Question 1

Overview of the anatomy

Accepted Answer

The plantar fascia is a thick fibrous band of tissue underneath your foot that runs from your heel bone to your toes. Plantar fasciitis is the most common cause of pain under the heel in athletes and non-athletes. It is caused when you overload the plantar fascia where it attaches to the heel bone.

Question 2

Symptoms of plantar fasciitis

Accepted Answer

The intensity of your symptoms will vary throughout the day depending on how irritated your plantar fascia is. The most common reported symptoms include:

No pain when you’re off your feet, like lying down or sitting
The main pain and stiffness is on the inner part of your heel or inside foot arch when standing, walking, or pressing on that area
The first few steps when getting out of bed in the morning is uncomfortable and painful
Pain decreases once you’re moving around but increases again when you spend too much time on your feet
You feel pain when you stand and walk again after a long period of sitting or being off your feet

Question 3

When to see a doctor

Accepted Answer

Plantar fasciitis can be treated effectively at home using a conservative exercise-based treatment plan as outlined in the app.

You should consider seeing a medical practitioner if you have any concerns about your injury, particularly if:

You have pain at night that keeps you awake or interrupts your sleep.
You feel pins and needles or tingling in your leg or foot.
Your symptoms are getting worse.
Your injury is not healing as expected (see expected healing times below).

Question 4

Causes of plantar fasciitis

Accepted Answer

The plantar fascia strengthens the arch of your foot and keeps it from collapsing under load. Plantar fasciitis occurs after repeated over-loading, especially after high-impact activities such as hill running.

Common causes of plantar fasciitis include:

Insufficient shoe support for your foot arch – for example, going sightseeing in flip-flops or doing long-distance running in minimalist shoes
Sudden weight increases can overload the feet
Tight calves, hamstrings, or glute muscles can create a strong pull on your plantar fascia
Increasing your running intensity or training volume too quickly with, for example, fast or hill running
Walking or running on harder surfaces
Weak leg and foot muscles that cannot absorb high-impact activities

Question 5

Treatment, recovery times & prevention

Accepted Answer

Treatment

There is no single treatment to cure plantar fasciitis because various factors can cause it. Although the following treatment options may help reduce your pain in the short term, only strength training can ultimately help you recover in the long term.

Treatment options include:

Relative rest – cutting out aggravating activities and reducing your training program to avoid increasing symptoms
Supportive shoes – shoes with or without orthotics that adequately support the arch of your foot
Gentle plantar fascia stretching, don’t be aggressive as overstretching can increase pain
Stretches for glutes, hamstrings, and calf muscles
Self-massage of your plantar fascia and the other leg muscles
Progressive strength training for your foot and leg muscles

Other treatments that may be useful:

Wearing a night splint while sleeping
Taping to support the arch of your foot
Losing weight
Using shockwave and low-level laser therapy
Corticosteroid injections (but note, although they can reduce short-term pain, they may hinder long-term recovery)

Healing times

Recovery can take anywhere from 12 weeks to 18 months or longer, depending on the severity of your symptoms and how quickly you follow the correct treatment advice.

Prevention

Wear supportive shoes.
When switching to less supportive, minimalist shoes, transition slowly, and when beginning, only run short distances in them.
Avoid walking barefoot on hard surfaces.

Do regular strength training for your core and general leg muscles.

Question 6

Research References

Accepted Answer

Belhan, Oktay, Mehmet Kaya, and Murat Gurger. “The thickness of heel fat-pad in patients with plantar fasciitis.” Acta orthopaedica et traumatologica turcica 53.6 (2019): 463-467.
Morrissey, D., et al. (2021). “Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values.” British Journal of Sports Medicine.
Rathleff, M. S., et al. (2015). “High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.” Scandinavian Journal of Medicine & Science in Sports 25(3): e292-e300.
Schuitema, D., et al. (2019). “Effectiveness of mechanical treatment for plantar fasciitis: a systematic review.” Journal of sport rehabilitation 29(5): 657-674.
Robroy L. Martin, et al. (2014). “Heel Pain—Plantar Fasciitis: Revision 2014.” Journal of Orthopaedic & Sports Physical Therapy 44(11): A1-A33.
Tu, P. (2018). “Heel pain: diagnosis and management.” American family physician 97.

Plantar fasciitis treatment plan