Plantar fasciitis: Symptoms, diagnosis and treatment

What is plantar fasciitis?

Plantar fasciitis is inflammation of the thick, fibrous band of tissue that stretches from the heel to the toes, supporting the muscles and arch of the foot. ‘Plantar’ refers to the bottom of the foot; ‘fascia’ is supportive tissue. When the plantar fascia becomes overly stretched, tiny tears can riddle its surface. The band of fascia can become inflamed and become quite painful. While some people have attributed this type of pain to bony growths called heel spurs, it's now believed that heel spurs are usually just a coincidental finding in people with plantar fasciitis.

What causes plantar fasciitis?

Plantar fasciitis occurs when the plantar fascia is overly stretched. A number of factors can contribute to this. While men can get plantar fasciitis, it is more common in women. You're also more likely to have this condition as you age or if you:

• Are overweight.
• Take up a new form of exercise or suddenly increase the intensity of your exercise.
• Are on your feet for several hours each day.
• Have other medical conditions such as rheumatoid arthritis or lupus (systemic lupus erythematosus).
• Tend to wear high-heeled shoes, and then switch abruptly to flat shoes.
• Wear shoes that are worn out with weak arch supports and thin soles.
• Have flat feet or an unusually high arch.
• Have legs of uneven lengths or an abnormal walk or foot position.
• Have tight achilles tendons, or ‘heel cords’.

What are the symptoms of plantar fasciitis?

The symptoms of plantar fasciitis include:

• Pain in the bottom of your foot, especially at the front or centre of the heel bone
• Pain that is worse when first rising in the morning (called "first-step pain"), when first standing up after any long period of sitting, or after increased levels of activity especially in non-supportive shoes

Seek medical advice about plantar fasciitis if:

You have heel pain or pain in the bottom of your foot, especially when you get up in the morning, that does not respond to treatment or if there is redness or bruising in the heel. 

How do I know if I have plantar fasciitis?

Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have to press on the bottom of your feet -- the area most likely to be painful in plantar fasciitis.

Because the pain of plantar fasciitis has unique characteristics -- pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas -- your health care provider will probably feel comfortable making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.