Plantar Fasciitis: What It Is, Causes, and Symptoms

Heel pain with the first steps after sleep is a common complaint at an orthopedist's office. It is usually caused by plantar fasciitis: overload of the dense tissue that supports the arch of the foot. Below we describe how it is structured, why it becomes inflamed, and by what signs the disease is recognized.

What plantar fasciitis is and where the plantar fascia is located

The plantar fascia is a thick tissue on the sole. It connects the heel bone to the toes and forms the longitudinal arch of the foot. It works like a taut bowstring: when a person stands up, the foot sinks, and the fascia springs back and returns the arch to its position.

In an upright position, about half of the body weight presses on the fascia, and the greatest tension is experienced by the tissue at its attachment to the heel tubercle. Plantar fasciitis (plantar, or heel, fasciitis) is a condition in which the tissue swells and becomes inflamed, and the lower part of the foot hurts in the heel and arch area. Among orthopedic foot complaints, this is one of the most common.

Causes of inflammation of the foot fascia

The cause is overstretching or overload of the fascia. During walking, microtears occur in it; they usually heal on their own, but with constant microtrauma, chronic aseptic inflammation with pain develops.

Often the underlying cause is shortening and contracture of the calf muscles and the fascia itself: the stiffer this system, the greater the load on the heel tubercle. Inflammation of the fascia is provoked by a sharp change in activity level, running on uneven and hard surfaces, footwear with poor shock absorption, and excess weight. A heel spur was long considered the cause of pain, but research has refuted this: on X-rays, spurs are also seen in people without fasciitis.

Symptoms of plantar fasciitis

The main symptom is pain at the bottom of the foot, around the heel and arch; sometimes it radiates along the inner edge of the sole. The pain can be dull or sharp, accompanied by burning and stiffness. With the first steps after sleep or rest, it sharply intensifies, then subsides while walking, but returns after prolonged standing, walking, or running. It also hurts on stairs and when trying to stretch the sole by lifting the toes off the floor.

The pain develops slowly or appears suddenly after intense exertion; sometimes the arch of the foot and the ankle hurt.

Who is at risk

Fasciitis more often occurs under the following conditions:

• age 40–60 years;
• overweight, obesity, or rapid weight gain;
• flat feet or high arch of the foot;
• tight, shortened calf muscles and Achilles tendon;
• work on one's feet, prolonged standing and walking on hard surfaces, running, dancing.

This also includes a sedentary lifestyle, work with prolonged sitting, and high-heeled shoes. Fasciitis occurs in both men and women. Heel spurs are more often found in people over 40 years old, and more in women. It is associated with obesity and inflammatory arthritides—rheumatoid, reactive, psoriatic.

How plantar fasciitis is diagnosed

The diagnosis is made based on complaints and examination. The doctor checks for tenderness on pressure along the sole and along the arch, assesses the shape of the foot, looks for mild swelling or redness, and checks the tension of the Achilles tendon and lower leg muscles. X-rays are done to exclude other causes of pain: the spur itself does not confirm the diagnosis. If there is no spur but the heel hurts, systemic inflammatory diseases are excluded—they can also begin with heel pain.

Possible complications and when to see a doctor

As a compensatory reaction, marginal bone growths—"heel spurs"—appear. Complications include fractures of such osteophytes. Most often the pain goes away without surgery: treatment takes from several months to two years, and most people feel improvement after 6–18 months.

You should consult a doctor if pain interferes with usual activities, intensifies or returns, if after two weeks of self-care measures it has not decreased, and also if there is tingling and loss of sensation in the foot. With diabetes, any foot pain is a reason to visit a doctor.

Plantar fasciitis by itself is not a reason to call an ambulance. Numbers 103 and 112 are for life-threatening conditions, such as signs of stroke or heart attack or severe trauma.

This material is for reference: it explains the essence of the diagnosis but does not replace a doctor's consultation—a specialist should evaluate the foot and make the diagnosis.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer