults and cushion and cradle the arch of the foot as it heals. AOL or Orthoheel insoles are readily available from various chemists and online and work well. It is important that you wear these insoles in all your shoes (they are interchangeable between shoes).

Night splints

Night splints are an extension of stretching as they both work on the same principles however, a night splint is worn for longer periods of time, applying a constant stretch to the plantar fascia. These can be bought on the internet. Ideally the splint should be worn all night, but this is often impractical. If they can be worn for periods of 15-30 minutes at a time, several times a day, then this should have similar effect. Night splints can take some getting used to and they do need to be worn for some time before any beneficial benefits are experienced.

In the first instance you should give these first line treatments 6-12 weeks to have an effect. If you are getting improvement, you should continue these treatments until the symptoms have resolved.

Further treatment options

Steroid injections may be used in more severe cases where conservative management (see below) is not helping. These are usually accessed via your GP or physiotherapist.

How to ease plantar fasciitis yourself:

• Rest and raise your foot on a stool when you can
• Put an ice pack (or bag of frozen peas) in a towel on the painful area for up to 20 minutes every 2 to 3 hours
• Wear wide comfortable shoes with a low heel and soft sole
• Use soft insoles or heel pads in your shoes
• Perform regular gentle stretching exercises
• Perform exercises that do not put pressure on your feet, such as swimming
• Take paracetamol
• Do not take ibuprofen for the first 48 hours
• Do not walk or stand for extended periods
• Do not wear high heels or tight pointy shoes
• Do not wear flip-flops or backless slippers
• Try not to walk barefoot on hard surfaces

You should consider contacting your GP when:

• you have any tingling or loss of feeling in your foot
• you have diabetes – foot problems can be more serious if you have diabetes

You should consider contacting your GP or speaking to a physiotherapist when:

• the pain results from a specific injury
• the pain is severe or stopping you doing normal activities
• the pain is getting worse or keeps coming back
• the pain has not improved after treating it yourself for 4 weeks

Treatment for plantar fasciitis from a foot specialist

A GP might refer you to a physiotherapist for exercises or to see a foot specialist (podiatrist), who can recommend things like insoles and the right shoes to wear.

Physiotherapy is available free of charge on the NHS throughout the UK but waiting times can sometimes be long. Depending on where you live, you may be able to self-refer or you may need to visit a GP or consultant first.

Read more about accessing physiotherapy.

Podiatry may not be available for free on the NHS everywhere and waiting times can sometimes be long.

You can also pay to see a podiatrist or physiotherapist privately

• Find a registered podiatrist
• Find a registered physiotherapist

Useful information about Plantar Fasciitis

• Plantar Fasciitis: Patient information leaflet – Royal Berkshire NHS Foundation Trust
• Plantar Fasciitis: A guide for patients – Plymouth Hospitals NHS Trust
• Footwear: patient information leaflet – Torbay & South Devon NHS Trust

Exercises:

• Plantar Fasciitis Exercises – NHS Ayrshire & Arran
• Video exercises for foot pain – Chartered Society of Physiotherapy

If you have been referred for a specialist opinion your details will be reviewed and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

• Waiting times
• Find services near you