The plantar fascia is a thick band of connective tissue that runs along the bottom of the foot, connecting the heel bone (calcaneus) to the toes and supporting the arch. Plantar fasciitis is inflammation, irritation, or microtearing of this tissue, most commonly at its attachment to the heel.
Heel pain from plantar fasciitis can sometimes be confused with other conditions — a calcaneal stress fracture or sinus tarsi syndrome can produce similar symptoms and may coexist in the same patient.
Causes
Overuse and repetitive stress
Repetitive impact from running, jumping, prolonged standing, or walking on hard surfaces can strain the plantar fascia and lead to microtears at the heel attachment.
Biomechanical factors
Flat feet, high arches, tight calf muscles, and abnormal walking patterns place excess tension on the plantar fascia. Sudden increases in activity, weight gain, and unsupportive footwear are also common contributors.
Other contributing factors
Age (most common between 40 and 60), obesity, occupations requiring long hours on the feet, and certain inflammatory conditions can all increase risk.
Symptoms
Patients typically describe a sharp, stabbing pain at the bottom of the heel, especially with the first steps in the morning or after periods of rest. Pain often improves with movement but worsens again after prolonged standing or activity. Tenderness along the arch and stiffness in the foot are also common.
Diagnosis
Diagnosis is usually made through clinical examination, with characteristic tenderness at the medial heel where the plantar fascia attaches to the calcaneus. The doctor may also assess foot mechanics, calf flexibility, and gait.
When symptoms are severe, persistent, or atypical, an MRI is warranted to evaluate the thickness of the plantar fascia, identify partial tears, detect heel bone marrow edema, and rule out other causes of heel pain such as stress fractures, nerve entrapment, or fat pad atrophy.
Severity Stages
Plantar fasciitis is generally categorized by duration and tissue changes:
- Acute: Symptoms present for less than 6 weeks, with inflammation as the predominant finding.
- Subacute: Symptoms lasting 6 weeks to 3 months, with early degenerative changes.
- Chronic (plantar fasciosis): Symptoms persisting beyond 3 months, with degenerative thickening of the fascia and possible partial tearing.
Treatments
Treatment is almost always nonsurgical and aimed at reducing inflammation, supporting the arch, and addressing underlying biomechanics.
First-line treatment: Rest, activity modification, ice, anti-inflammatory medications, calf and plantar fascia stretching, and supportive footwear with arch support or orthotics.
Persistent symptoms: Night splints to maintain stretch on the fascia overnight, formal physical therapy, and corticosteroid injections may be considered. Extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP) injections are options for chronic cases.
Refractory cases: When conservative treatment fails after 6-12 months, surgical options such as plantar fascia release may be considered, though this is required in only a small percentage of patients.
Get an MRI to Confirm Your Diagnosis
Before surgical planning or starting treatment, a clear MRI diagnosis ensures the right path forward. First Look MRI offers self-pay Foot and Ankle MRI scans — no doctor's order or insurance required — at our locations in Georgia, Texas, and Colorado.