Pain under the foot (plantar fasciitis)

At a glance

  • Plantar fasciitis is an inflammation of the band of thick connective tissue beneath your foot (the plantar fascia).
  • It causes pain in the heel or sole of the foot.
  • The risk of plantar fasciitis is higher if too much strain is put on your foot.
  • The pain usually goes away in the space of a few months.
  • Wearing comfortable shoes, cooling the sole and doing stretching exercises can offer relief.
  • There are only a handful of medical treatments that have been proven to help.

Introduction

Photo of a runner holding his foot in pain

Pain under the foot can have very different causes. One of the most common ones is of a wide band of thick connective tissue that runs along the sole of the foot – a condition known as “plantar fasciitis.”

This band of tissue is called the “plantar fascia.” It supports the feet when we walk and run. The tissue can become inflamed if it’s put under great strain. For this reason, plantar fasciitis is particularly common in runners. Though the pain brought on by plantar fasciitis is unpleasant, most people find it goes away within a year without any treatment.

When someone has foot and heel pain, a heel spur is often suspected to be the cause. A heel spur is a thorn-shaped bony bump on the heel, just a few millimeters in size. Heel spurs themselves don’t usually cause pain but it’s common for them to develop in people who have plantar fasciitis. This can happen when the body attempts to mend the irritated tissue.

Symptoms

Plantar fasciitis causes severe burning or stabbing pain under the heel or foot. It can also feel as if you’re walking on broken glass. The following is typical in plantar fasciitis:

  • Extreme pain in the sole of the foot when you take your first steps in the morning or after you’ve been sitting for a long time.
  • The pain subsides once you’ve walked around for a while. But it can come back again after very strenuous days or activities – for example, if you spend a long time in a standing position or carrying something heavy.

Plantar fasciitis can affect one foot or both feet at the same time. In roughly one third of cases, the plantar fascia in both feet are inflamed.

Causes

The plantar fascia starts beneath the heel bone and extends into the toes. It stabilizes the foot during movement and has a cushioning effect. During the heel-to-toe rolling movement you make with each step, the plantar fascia tissue tightens so that it can support the arch of your foot. During this movement, the strain at the point where the tissue attaches to the heel is particularly high.

If it becomes too much, small tears occur around the attachment point. These can become irritated and lead to . It is thought that this overload and irritation is caused by a combination of factors coming together.

Illustration: Foot with plantar fasciitis

Foot with plantar fasciitis

Risk factors

Heavy, persistent or unusual strain on the heel or foot increases the risk of plantar fasciitis. Because of this, it’s particularly common in people who do a lot of sports: people who often run long distances, play football or dance, for example. People who return to sport too quickly and do too much after a break are also at risk. Another risk factor is standing for long periods of time – as is standard practice for sales assistants, for instance.

Other factors that can lead to unusual or too much strain on the plantar fascia include

  • foot deformities like a pronated foot, flat foot or high arches;
  • short calf muscles or a short Achilles tendon: In this case, the plantar fascia is under constant tension because it’s joined to the calf muscle by the Achilles tendon;
  • uncomfortable shoes such as shoes with a hard heel. Wearing running shoes that don’t have enough cushioning and running on hard surfaces are also considered risk factors; and
  • being overweight – perhaps because this can place additional strain on the plantar fascia.

Inflammatory diseases like gout, arthritis or ankylosing spondylitis are considered risk factors too because they affect the tissue.

The risk of developing plantar fasciitis also increases with age because tissue becomes less elastic and the fat pads under the heel start to get thinner.

Prevalence

Up to 10 out of 100 people develop plantar fasciitis at some point in their life. In adults, it's one of the most common causes of foot and heel pain. It is particularly common in 45- to 65-year-olds.

Runners develop plantar fasciitis more often and at a younger age than other people do.

Outlook

In most cases, the symptoms disappear after a few months. Even when no special treatment is given, plantar fasciitis often goes away within a year.

But an estimated 10 to 20 out of 100 people who have plantar fasciitis are affected for longer than a year.

Diagnosis

Talking to a doctor and having your foot examined is usually enough to find out whether you have plantar fasciitis. It is important that you describe your symptoms in as much detail as possible. The doctor will examine you by checking your flexed foot for tenderness in the sole or heel. They will also examine your overall foot, and look to see how you walk and whether you have a short Achilles tendon or short calf muscles.

Ultrasound scans aren't always needed for but they are sometimes carried out before giving injections for treatment. This is done to see the inflamed area and determine where the needle should be inserted.

Other examinations such as x-rays or (MRI) are only needed in some cases – to rule out bone fractures, for example, or if the symptoms don’t improve despite treatment.

Treatment

Continuing to put too much strain on your painful foot can make the plantar fasciitis worse. So it’s important to rest the foot at first, but it doesn’t need to be immobilized (kept still).

To ease the pain, you can cool the sole of your foot using a cool pack, for instance. You can also take painkillers as a short-term solution.

Once your foot has recovered a little, you will usually be advised to do stretching and strengthening exercises. If you have a deformed foot, your doctor will also prescribe orthopedic insoles. People who are overweight are advised to lose weight.

If your symptoms don’t improve after a few weeks, other treatments like corticosteroid (steroid) injections or extracorporeal shock wave therapy (ESWT) can be considered. ESWT involves exposing the plantar fascia to high-pressure sound waves that are passed through the skin of the heel. Surgery is considered the last option. But injections and operations have their risks. The question of whether surgery can relieve the symptoms has not been researched enough so far.

Everyday life

People who have plantar fasciitis need a lot of patience because it takes quite a while for the body to get the under control.

That might sound disconcerting, particularly if you do a lot of sports, but most people don't need to take a long-term break from activities that put strain on their plantar fascia. In many types of sports, it’s possible to reduce the strain by changing technique or shortening training sessions. Stopping every now and again for a rest also gives your body an opportunity to recover.

Doctors often give people with plantar fasciitis a combination of treatments, or various different treatments are tried out one after another. As well as having patience, you have to have time because there can be quite a lot of doctor’s and physiotherapist’s appointments.

But there are also plenty of things you can try yourself to ease the symptoms of plantar fasciitis. Wearing comfortable shoes with a soft, cushioning sole, and lightly massaging the sole of your foot can offer relief. Cooling the painful area before you exercise can help too. Walking barefoot, on the other hand, is not a good idea.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on October 20, 2021
Next planned update: 2024

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Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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