Plantar Fasciitis - Causes, Symptoms & Treatments

What is it?

Plantar fasciitis is one of the most common causes of foot pain that we see in the clinic. Studies showing that 1 in 10 adults will experience this injury in their lifetime (1). Plantar fasciitis is the degeneration of the thick band of tissue (plantar fascia) that runs across the bottom of your foot from the heads of the metatarsals to the base of your heel.

People with plantar fasciitis will report sharp heel pain with weight bearing. This is often worse in the morning when getting out of bed or on standing after inactivity. Symptoms will often reduce during the day and then deteriorate again in the evenings.

Do you need a scan?

Investigations are not usually necessary for diagnosis in acute cases but Ultrasound or MRI are often used in chronic conditions (ongoing symptoms for over 3 months) to rule out differential diagnoses and to assess extent of tissue damage.

Who’s at risk

This injury is seen in the sedentary population with high BMI and reduced ankle dorsiflexion being big risk factors. We also see it in the athletic population – particularly in runners - due to the excessive loading of the plantar fascia.

In my experience – working close to the beach – one of the biggest causes is when people are changing their footwear from supportive winter shoes to less supportive flip/flops and bare feet in the early months of summer.

How do we treat it?

There are a list of treatment options from self massage with a golf ball to surgical intervention.

Recent systematic reviews looking at the literature around best treatment have given us some directions of which are the best treatment options (2,3). They have shown that placeabo or sham treatments are the least effective and that steroid injections along with exercise and shock wave therapy are the most effective (3). From these studies a core approach for the treatment of plantar fasciitis was developed. This approach recommends taping, education and exercise for acute pain and then progressing to shock wave therapy and ultimately cortisone injection if no improvement over 4 weeks. (2)

What are the best exercises?

The exercises that are historically used involve stretching the plantar fascia with varying loads and intensities. These stretches can be undertaken in various different foot positions to increase the loads through the plantar fascia.

We have progressed this exercise program over the last 10 years to incorporate more strengthening after studies showed that heavy slow resistance training gave superior outcomes to standard plantar fascia stretch programs (4). It is now common to combine both a strengthening program aimed at heavy slow loads on set days alongside regular stretches.

Here we are using a Smith Machine and incline board to help add heavier loads through the plantar fascia

Take home message

Plantar fasciitis is a common and debilitating injury but there is now a core treatment pathway with escalating levels of intervention depending on the longevity and severity of the pain.  

1. Uden H, Boesch E, Kumar S. Plantar fasciitis – to jab or to support? A systematic review of the current best evidence. J Multidiscip Healthc. 2011;(4):155-164

2. Morrissey D et al. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. (2021) Br J Sports Med

3. Babatunde O et al. Comparative effectiveness of treatment options for plantar heel pain: a systematic review with network meta-analysis. (2017) Br J Sports Med

4. Rathleff M S et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. (2015) Scand J Med Sci Sports