Plantar fasciitis is a painful condition of the feet, affecting the plantar fascia — the strong band of connective tissue that runs along the bottom of the foot. The plantar fascia connects the heel bone to the toes. When it becomes inflamed, stressed or injured the result is pain along the bottom of the foot back to the heel.. This supportive tissue is also subject to more severe injury, partial tears or even full ruptures in the most severe cases. Plantar fasciitis is the most common cause of heel pain. Typically the pain is worse on first getting up in the morning then eases as the day goes on. Prolonged standing or walking, however, can make the pain worse.

Doctors often interchange the terms heel spur and plantar fasciitis for patients who present with pain at the inferior aspect of the heel. While these two diagnoses are related, they are not the same. Plantar fasciitis refers to the inflammation of the plantar fascia–the tissue that forms the arch of the foot. A heel spur is a deposit of bone that can form on the heel bone (calcaneus) and is associated with plantar fasciitis.

Many patients with plantar fasciitis have a heel spur that can be seen on an X-ray. However, many patients without symptoms of pain can also have a heel spur. The development of a spur is thought to be the result of chronic irritation/traction to the covering (periosteum) of the heel bone from the plantar fascia.

Heel spurs are common in patients who have a history of foot pain caused by plantar fasciitis. In the setting of plantar fasciitis, heel spurs are most often seen in middle-aged men and women, but can be found in all age groups. The heel spur itself is not thought to be the primary cause of pain, rather inflammation and irritation of the plantar fascia is thought to be the primary problem. A heel spur diagnosis is made when an x-ray shows a hook of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone.



The plantar fascia is a thick connective tissue that runs from the calcaneus (heel bone) to the ball of the foot. This strong and tight tissue helps maintain the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. That’s why tremendous stress is placed on the plantar fascia. The plantar fascia is like a bowstring that provides support for the foot. If the tension on this foot support structure is too great, it can become overly stretched eventually resulting in small tears in the fascia. This is a vicious cycle, the end result is foot and heel pain. During the initial stages, many patients with plantar fasciitis fail to demonstration a heel spur on x-ray.

When a patient has plantar fasciitis, the plantar fascia becomes inflamed and degenerative (fasciosis)–these abnormalities can make normal activities quite painful. Symptoms typically worsen early in the morning after sleep. At that time, the plantar fascia is tight so even simple movements stretch the contracted plantar fascia. As you begin to loosen the plantar fascia, the pain usually subsides, but often returns with prolonged standing or walking.



It has been long established and generally accepted by most physicians that plantar fasciitis responds well to non-surgical management.

The first treatment step is avoiding activities that aggravate symptoms. For example, take a few days off from jogging or prolonged standing to try to replace with low impact activities such as the stationary bike or elliptical etc.

Icing will help diminish some of the symptoms and control the heel pain. Icing is especially helpful after an acute exacerbation of symptoms.

Posterior stretching and plantar fascial massage are designed to relax the tissues that surround the heel bone. Some simple exercises, performed in the morning and evening, often help you feel better quickly.



Anti-inflammatory medications both orally (Ex. Motin) and topically (Ex. topical anti-inflamatory creams) help control pain and decrease inflammation. Over-the-counter medications are usually sufficient, but prescription options are also available.

Orthotic inserts are often the key to successful treatment of plantar fasciitis. This is usually an activity related stress induced condition that requires off loading at the injured area. Custom orthotic shoe inserts are designed to control the abnormal flattening (pronatory stress) that contributes to the micro injury and inflammation.

Night splints are worn to keep the heel stretched out when you sleep. They prevent the arch of the foot from becoming contracted at night, and is hopefully not as painful in the morning.


Cortisone injections. Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be injected into the plantar fascia to reduce inflammation and pain. Some doctors may limit your injections. The two problems that cause concern are fat pad atrophy and plantar fascial rupture. A lot depends on the type of cortisone and location of the injection. While both of these concerns only occur in a small percentage of patients, they can worsen heel pain symptoms.

While these treatments have historically relieved pain 70 -80% in most patients, the symptoms usually will not resolve quickly and most patients find relief within about two to three months of conservative care and may take up to a year.
A new treatment for heel spur syndrome/ chronic plantar fasciitis is called extracorporeal shock wave therapy, or ESWT, uses energy pulses to induce microtrauma to the tissue around the heel spur. This microtrauma is thought to induce a tissue repair process by the body. ESWT is recommended in patients who have failed the previously mentioned treatments, and are considering surgical options. (See our page section in specialized services – ESWT.)

An alternative new treatment is Platelet rich plasma therapy , non-surgical approach to the treatment of plantar fasciitis. PRP is derived from your own blood. Blood is drawn from your arm and put into a special machine that separates out the PRP. Platelet rich plasma contains growth factors, cytokines, proteins and other components that stimulate natural tissue healing and regrowth. PRP is the highly concentrated healing part of the blood. With the best centrifuges, concentrations of platelets of up to 700% can be obtained. PRP is administered as an injection in the heel area where the plantar fascia is attached. It works by regenerating and healing damaged tissue in the plantar fascia. This is done with local anesthesia to minimize the discomfort. PRP works by using the body’s own natural healing mechanism to repair the damaged or torn plantar fascia. Healing time is 6-8 weeks, a dramatic improvement over the typical natural history of 6-8 months to heal with other therapies. Most of the time, it will help to avoid foot surgery. (See our page section in specialized services – PRP)

To prevent the recurrence of heel spur symptoms after treatment, proper fitting footwear is essential.. Custom orthotics should always be worn especially if there appears to be a problem with the mechanical structure of the foot. It is also important to continue the stretching and exercises. These simple exercises will help maintain the flexibility of the foot and prevent the plantar fasciitis pain from returning.

In a small number of cases (usually less than 5 percent), patients may not experience relief after trying the recommendations listed above and may require surgery. It is usually recommended that conservative treatments (such as those listed above) be performed for AT LEAST a three to 6 month period before considering surgery. Time is important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications from the procedure. Surgical treatment can range from simple release of the plantar fascia to removal of the spur itself. (See endoscopic procedure page under specialized services section.)
Historically surgery has about an 80 percent success in relieving pain in the small group of patients who do not improve with conservative treatments.