CONDITION

Plantar Fasciitis

The “-itis” in plantar fasciitis implies that there is [inflammation](https://www.healthline.com/health/chronic-inflammation) present in the plantar fascia. Researchers and healthcare professionals now believe that there is not an active inflammatory response regarding this injury but instead thickening and degenerative tissue findings of the plantar fascia.

Dr. Tristan Ginkel
Written by Dr. Tristan Ginkel, DC, FRCms
Sports Chiropractor
7 min read

Therapy & Treatment for Plantar Fasciitis

What is Plantar Fasciitis/-opathy?

The “-itis” in plantar fasciitis implies that there is inflammation present in the plantar fascia. Researchers and healthcare professionals now believe that there is not an active inflammatory response regarding this injury but instead thickening and degenerative tissue findings of the plantar fascia. The plantar fascia is the connective tissue between the heel of the foot and the toes. Pathology of the fascia produces pain in the heel and foot which tends to occur when standing after a long period of being off of one’s feet (after waking up and getting out of bed in the morning for example) or after standing for long periods of time.

Symptoms

Plantar fasciopathy presents typically as a sharp, stabbing pain in the heel. The pain can also occur along the medial longitudinal arch of the foot which is the arch located along the big toe side of the foot. Pain tends to appear after overuse (exercise, for example), when using the foot following a period of inactivity (taking those first few steps in the morning or after sitting for long periods of time), or when walking on hard surfaces. Pain which is caused by plantar fasciopathy tends to improve some after some walking/movement.

Causes

The plantar fascia is like a ribbon of connective tissue which absorbs the impact of your foot when you walk or run. It is designed to absorb these high stresses however too much pressure and tension can lead to damage of the fascia and result in pain. Most commonly, plantar fasciopathy is brought on due to overuse and repetitive strain which cause micro-tears of the plantar fascia.

Risk Factors

There are many risk factors associated with plantar fasciitis.  Here are a few common ones:

Biomechanical dysfunction

Typical biomechanically dysfunctional causes of plantar fasciitis are limited ankle dorsiflexion (decrease in the amount one can bring the top of their foot towards their shin) which can often be due to tightness of the gastrocnemius and soleus muscles as well as the Achilles’ tendon, deformities of the foot (flat feet or high arches), ankle, and/or leg, overpronation (middle of the foot rolls in, flattening the arch), and weak muscles in the foot.

Exercises/Occupation/Use

Athletes use their feet a lot and their feet must be able to withstand the pounding and twisting of constant running and cutting.  Many jobs require an individual to stand or walk for long periods and some individuals make lifestyle choices that require them to be on their feet for long periods of time or to walk for long distances.  Activities that require significant running or walking or even standing for long periods of time can contribute to the development of plantar fasciitis.

Footwear

Heavily worn footwear, or footwear which is poorly designed for your feet, can lead to an increase in stress and tension in your feet.  This can result in damage to the plantar fascia.  Also, wearing high-heeled shoes can contribute to the development of plantar fasciopathy.

Age

As we age, our risk of developing plantar fasciitis increases.  Plantar fasciitis is most common in adults between the ages of 45-65 and can be related to degenerative changes which may cause a decrease in elasticity and shock-absorbing capabilities of the plantar fascia.

Body Weight

Individuals with an elevated BMI demand their feet absorb higher forces via daily activities.  This additional strain increases the probability of developing plantar fasciopathy.

Sex

There seems to be no statistical difference in prevalence between men and women.

Complications

If plantar fasciitis is left untreated, it can eventually lead to chronic heel pain, which will make it difficult for the individual to enjoy regular activities such as walking or exercise.  Chronic heel pain can also make an individual want to adjust his or her gait to minimize the pain, which can in turn lead to additional difficulties and compensations up the anatomical chain.

Prevention

There are a number of ways to avoid plantar fasciopathy which includes but is not limited to:

  • Performing regular foot and calf stretches and strengthening exercises
  • Choosing shoes with the proper room and support for your foot and avoiding high heeled shoes when possible
  • Avoiding spending too much time walking or standing on hard surfaces
  • Choose low-impact sports and exercises (e.g. swimming, cycling)
  • Being conscious of body weight and the potential effects it may have on your musculoskeletal system

Diagnosis

Diagnosis of plantar fasciitis is done by a qualified healthcare professional who will evaluate your medical history and symptoms. Of note here are the location, quality, timing, and frequency of your foot pain. In some cases, the doctor will recommend an MRI or X-ray to rule out fractures, arthritis, or other troublesome conditions.

Treatment

There are many non-invasive methods for treating plantar fasciitis and about 90% of individuals with plantar fasciopathy can fully recover without surgery. Some of the treatment options address the symptoms, others the cause. Virtually all of the methods of prevention listed above are also effective forms of treatment.

Physical Rehabilitation

A good clinician will provide you with stretching techniques, exercises to strengthen your foot and calf musculature, and provide educational information about plantar fasciopathy, the activities to avoid initially, and better aid in managing expectations regarding a timeframe for recovery.  Rehabilitative exercises for plantar fasciopathy primarily focus on high-load strength training and increasing mobility of the tissues involved.

Night Splints

Splints for plantar fasciitis place the foot and ankle in a position which allows for a constant stretch of the plantar fascia on the bottom of the foot throughout the night.

Footwear and Inserts

Wearing shoes with adequate and appropriate support for your foot specifically can be an important factor.  Shoe inserts/orthoses tend to produce minimal benefits in regard to pain and function for individuals with plantar fasciopathy and can therefore be useful during the initial treatment plan; however long-term benefits are not often found.

