Our feet help us stand, get from place to place, run, jump, dance and more. That activity relies on a network of bones, muscles, tissues, and nerves that all must work together. When something isn’t quite right, you will typically feel pain.

The heel of the foot is often the site of some pain in many individuals, and often that pain is caused by what is known as plantar fasciitis. More than two million patients receive treatment for plantar fasciitis in the United States each year. About one in 10 people will have heel pain, most commonly plantar fasciitis, in their lifetime.

The cause

The foot contains a thick band of fibrous tissue known as the plantar fascia. This tissue supports the bottom of the foot along the arch and connects from the heel bone all the way to the toes. If that tissue becomes damaged, it causes pain in the heel.

Inflammation of the plantar fascia contributes to the pain and swelling. However, the underlying issue is typically more of a degenerative process, with microtears and degeneration of the attachment of the plantar fascia to the heel bone.

This condition can affect adults across the whole age spectrum. There are some factors that increase your risk for developing plantar fasciitis, including:

The signs

The main symptom of plantar fasciitis is long-term heel pain on the inside bottom of the heel.  The pain is usually worse with activity and especially bad with the first few steps getting up from bed or a seated position. Patients often report that ice and anti-inflammatory medications help, but only temporarily.

Effective treatments

Over 90% of patients with plantar fasciitis can be successfully treated with conservative treatment.  While this can take six to 12 months, there is more evidence for calf stretching as well as dedicated plantar fascia stretching and massage than any other treatment.

  • Calf stretches can be done in a sitting position with the knee extended and pulling the foot up using a belt. They can also be performed by leaning forward into a wall with the affected leg extended behind and the heel planted – “a runner’s stretch.” Dedicated plantar fascia stretching involves pulling the foot up and the toes up at the same time to really stretch out the bottom of the foot and then massaging the painful area on the inside of the heel.  Regardless of the stretching method, these exercises are most effective if performed consistently and spread out throughout the day.
  • Using night splints. Night splints, which hold the foot and toes stretched out at night, can be helpful and are available at most pharmacies.
  • An off-the-shelf prefabricated orthotic or insert that is cushioned with an arch support can be helpful in combination with the stretching. These are typically in the $30 to $50 price range.

Treatments to avoid

While stretching, splints and orthotics can help, there are other methods that should be avoided.

  • Custom orthotics. There is no evidence to support the use of $300-$500 custom orthotics. Occasionally custom orthotics are indicated, but in general off the shelf options that are more economical serve their purpose just as well.
  • There is evidence against steroid injections as they are more likely to cause more degeneration or a rupture of the plantar fascia than help.

Surgery as a last resort

There are surgical treatments that can be used to treat plantar fasciitis. The surgery involves cleaning up the degenerative tissue, releasing any adjacent entrapped nerves, and releasing some of the tension in the calf muscles. These surgical options should be reserved as a treatment of last resort after at least six months of active conservative treatments with stretching, splints and/or inserts.

Preventing the pain

There are things that you can do to reduce your risk of developing plantar fasciitis. Taking the tension off that region of the foot is key.

  • Runners, especially when changing work out regimens or shoe wear, should be diligent about stretching before and after running.
  • For people who work standing on their feet, find time to stretch or rest, and wear shoes or orthotics that are comfortable.
  • Identifying the symptoms early and treating with stretching can help prevent chronic pain.

If you are experiencing plantar fasciitis or have another concern, the experts in our Lifespan Orthopedics Institute can help. For more tips on keeping active for your health, visit the Moving section of our Lifespan Living health and wellness blog.

Raymond Hsu, MD

Dr. Raymond Hsu is an orthopedic surgeon at the Lifespan Orthopedics Institute and an assistant professor of orthopedics at The Warren Alpert Medical School of Brown University. He specializes in treating foot and ankle injuries, both acute and chronic, including fractures, tendon and ligament injuries, arthritis, foot deformities, bunions, and arch-related issues.