Your healthcare professional will diagnose plantar fasciitis based on your symptoms and a physical exam. They will check how you walk and stand and may do an X-ray to be sure another problem isn’t causing your heel pain.

To help ease plantar fasciitis, your healthcare provider might recommend over-the-counter NSAIDs to reduce pain and inflammation. They might also recommend using a night splint or custom-fitted orthotics to distribute pressure evenly across your feet.

Symptoms

Plantar fasciitis is caused by too much stress on the bottom of your foot. The plantar fascia is a thick band of tissue that supports the arch of your foot and connects from your heel bone to your toes. The ligament can get damaged from repetitive stress, especially if it’s not supported by good shoes or too much exercise.

Heel pain is the most common symptom of plantar fasciitis. The pain is usually the worst first thing in the morning or after sitting for a long time, and gets worse with activity that puts more pressure on your feet, such as walking, running or climbing stairs. Your doctor may recommend rest to reduce symptoms. He or she might also recommend a special shoe, off-the-shelf or custom-fitted arch support (orthotic) to help distribute weight evenly on your feet. A splint that holds your foot in a certain position might help as well.

Taking ice baths or applying a cold ice pack to the affected area several times a day can reduce pain and inflammation. Your doctor might also suggest stretching exercises to stretch the muscles of your feet and calves. Studies show that specific plantar fasciitis stretches can improve heel pain by up to 52% in just eight weeks.

Your healthcare provider may order an X-ray or ultrasound to see how your plantar fascia looks and for other signs of injury, like tiny tears in the ligament or calcium deposits, called heel spurs. Your doctor may also order an MRI if the other treatments don’t relieve your symptoms.

You can help prevent plantar fasciitis by wearing shoes that fit well and avoiding high heels. You can also reduce your risk of getting the condition by maintaining a healthy weight, switching to running shoes as your feet wear down, and avoiding long periods of standing or prolonged activity. Recognizing the early warning signs and seeking treatment promptly can help you avoid serious complications. Your doctor can help you find the best ways to manage your foot pain so you can get back to enjoying your regular activities.

Diagnosis

The plantar fascia is a fibrous band of tissue that runs from your heel bone to your toes on the bottom of your foot. When it is strained or overexerted, it becomes weak, stiff, and painful. This condition is called plantar fasciitis. At NYU Langone, our specialists diagnose this painful foot problem by reviewing your symptoms and performing a physical exam. They check how you walk and look for tender areas on the bottom of your feet. They may suggest X-rays or an MRI scan to help rule out other causes of heel pain, such as a stress fracture or a bone spur (heel bump).

Heel pain from plantar fasciitis is most often worst with the first few steps when you get up out of bed or after long periods of sitting. It also gets worse with exercise and sports activities that put pressure on your heels. It is often aggravated by wearing high heels or shoes with narrow toe boxes, by running or jumping, or by walking up and down hills.

Our specialists recommend simple treatment methods to reduce heel pain. These include resting, reducing or stopping activities that make the pain worse, and using ice to reduce inflammation. We also recommend calf and Achilles tendon stretching exercises, and we advise using over-the-counter pain relievers such as ibuprofen or naproxen (Advil, Motrin IB, others). More than 90% of people with plantar fasciitis improve within several months of starting these simple treatments.

If you continue to have heel pain for more than six months, our specialists may recommend further treatments. These might include extracorporeal shock wave therapy, a procedure where a machine sends shock waves to the heel, or a surgical procedure called a plantar fasciotomy, in which your doctor removes thickened tissue from under your heel.

Risk factors for plantar fasciitis include age, flat or high arches, tight calf muscles that make it hard to flex your foot, and an uneven gait (an unnatural way of walking). It’s also common in runners and those who spend too much time standing or on their feet for work or play.

Treatment

Plantar fasciitis is generally self-limiting, improving over weeks or months as simple treatments are implemented. Over-the-counter pain relievers and a stretching routine can help alleviate pain and reduce inflammation.

A podiatrist can recommend specific exercises and movements to strengthen the foot, which will reduce stress on the plantar fascia ligament. Ice application two to three times a day for 10 minutes can help reduce pain and swelling. Rolling the bottom of the foot on a hard, plastic ball covered in soft spikes or massaging the affected area can also provide relief. Changing the shoes you wear to ones that have good arch support and are cushioned can decrease stress on your feet. In some cases, wearing a heel cup or using custom orthotics can help as well.

If you’re a very active person, you may need to take a break from activities that put stress on your feet (like running, ballet or step aerobics). This will give the injured plantar fascia time to heal. For more severe cases, a doctor can recommend crutches or a walking boot that immobilizes the foot and helps unload the heel.

Platelet-rich plasma injections can help stimulate your body’s natural healing response. Your doctor takes a sample of blood from your arm and uses a machine to separate the platelets, which contain growth factors, from the rest of the blood. Then they inject the platelet-rich plasma directly into the plantar fascia. This process can relieve pain for a few weeks and reduce inflammation dramatically.

If your symptoms don’t improve after trying conservative methods, a doctor can inject a steroid into the plantar fascia to reduce inflammation and pain. However, multiple steroid injections can weaken the fascia ligament and lead to chronic heel pain. Your doctor might also try extracorporeal shock wave therapy, which sends sound waves into the tissue to stimulate your body’s natural healing response. This noninvasive treatment is similar to the procedure used to break up kidney stones. Some people find this treatment less painful than corticosteroid injections.

Prevention

The plantar fascia is responsible for maintaining the arch of the foot and absorbing shock when you walk, run or stand. When it becomes irritated or damaged, it causes pain that is most intense upon initial contact with the ground. Over time, it can become a chronic problem that interferes with daily activities. If you have persistent heel pain, a doctor can recommend treatment methods that can help reduce the symptoms.

Plantar fasciitis occurs more frequently in athletes and people with physically demanding jobs, such as those who spend long hours on their feet. It can also be triggered by wearing high heels, walking up or down stairs, or exercising on hard surfaces.

In most cases, the pain of plantar fasciitis resolves on its own within 10 months. The first step in reducing the pain is to take it easy and decrease or stop activities that make it worse. This may include avoiding exercise that involves repetitive stress on the heel and balls of the feet, like jogging or dancing. It may also be necessary to remove or change the type of shoes you wear.

Athletes should also be very diligent in stretching the muscles and tendons of their feet and lower legs. Stretching can be done by sitting in a chair, crossing your sore foot over the opposite leg and pulling the toes back toward your shin. Doing these stretches several times throughout the day can be very effective. In addition, a night splint that holds the foot and toes up while you sleep can also be very helpful.

Other preventive measures that can be taken include avoiding wearing high heels or switching to flat shoes; adding cross-training to your workout routine, such as cycling or flexibility training like yoga; and using a foam roller. A podiatrist can also provide custom-made orthotic inserts for your shoe that can help relieve pressure on the plantar fascia.

For runners, the most important preventive measure is to seek a biomechanical/anatomical evaluation of the feet before starting a new running routine or training program. In many cases, a properly fitting running shoe and reasonable training programs can alleviate the symptoms of plantar fasciitis in a large number of patients.