The most common cause of pain on the bottom of the heel, plantar fasciitis occurs when the strong band of tissue that supports the arch of the foot becomes irritated and inflamed.
The plantar fascia is the long, thin ligament that connects the heel to the front of the foot and lies directly beneath the skin on the bottom of the foot. The plantar fascia supports the arch of the foot.
What causes plantar fasciitis?
Too much pressure on the plantar fascia can damage or tear the tissues, causing heel pain, inflammation and stiffness. Most commonly it develops without a specific reason. However, tighter calf muscles (that make it difficult to flex the foot and bring toes up toward the shin), obesity, a very high arch, repetitive impact activities such as running, or new or increased activity may play a role in the likelihood of it developing.
The most common symptoms of plantar fasciitis include:
- Pain on the bottom of the foot near the heel
- Pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. The pain subsides after a few minutes of walking
- Greater pain after (not during) exercise or activity
Plantar fasciitis treatment
More than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods, which include:
- Rest: Decreasing or even stopping the activities that make the pain worse is the first step in reducing the pain. Athletic activities may need to be stopped where the feet pound on hard surfaces (running or step aerobics for example).
- Ice: Rolling the foot over a cold water bottle or ice for 20 minutes is effective. This can be done 3 to 4 times a day.
- Anti-inflammatory medication: Drugs such as ibuprofen or naproxen reduce pain and inflammation.
- Exercise: Plantar fasciitis is aggravated by tight muscles in the feet and calves. Stretching the calves and plantar fascia is the most effective way to relieve the pain that comes with this condition.
- 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.
- Orthotics: Shoes with thick soles and extra cushioning can reduce pain with standing and walking.
- Night splints: Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone.
- Physical therapy: A physical therapy program may involve an exercises program focused on stretching the calf muscles and plantar fascia. It may also involve specialized ice treatments, massage, and medication to decrease inflammation around the plantar fascia.
In extreme cases, when nonsurgical options have not provided relief after 12 months, surgery may be considered. Surgery generally consists of a release of a portion of the plantar fascia to decrease the pull on the plantar fascia.
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