Plantar Fasciitis - Pain in the Foot

The plantar fasciitis is one of the most common causes of heel pain or soles, being caused by inflammation of the plantar fascia, a kind of ligament located on the sole of the foot.

Plantar fasciitis
Plantar fasciitis

Plantar fascia

The plantar fascia, also called plantar aponeurosis, is a ligament which is along the bottom of the foot, known as sole or sole of the foot. The plantar fascia is a thick band of tissue, closely linked to skin and elastic properties, able to stretch slightly as the movement of the feet. This fabric covers the entire base of the foot, extending from the heel bone, called the calcaneus, to the tip of the foot, where it divides into five branches, one for each finger.

The plantar fascia acts like a rubber band. It creates a voltage so that the foot was always slightly arched. When we walk, at the moment when the heel is raised off the ground with only the toes resting against the ground, the plantar fascia acts as a winch reducing pressure from fingers which keep the whole body weight at the moment.

Plantar fasciitis

The plantar fasciitis is an inflammation of the plantar fascia. There is usually greater inflammation of the fascia near its attachment to the heel bone.


The plantar fasciitis arises after repetitive stresses in the region of the foot sole, typically caused by tension and tearing of the plantar fascia, which lead to microtrauma of this tissue and consequently inflammation of lesion area.

The plantar fasciitis usually occurs in people between 40 and 60, who throughout their life had activities or problems that caused repeated stress on the plantar fascia, for example:
  • Obesity
  • Cavus foot
  • Flatfoot
  • Work requiring long standing such as security guards, teachers, surgeons, factory workers, etc
  • Excessive use of high heels
  • Use of inappropriate footwear for little feet as tight, wide or old shoes
  • Gait, like stepping with clubfoot, especially with the inside of the feet

The plantar fasciitis is also very common for people who are engaged in certain activities such as racing, ballet, dance and weight lifting. Hiking without proper shoes can also cause stress on the soles of the feet and lead to injury of the plantar fascia. These activities can cause the early onset of plantar fasciitis, before the age of 40.

Calcaneal spur and plantar fasciitis

The calcaneal spur is a lump that appears on the heel bone due to multiple microtrauma in this region. Therefore, the same injury that triggers the onset of plantar fasciitis also causes the appearance of the spur.

Previously it was thought that the spur was a cause of plantar fasciitis, but today we know that only 5% of patients present with spur framework of pain and inflammation in the sole of the foot.

Symptoms of plantar fasciitis

The most common symptom of plantar fasciitis is stab pain in the foot, especially in the region just below the heel. The pain is typically worse during the first steps, like getting out of bed in the morning or stand up after sitting for a while. The pain of plantar fasciitis usually involves only one foot, although it is possible to have a lesion on both feet simultaneously.

The pain may be aggravated by walking barefoot on hard surfaces or climbing stairs. For athletes it can be exacerbated by a race. Professionals who remain standing for a long time often complain of worsening at the end of the day.

An important element in medical report is the period that precedes the onset of plantar fasciitis. Patients may say that before the onset of pain there was increased amount of physical activity, change in the usual type of footwear or trauma in the foot.


The diagnosis can be made through the patient's medical report and physical examination of the feet. A doctor will look for signs of damage in the feet, pain points and anatomical abnormalities such as flat feet.

If in doubt, ultrasonography and magnetic resonance imaging may help in the diagnosis. A radiograph of the foot is usually requested when we want to find out other cause for the pain.


Plantar fasciitis treatment
Plantar fasciitis treatment
Treatment is initially done conservatively with rest and ice spot. Other treatments for plantar fasciitis include:
  • Physiotherapy with specific exercises and stretches for the feet and calves
  • Footwear with special insoles. It is important for those whose work requires long standing
  • In some cases the use of anti-inflammatory for a few days may be necessary to control pain
  • The use of night splints is also an option
  • People who are overweight should lose weight

Injections of corticosteroids in the heel may be used in cases when there is no satisfactory response to conservative treatment.

In general, more than 80% of patients respond to such treatment. Surgery is the last option and is rarely needed.

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