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What is Plantar Fasciitis?

Plantar fasciitis is a common foot condition characterized by chronic inflammation of the plantar fascia, a thick fibrous band of tissue that connects the heel to the ball of the foot. This condition is caused by repetitive small tears in the plantar fascia, which do not fully heal after each injury. It primarily affects people who spend long hours on their feet, those with altered foot biomechanics (e.g., high arches or flat feet), and individuals who are overweight.

Symptoms of Plantar Fasciitis

The main symptom of plantar fasciitis is heel pain that may radiate into the arch of the foot. The pain is often described as sharp, burning, or aching. It is typically most severe in the morning or after long periods of sitting, while it tends to improve or subside with movement. However, symptoms can return after prolonged standing, walking, or running.

Treatment for Plantar Fasciitis

Plantar fasciitis is a self-limiting condition that generally resolves on its own, but it can persist for up to 18 months or longer. Here are some common treatment options:

  1. Appropriate Footwear: Wear supportive shoes that fit well and have cushioned heel pads. Avoid high heels, as they can tighten the Achilles tendon and worsen symptoms.
  2. Orthoses (Medical Insoles): These can improve foot positioning and reduce stress on the plantar fascia during walking. Consult an orthotist for a specialist opinion.
  3. Pain Relief: Simple painkillers like paracetamol or anti-inflammatory medications (e.g., ibuprofen) can provide relief. Consult your doctor or pharmacist before taking anti-inflammatory medicines, as they may have side effects for some individuals. Anti-inflammatory gels may also be beneficial.
  4. Weight Management: If you are overweight, weight loss is an essential part of the treatment plan. Your doctor may refer you to a weight loss program for guidance.
  5. Activity Modification: Reduce activities that exacerbate plantar fasciitis symptoms, particularly high-impact activities like running. A temporary reduction in such activities may be necessary.
  6. Stretching Exercises: Regularly perform stretching exercises for the calf muscles and plantar fascia. These exercises are highly effective in promoting long-term resolution of plantar fasciitis. A physiotherapist can provide specialized guidance.
    For the majority (80 - 95%) of people, these measures, combined with patience and adherence to the treatment plan, lead to symptom resolution over time. However, if the pain persists, further specialist treatments may be required, including:
  7. Night Splints: These can apply a constant stretch to the Achilles tendon while you sleep, promoting healing. They can also be worn for shorter periods during the day.
  8. Injections: Steroid injections into the heel attachment of the plantar fascia can reduce inflammation, but they may cause temporary pain and symptoms can return after a month. Rarely, they can lead to fat pad atrophy or plantar fascia rupture.
  9. Extracorporeal Shockwave Therapy: This procedure uses low-energy sound waves to stimulate healing by increasing blood flow to the plantar fascia. It is typically offered when other treatments have not been effective.

Surgery for Plantar Fasciitis

Surgery is considered a last resort when non-surgical treatments have failed. Its viability depends on the severity of the condition and your medical history.

Note: Keep in mind that heel pain can have other causes, such as stress fractures, arthritis, or referred pain from the back. If your condition does not improve or if another cause is suspected, it may be necessary to consult another healthcare practitioner.

When to Consider Seeing a Surgeon

While most cases of plantar fasciitis can be effectively managed with non-surgical treatments, there are instances when surgical intervention may be considered. It is important to consult with a healthcare professional or specialist to determine if surgery is the right option for you. Consider seeking a surgeon's evaluation if:

  1. Non-surgical treatments have failed: If you have diligently followed conservative treatments such as orthoses, pain relief measures, activity modification, and stretching exercises without experiencing significant improvement, surgery may be considered.
  2. Symptoms persist for an extended period: If you have been experiencing chronic and debilitating pain from plantar fasciitis for an extended period, typically more than 6 to 12 months, despite non-surgical interventions, surgery may be an option to explore.
  3. Severe functional limitations: If plantar fasciitis significantly impairs your daily activities, mobility, or quality of life to a point where conservative treatments are unable to provide adequate relief, surgery may be a consideration.
  4. Structural abnormalities or complications: Certain structural abnormalities, such as the presence of a heel spur, or complications like a partial tear of the plantar fascia, may increase the likelihood of surgical intervention being recommended.

It is important to note that surgery should be considered as a last resort after non-surgical treatments have been exhausted and depending on the extent of your condition and medical factors. Your healthcare provider or specialist will assess your specific situation and determine the most appropriate course of action.

Remember, every individual's case is unique, and a personalized approach is essential in determining whether surgery is the right option for you. Always consult with a qualified healthcare professional to discuss your symptoms, treatment options, and the potential benefits and risks associated with surgery.

What stretches can I do? 

Calf stretching

Muscle tightness in the feet and calves can make plantar fasciitis worse. Loosening the calf muscles can relieve the pain. People can try performing a calf stretch, which involves the following steps:

  • Lean the hands against a wall.
  • Straighten the knee of the affected leg and bend the other knee in front.
  • Keep both feet flat on the ground.
  • Hold the stretch for 10 seconds.
  • Repeat the stretch 2–3 times.

Ball roll

Placing a round object under the foot and rolling it back and forward can loosen the foot muscles. People can use a rolling pin, golf ball, or specialized foam roller for this exercise. Many sports stores and online retailers sell foam foot rollers.

Another option is to try using a frozen bottle of water for arch rolls. This technique may be particularly beneficial because the cold surface of the bottle may help reduce inflammation.

This simple exercise stretches the foot:

  • Sit tall on a chair.
  • Place a ball or another rollable object under the foot.
  • Roll the object back and forward for 2 minutes.

Seated foot stretch

A person may also be able to relieve muscle tightness in the plantar fascia using a seated foot stretch. They can perform this exercise by following these steps:

  • Sit on a chair and cross the injured heel over the opposite leg.
  • Pull the toes toward the shin to create tension in the arch of the foot.
  • Place the other hand on the bottom of the foot to feel for tension in the plantar fascia.
    • Hold for 10 seconds.
    • Repeat 2–3 times.

Towel curls

Curling a hand towel or washcloth with the toes can stretch the foot and calf muscles. People may find it beneficial to do these stretches before walking or completing any other morning tasks. The exercise involves the following steps:

  • Sit on a chair with both feet flat and a small towel in front of the feet.
  • Grasp the center of the towel with the toes.
  • Curl the towel toward the heels.
  • Relax the foot and repeat 5 times.

Marble pickups

Picking up a marble with the toes will flex and stretch the foot muscles. A person can try the following:

  • Sit on a chair with the knees bent and the feet flat on the floor.
  • Place a handful of marbles on the floor.
  • Pick up one marble at a time by curling the toes.
  • Repeat 20 times.

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