Symptoms

• Sharp, stabbing pain at the bottom of the heel, often worse with first steps in the morning or after long periods of rest.
• Pain that decreases with activity but may return after prolonged standing or after exercise.
• Tenderness when pressing the inside of the heel or the arch.

Common Causes

• Overuse from running, jumping, or prolonged standing.
• Biomechanical issues such as high arches, flat feet, a tight Achilles tendon, or an abnormal gait.
• Sudden increases in activity.
• Improper footwear, especially high heels or barefoot walking.
• Obesity or rapid weight gain.
• Age, with plantar fasciitis most common between ages 40 and 60.

Risk Factors

• High-impact sports such as running, volleyball, basketball, pickleball, and soccer.
• A recent job or routine change that requires prolonged standing, walking, or lifting.

Conservative Treatment

• Rest and activity modification by reducing running and jumping, avoiding hard surfaces, and avoiding barefoot walking.
• Ice for 10 to 15 minutes at least twice daily, especially after sporting activity.
• Over-the-counter anti-inflammatory medication for short-term pain relief, such as ibuprofen or naproxen, unless contraindicated. Consult your doctor before taking anti-inflammatories.
• Orthotic insoles for arch support.
• Night splints to keep the foot dorsiflexed and stretch the plantar fascia overnight.
• Proper footwear with good arch support and cushioning. Avoid flat shoes and high heels.

Physical Therapy and Exercises

• Calf and Achilles stretching exercises.
• Plantar fascia-specific stretching by pulling the toes toward the shin while seated or with a band.
• Strengthening exercises such as towel scrunches, toe curls, and intrinsic foot muscle exercises.
• Corticosteroid injections may be considered for short-term pain relief, though prolonged or excessive use can increase the risk of plantar fascia rupture.
• Platelet-rich plasma (PRP) may be used, though some physicians avoid it because the evidence for effectiveness varies.
• Shockwave therapy can help chronic cases that do not respond to other treatments.

Surgery

Plantar fascia release is reserved for persistent, severe cases associated with heel spurs.

Prevention Tips

• Gradually increase exercise intensity and duration.
• Wear supportive, properly fitting shoes for activity and daily life.
• Replace worn-out shoes regularly. For runners, shoes generally should not be used beyond 500 miles.
• Maintain a healthy body weight.
• Stretch the calves and plantar fascia regularly, especially before and after exercise.

When to See a Doctor

• Severe pain that prevents walking or daily activities.
• Pain that does not improve after two to four weeks of conservative care.
• Numbness, tingling, or weakness in the foot.
• Sudden severe heel pain following an injury.