Other Procedures

Additional treatment procedures/modalities may include: Platelet-rich plasma, corticosteroid injections, shockwave therapy, and ultrasound.

Surgery

Conservative treatment for PF has a high success rate and therefore surgery is rarely necessary.  Non-operative treatment options should be exhausted prior to surgery being a consideration for PF and it is recommended that surgery not be considered until 12 months following the onset of plantar fasciopathy because research suggests that 95% of individuals will be pain-free by that time.

An important point that hasn’t been stated yet is foot and/or heel pain can be debilitating, but you should not let it control your life.  Do not avoid all activity and become sedentary simply out of fear of the pain.  Confront the pain head-on with some of these strategies and seek out guidance from an expert in your area if needed; that is the only path to recovery.

Dr. Tristan Ginkel
About the author
Dr. Tristan Ginkel, DC, FRCms
Sports Chiropractor

Dr. Tristan Ginkel is a passionate and skilled sports chiropractor and Functional Range Conditioning mobility specialist based in Nevada City, California, dedicated to helping patients move better, feel stronger, and perform at their best. Originally from Gilroy, CA, Dr. Tristan brings a warm, personable approach to care—blending cutting-edge techniques with a sincere commitment to each patient’s health journey. Known for his kindness, approachability, and family-first values, he strives to create a supportive and empowering experience for every individual he treats.

More from Dr. Tristan Ginkel →

Frequently Asked Questions

Common questions about plantar fasciitis.

What is plantar fasciitis, and is it really inflammation?

Plantar fasciitis is the most common cause of heel pain, affecting the plantar fascia where it attaches at the heel. Despite the "-itis" name, it is primarily a degenerative process rather than active inflammation. As one peer-reviewed overview puts it, "an absence of inflammatory cells characterizes this condition despite its name," with histological findings that instead include micro-tears, collagen disarray, and granulation tissue. For this reason it is sometimes called plantar fasciopathy.

What does plantar fasciitis feel like, and why is the pain worst with the first steps in the morning?

Plantar fasciitis typically causes sharp, stabbing pain on the underside of the heel, sometimes with tightness or tenderness along the arch. The pain is often worst with the first few steps after getting out of bed in the morning, or after a long period of rest such as a long car ride. This first-step pain occurs because the fascia tightens up during rest; the pain usually eases after a few minutes of walking, then can worsen later in the day as activity increases.

What causes plantar fasciitis and who is most at risk for developing it?

Most cases of plantar fasciitis result from overuse stress on the plantar fascia. Common risk factors include repetitive high-impact activity (such as running or sports), standing for long periods, tight calf muscles and limited ankle dorsiflexion, foot structure such as flat feet (pes planus) or high arches (pes cavus), increased body weight, and unsupportive footwear or high heels. It is most common among people aged 40 to 60 years.

How long does plantar fasciitis take to heal?

Recovery from plantar fasciitis usually takes time, and most cases improve with conservative (non-surgical) treatment. One peer-reviewed overview reports that about 75% of cases resolve spontaneously within 12 months, and about 5% need surgery. Patient education materials describe healing as taking anywhere from a few weeks to a few months, while orthopedic guidance notes that more than 90% of patients improve within 10 months of starting simple treatment. Resolution can still take weeks or months.

What are the most effective treatment options for plantar fasciitis?

Plantar fasciitis is usually managed with conservative treatments, and surgery is rarely needed. First-line options include stretching of the calf and plantar fascia, activity modification, supportive footwear, shoe inserts or orthotics, and night splints that hold the foot in a stretched position overnight. Lower-impact exercise such as cycling or swimming puts less stress on the feet. More advanced options include extracorporeal shock-wave therapy and injections such as platelet-rich plasma or corticosteroids, though corticosteroid relief tends to be short-term.

Do stretching and strengthening exercises help plantar fasciitis?

Yes. Research shows that both strengthening and stretching exercise programs, including stretching the Achilles tendon, can greatly reduce pain and improve walking in people with plantar fasciitis. Stretching targets the calf muscles and the plantar fascia, while strengthening targets the intrinsic foot muscles and ankle stabilizers. A physical therapist can design a program of specific stretching and strengthening exercises, since plantar fasciitis is aggravated by tight muscles in the feet and calves.

How can I prevent plantar fasciitis or keep it from coming back?

Steps that may help prevent plantar fasciitis include stretching your calves and feet before and after running or walking, choosing shoes with proper arch support and appropriate heel height, replacing worn shoes regularly, giving your feet time to rest and recover after intense activity, avoiding walking barefoot on hard surfaces, and maintaining a healthy body weight. One patient guide suggests replacing athletic shoes every six to nine months, or after walking or running 250 to 500 miles in them.

When should I see a clinician about heel pain?

See a healthcare provider if you have heel or foot pain that does not get better on its own within a week, or if your symptoms do not improve after about two weeks of self-care treatment. Plantar fasciitis is the most common cause of heel pain, but a clinician can confirm the diagnosis and rule out other causes. Most cases improve over time with conservative care, and a physical therapist can design an individualized program.

Sources

The information on this website is general education about musculoskeletal and movement-related conditions. It is not medical advice or a diagnosis, and it cannot tell you what is causing your symptoms. Reading it is not a substitute for an in-person evaluation, and booking a visit does not confirm that your condition is right for our care until a provider has examined you. This information cannot identify every condition, and some urgent problems can feel like musculoskeletal pain. If your symptoms are severe or getting worse, or you are unsure how urgent they are, contact your physician, call 911, or go to the nearest emergency room. When in doubt, seek emergency care.

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