Plantar Fasciitis

Plantar fasciitis is a condition affecting the thick band of tissue (plantar fascia) that connects the heel bone to the toes. It causes sharp heel pain, typically most noticeable with the first steps in the morning or after prolonged rest. The plantar fascia acts as a shock-absorbing structure, supporting the foot’s arch during weight-bearing activities. Excessive stress and tension can lead to small tears, resulting in inflammation and discomfort.

Dr. Zackary Chua

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (Aus) | MMed (Singapore) | MRCS (Glasgow) | FRCSEd (Orth)

Symptoms Causes Types Diagnosis Treatment Prevention FAQ

Symptoms of Plantar Fasciitis

These symptoms characterise plantar fasciitis, with varying intensity throughout the day and during different activities.

Sharp Heel Pain: A stabbing sensation occurs at the bottom of the heel and often becomes most intense with the first few steps after waking up or prolonged sitting.
Pain After Exercise: Discomfort typically increases after physical activity rather than during it, resulting from repetitive stress on the plantar fascia.
Stiffness in the Heel: The affected area becomes stiff and tender, restricting toe movement and making everyday activities, such as climbing stairs, difficult.

Causes and Risk Factors

Plantar fasciitis can develop due to various factors, affecting both active individuals and those who are less physically active.

Age

The condition commonly occurs between ages 40 and 60, as the plantar fascia loses its elasticity and becomes more susceptible to degeneration.
Physical Activity Patterns

Long-distance runners, ballet dancers, and athletes participating in high-impact sports experience increased stress on their feet.
Body Weight

Excess body weight adds pressure to the plantar fascia, potentially accelerating the onset of the condition or intensifying its symptoms.
Foot Structure

Both high arches or flat feet affect how weight is distributed across the foot, which can lead to strain on the plantar fascia.
Occupational Factors

Extended periods of standing or walking on hard surfaces can put additional strain on the plantar fascia.

Forms of Plantar Fasciitis

Acute Plantar Fasciitis

Occurs suddenly, often following increased activity or specific incidents. Symptoms typically improve within a few weeks with appropriate conservative treatment. The pain is sharp and intense, particularly during the first steps after rest.

Chronic Plantar Fasciitis

The condition persists beyond 6 months despite conservative treatment. It is generally associated with the degeneration of the fascia rather than acute inflammation. The pain becomes persistent and affects daily activities significantly.

Diagnostic Methods

Physical Examination

Tender points along the plantar fascia are identified, and foot structure, flexibility, and strength are assessed. Specific movements help determine symptom patterns and severity.
Imaging Studies

X-rays are used to rule out heel spurs or fractures, while MRI or ultrasound scans can detect any soft tissue damage and inflammation.
Gait Analysis

Walking patterns are analysed to identify biomechanical factors contributing to the condition, focusing on foot positioning throughout different phases of movement.

Treatment Options

Plantar fasciitis is primarily managed with non-surgical treatments that relieve pain and support healing. Surgery is rarely necessary and is only considered if conservative methods fail to provide relief.

Non-Surgical Treatment

Supportive Footwear: Wearing shoes with proper arch support and cushioning helps distribute pressure evenly, reducing strain on the plantar fascia. Avoiding unsupportive footwear, such as high heels or flat-soled shoes, can prevent aggravating the symptoms.
Stretching and Physical Therapy: Targeted exercises improve flexibility in the plantar fascia and Achilles tendon while strengthening foot muscles to enhance arch support and prevent recurrence.
Pain and Inflammation Management: Over-the-counter anti-inflammatory medications help alleviate discomfort. Applying ice packs for 15–20 minutes several times a day can further reduce inflammation and swelling.
Orthotic Support: Custom or over-the-counter arch supports help redistribute weight, reducing strain on the plantar fascia and improving foot mechanics.
Immobilisation: In more severe cases, walking casts or splints may be used to limit foot movement, reduce pressure on the plantar fascia, and promote tissue healing..
Shockwave Therapy: High-energy sound waves stimulate blood flow to the affected area, accelerating healing and reducing inflammation.
Autologous Plasma Injections: Platelet-rich plasma (PRP) injections use concentrated growth factors from the patient’s blood to promote tissue repair and reduce pain.

Surgical Treatment

Surgery is considered only when symptoms persist despite extensive non-surgical treatment. A thorough evaluation determines the most appropriate approach based on individual needs. Surgical options may include releasing a portion of the plantar fascia to reduce tension or lengthening the calf muscle to alleviate strain.

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Prevention and Management

Consistent stretching exercises for feet and calves, appropriate footwear, and weight management reduce plantar fasciitis risk. Activity levels should increase gradually to allow tissue adaptation. Regular replacement of athletic shoes and proper sports technique help prevent recurrence.

Frequently Asked Questions (FAQ)

How long does plantar fasciitis take to heal?

Recovery spans from 6 weeks to several months, with most cases resolving through conservative treatment within 6-12 months. Healing duration varies based on treatment adherence and individual factors.

Can I continue exercising with plantar fasciitis?

Low-impact activities such as swimming or cycling help maintain fitness while supporting plantar fascia healing. Adjusting exercise routines prevents symptom aggravation.

What makes plantar fasciitis worse at night?

The plantar fascia naturally contracts during sleep. This contraction, combined with periods of inactivity, results in increased stiffness and pain upon initial movement.

Dr. Zackary Chua

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (Aus)|MMed (Singapore)|MRCS (Glasgow)|FRCSEd (Orth)

A distinguished Senior Consultant Orthopaedic Surgeon specialising in both adult and paediatric orthopaedic care.

Dr. Chua graduated from the University of Adelaide, Australia, with a Bachelor of Medicine and Bachelor of Surgery. He completed his Orthopaedic Specialist training under NUHS in Singapore in 2017.
In 2019, he was awarded the HMDP award, which enabled him to pursue a fellowship in Foot and Ankle Surgery at Oxford University Hospital NHS Trust in the UK.

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