Signs and Symptoms
Plantar fasciitis usually causes:
- Sharp or stabbing pain at the bottom of the heel, often toward the inner side
- Pain with your first steps in the morning or after sitting for a while, which often eases as you keep walking
- Pain that returns after long periods of standing or walking, or after exercise rather than during it
- Tenderness when you press on the bottom of the heel
- Tightness in the arch or calf
It usually affects one foot, but both feet can be involved.
What Causes It?
Plantar fasciitis develops when repeated stress on the plantar fascia leads to small areas of damage where it attaches to the heel bone. Long-standing cases often involve wear and thickening of the tissue rather than true inflammation, similar to tendinopathy (long-term tendon wear).
Common contributing factors include tight calf muscles or a tight Achilles tendon, a sudden increase in walking, running or standing, long hours on hard floors, worn-out or unsupportive shoes, going barefoot often, very flat feet or high arches, and extra body weight. A heel spur, a small bony growth on the heel seen on X-ray, is common in people with and without heel pain, and it is usually not the cause of the pain.
How We Diagnose It at POPB
Diagnosis is mainly based on your history and a physical exam. Your physician asks when the pain started and when it is worst, presses on the heel and arch to find the tender spot, and checks calf flexibility, foot shape and how you walk.
X-ray and diagnostic ultrasound are available in our office. An X-ray can help rule out other causes of heel pain, such as a stress fracture or arthritis. Dr. Adelman can use ultrasound to look at the plantar fascia in real time, which can show thickening of the tissue, and to check nearby structures such as the Achilles tendon. MRI is rarely needed but is available on site if the diagnosis is unclear.
Non-Surgical Treatment Options
Most people improve with non-surgical care, usually by combining several of these steps:
- Stretching of the calf and the plantar fascia, done several times a day and especially before your first steps in the morning
- Supportive shoes with good arch support and cushioning, and over-the-counter or custom shoe inserts
- Night splints, which hold the foot gently flexed while you sleep so the fascia and calf stay stretched
- Activity changes, such as cutting back on running or long periods of standing, and switching to lower-impact exercise for a while
- Ice to the heel and arch after activity
- Short courses of anti-inflammatory medication when it is safe for you
- Physical therapy in our office, focused on stretching, strengthening the foot and calf, and gradual return to activity. Therapists share your chart with your physician.
- Ultrasound-guided injections in selected cases. A cortisone injection can ease pain, but it has trade-offs: repeated injections into the heel can thin the fat pad that cushions it and may weaken the plantar fascia, so your physician uses them sparingly.
- Shockwave therapy, which our office offers for stubborn heel pain. It delivers sound-wave pulses to the painful area through a handpiece on the skin. Coverage varies by plan.
- PRP (platelet-rich plasma), prepared from your own blood, for selected long-standing cases. Evidence is still developing, results vary, and it is not FDA-approved for specific orthopedic conditions.
Surgical Options
Surgery is rarely needed for plantar fasciitis. If pain continues after many months of consistent non-surgical care, your physician can discuss referral to a foot and ankle surgeon to talk about surgical options.
Recovery
Plantar fasciitis often improves slowly. Many people notice progress within a few weeks of starting a regular stretching and support routine, but full recovery can take several months, and some cases take a year. Keeping up with stretching and supportive footwear after the pain settles helps lower the chance of it coming back. Timelines vary with how long symptoms have been present and how active you are.
Insurance and Cost
Office visits, X-ray, diagnostic ultrasound, ultrasound-guided injections and physical therapy are generally covered by Medicare and most commercial PPO plans when medically necessary. Shockwave therapy coverage varies by plan, so ask our team before treatment. PRP is usually not covered by insurance. HMO and managed-care plans need a referral in our office before your visit. Our staff verify benefits when you call.
When to Be Seen
Call our office if heel pain lasts more than a few weeks despite rest, stretching and better shoes, if it keeps you from walking or exercising normally, or if it keeps coming back.
Call sooner if you have numbness, tingling or burning in the foot, or pain and swelling that began after an injury. Go to the emergency room or call 911 if the foot looks deformed, you cannot bear any weight, or the heel becomes hot, red and swollen with fever.
