Version July 2025
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OVERVIEW —
Plantar fasciitis is one of the most common causes of heel and foot pain in adults. It is caused by a strain of the area of the foot called the plantar fascia (figure 1). The plantar fascia (pronounced FASH-uh) is a thick piece of tissue with long fibers that starts at the heel bone and fans out along the bottom surface of the foot to the toes. Plantar fasciitis involves the area near the heel. The fascia provides support as the toes bear the body's weight when the heel rises during walking. Running, jumping, or standing for long periods of time can strain the plantar fascia.
Most people with plantar fasciitis will recover fully over time, with or without treatment, with most people becoming pain-free within a year. Even patients with persistent symptoms typically have good outcomes.
SYMPTOMS —
The most common symptom of plantar fasciitis is pain beneath the heel and sole of the foot (figure 1). The pain is often worst when stepping onto the foot, particularly when first getting out of bed in the morning or when getting up after being seated for some time. It might also be painful after spending a lot of time on your feet. You may have pain in one or both of your feet.
RISK FACTORS —
Plantar fasciitis is more likely to occur in people whose lifestyle or occupation causes repetitive impact to the heel. Activities such as running, marching, or dancing may trigger or worsen symptoms. Possible other factors that increase the risk of plantar fasciitis include obesity, prolonged standing, jumping, flat feet, and limited ankle flexibility.
Plantar fasciitis occurs more frequently among runners. Although evidence is limited, possible factors that increase the risk in this group include:
●Excessive training (particularly a sudden increase in the distance run)
●Improper running shoes
●Running or prolonged standing or walking on hard surfaces
●Flat feet
●High arches
Plantar fasciitis usually occurs in people without underlying medical problems, although it is more common in people with type 2 diabetes, and it can be associated with other rheumatic disorders such as ankylosing spondylitis or psoriatic arthritis. (See "Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics)" and "Patient education: Psoriatic arthritis (Beyond the Basics)".)
DIAGNOSIS —
To diagnose plantar fasciitis, a health care provider will take a medical history and examine your feet to locate painful areas. This involves holding your foot in a flexed position with one hand and using the other hand to press on different parts of your sole (where the plantar fascia is located). It is important to tell your provider if you have noticed pain or tenderness in other areas not found during the examination.
If you have typical symptoms of plantar fasciitis, then no imaging tests (such as X-rays, ultrasound, or magnetic resonance imaging [MRI]) are required. This is the case for most people. In some instances, depending upon the nature and severity of pain as well as other individual factors, your provider may recommend imaging tests to determine if another issue (such as a fracture) is causing your pain.
TREATMENT
Initial treatment options — Many people with plantar fasciitis require no specific treatment as the condition gets better on its own. While some people might need treatment to manage pain, many commonly used treatments have not been proven to improve the symptoms or significantly shorten the duration of plantar fasciitis. Most patients are treated with rest, avoidance of aggravating factors, and a prefabricated silicone shoe insert to reduce pressure on the heel.
Rest and avoidance of aggravating factors — Limiting athletic activities and getting extra rest may help to relieve your symptoms. If possible, avoid excessive and repetitive heel impact from jumping, dancing, and distance running. A complete lack of physical activity, however, is not recommended, as this can lead to stiffening and a return of pain.
Cushioned footwear — Footwear should provide sufficient cushioning to reduce pressure on the heel. Most people can use prefabricated silicone heel inserts. Cushion-soled shoes with gel pad inserts or heel cups may also provide temporary pain relief. People who work or live in buildings with concrete floors should wear shoes with extra cushioning. In general, other types of inserts, including custom-made orthotics, do not provide more symptomatic relief and may be more expensive.
Wearing slippers or walking barefoot may cause worsening or recurrent symptoms, even on carpeted floors. Thus, it is best to wear supportive footwear before stepping out of bed in the morning.
Pain medication — A clinician may recommend a short course (two to three weeks) of a nonsteroidal antiinflammatory drug (NSAID) such as ibuprofen (sample brand names: Advil, Motrin) or naproxen (sample brand name: Aleve) to relieve pain. However, any benefit might be small, and these medications have many possible side effects. For these reasons, it is important to weigh the potential risks and benefits. Topical NSAIDs (such as creams or gels) applied to the painful area may also be helpful but have not been studied for this condition. (See "Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)".)
Stretching exercises — Stretching exercises may provide short-term benefit, although the evidence is uncertain. They are unlikely to cause harm. Home exercises include the calf-plantar fascia stretch (figure 2), foot/ankle circles (figure 3), toe curls (figure 4), and toe towel curls (figure 5). Go slowly and be careful when you start new exercises to avoid causing more pain.
Steroid injection — People with more acute and severe pain may benefit from an injection of a steroid (also called "glucocorticoid") medication in the foot. The injection can help to relieve pain quickly, although the effects may wear off after a few weeks. Steroid injection appears to be most effective for patients with morning pain and stiffness and/or pain after inactivity.
When giving the injection, the health care provider will press on your foot in order to locate the tender area and inject in that spot. The injection can be repeated if needed when the effects wear off. Most patients will only require one or two injections before their symptoms begin to resolve.
Other plantar fasciitis treatment options — If the measures above fail to improve the pain, your health care provider may recommend trying one of the following:
Tape support — Taping the affected foot with a technique known as "low-Dye taping" may help, particularly if you tend to have recent onset of symptoms, severe pain, or pain immediately on standing. Four strips of tape are applied as illustrated in the figure (picture 1). Do not wrap the tape too tightly. You can use hypoallergenic tape if you have an allergy or sensitivity to regular sports tape.
Splint support at night — It might help to wear a splint that keeps the foot straight while sleeping. These splints are sold in pharmacies and medical supply stores.
Casting — Another option is a short walking cast, which begins at the calf and covers the ankle and foot up to the toes. This type of cast has a rocker-shaped bottom that allows you to continue walking while wearing it. This treatment has not been tested in clinical trials.
Surgery — Surgery is rarely required for people with plantar fasciitis, and its efficacy remains unproven. It would only be recommended if all other treatments had failed and there were persistent and disabling symptoms for at least 6 to 12 months. Surgery involves detaching the plantar fascia from the heel bone.
Treatments of no or unproven benefit — While some clinicians recommend other approaches to people who do not improve with the above measures, these are typically more costly and are either experimental or not supported by high-certainty evidence.
We discourage use of shockwave therapy and platelet-rich plasma injections. High-certainty evidence indicates that shockwave therapy is ineffective for treating plantar fasciitis. While the evidence is less certain for platelet-rich plasma injections, there is compelling evidence from studies of similar conditions that these injections are unlikely to help people with plantar fasciitis.
WHERE TO GET MORE INFORMATION —
Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Plantar fasciitis (The Basics)
Patient education: Metatarsalgia (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the Basics)
Patient education: Psoriatic arthritis (Beyond the Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Heel pain in the active child or skeletally immature adolescent: Overview of causes
Foot and ankle pain in the active child or skeletally immature adolescent: Evaluation
Running injuries of the lower extremities in adults: Risk factors and prevention
Plantar fasciitis
Clinical manifestations and diagnosis of peripheral spondyloarthritis in adults
The following organizations also provide reliable health information.
●National Library of Medicine
(https://medlineplus.gov/healthtopics.html)
●American Academy of Orthopedic Surgeons
●American Podiatric Medical Association
