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Plantar fasciitis

Rachelle Buchbinder, MBBS, MSc, PhD, FRACP
Section Editor
Zacharia Isaac, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


The deep plantar fascia (plantar aponeurosis) is a thick, pearly-white tissue with longitudinal fibers intimately attached to the skin. Plantar fasciitis, characterized by pain in the plantar region of the foot that is worse when initiating walking, is one of the most common causes of foot and heel pain in adults.

A large number of additional disorders can cause foot and heel pain. These include:

Achilles tendinopathy

Haglund's syndrome

Stress fractures due to osteoporosis

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Literature review current through: Nov 2017. | This topic last updated: May 05, 2017.
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  1. Essentials of Musculoskeletal Care, 2nd, Greene WB (Ed), American Academy of Orthopaedic Surgeons, Rosemont 2001. p.487.
  2. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int 2004; 25:303.
  3. Furey JG. Plantar fasciitis. The painful heel syndrome. J Bone Joint Surg Am 1975; 57:672.
  4. Taunton JE, Ryan MB, Clement DB, et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2002; 36:95.
  6. Sadat-Ali M. Plantar fasciitis/calcaneal spur among security forces personnel. Mil Med 1998; 163:56.
  7. Prichasuk S, Subhadrabandhu T. The relationship of pes planus and calcaneal spur to plantar heel pain. Clin Orthop Relat Res 1994; :192.
  8. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am 2003; 85-A:872.
  9. Gill LH, Kiebzak GM. Outcome of nonsurgical treatment for plantar fasciitis. Foot Ankle Int 1996; 17:527.
  10. Rano JA, Fallat LM, Savoy-Moore RT. Correlation of heel pain with body mass index and other characteristics of heel pain. J Foot Ankle Surg 2001; 40:351.
  11. Onuba O, Ireland J. Plantar fasciitis. Ital J Orthop Traumatol 1986; 12:533.
  12. Moroney PJ, O'Neill BJ, Khan-Bhambro K, et al. The conundrum of calcaneal spurs: do they matter? Foot Ankle Spec 2014; 7:95.
  13. McBryde AM Jr. Plantar fasciitis. Instr Course Lect 1984; 33:278.
  14. Warren BL, Jones CJ. Predicting plantar fasciitis in runners. Med Sci Sports Exerc 1987; 19:71.
  15. Rome K. Anthropometric and biomechanical risk factors in the development of plantar heel pain - a review of the literature. Phys Ther Rev 1997; 2:123.
  16. Messier SP, Pittala KA. Etiologic factors associated with selected running injuries. Med Sci Sports Exerc 1988; 20:501.
  17. Warren BL. Anatomical factors associated with predicting plantar fasciitis in long-distance runners. Med Sci Sports Exerc 1984; 16:60.
  18. Hotta T, Nishiguchi S, Fukutani N, et al. The association between plantar heel pain and running surfaces in competitive long-distance male runners. J Sports Med Phys Fitness 2016; 56:1021.
  19. Waclawski ER, Beach J, Milne A, et al. Systematic review: plantar fasciitis and prolonged weight bearing. Occup Med (Lond) 2015; 65:97.
  20. Oloff LM, Schulhofer SD. Flexor hallucis longus dysfunction. J Foot Ankle Surg 1998; 37:101.
  21. Cheung JT, Zhang M, An KN. Effect of Achilles tendon loading on plantar fascia tension in the standing foot. Clin Biomech (Bristol, Avon) 2006; 21:194.
  22. Harty J, Soffe K, O'Toole G, Stephens MM. The role of hamstring tightness in plantar fasciitis. Foot Ankle Int 2005; 26:1089.
  23. Harvey CK. Fibromyalgia. Part II. Prevalence in the podiatric patient population. J Am Podiatr Med Assoc 1993; 83:416.
  24. Riggs BL, Hodgson SF, Hoffman DL, et al. Treatment of primary osteoporosis with fluoride and calcium. Clinical tolerance and fracture occurrence. JAMA 1980; 243:446.
  25. Paice EW, Hoffbrand BI. Nutritional osteomalacia presenting with plantar fasciitis. J Bone Joint Surg Br 1987; 69:38.
  26. Jarde O, Diebold P, Havet E, et al. Degenerative lesions of the plantar fascia: surgical treatment by fasciectomy and excision of the heel spur. A report on 38 cases. Acta Orthop Belg 2003; 69:267.
  27. Leach RE, Seavey MS, Salter DK. Results of surgery in athletes with plantar fasciitis. Foot Ankle 1986; 7:156.
  28. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003; 93:234.
  29. Osborne HR, Breidahl WH, Allison GT. Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis. J Sci Med Sport 2006; 9:231.
  30. Helie O, Dubayle P, Boyer B, Pharaboz C. [Magnetic resonance imaging of lesions of the superficial plantar fasciitis]. J Radiol 1995; 76:37.
  31. McGonagle D, Marzo-Ortega H, O'Connor P, et al. The role of biomechanical factors and HLA-B27 in magnetic resonance imaging-determined bone changes in plantar fascia enthesopathy. Arthritis Rheum 2002; 46:489.
  32. Dasgupta B, Bowles J. Scintigraphic localisation of steroid injection site in plantar fasciitis. Lancet 1995; 346:1400.
  33. Gibbon WW, Long G. Ultrasound of the plantar aponeurosis (fascia). Skeletal Radiol 1999; 28:21.
  34. Groshar D, Alperson M, Toubi A, et al. Plantar fasciitis: detection with ultrasonography versus bone scintigraphy. The Foot 2000; 10:164.
  35. Sabir N, Demirlenk S, Yagci B, et al. Clinical utility of sonography in diagnosing plantar fasciitis. J Ultrasound Med 2005; 24:1041.
  36. Walther M, Radke S, Kirschner S, et al. Power Doppler findings in plantar fasciitis. Ultrasound Med Biol 2004; 30:435.
  37. Buchbinder R. Clinical practice. Plantar fasciitis. N Engl J Med 2004; 350:2159.
  38. Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician 2005; 72:2237.
  39. Singh D, Angel J, Bentley G, Trevino SG. Fortnightly review. Plantar fasciitis. BMJ 1997; 315:172.
  40. Stephens MM. Haglund's deformity and retrocalcaneal bursitis. Orthop Clin North Am 1994; 25:41.
  41. Kleiger B. The posterior calcaneal tubercle impingement syndrome. Orthop Rev 1988; 17:487.
  42. Brunner J, Anderson J, O'Malley M, et al. Physician and patient based outcomes following surgical resection of Haglund's deformity. Acta Orthop Belg 2005; 71:718.
  43. Katoh Y, Chao EY, Morrey BF, Laughman RK. Objective technique for evaluating painful heel syndrome and its treatment. Foot Ankle 1983; 3:227.
  44. Spiegl PV, Johnson KA. Heel pain syndrome: Which treatments to choose? J Musculoskel Med 1984; 1:66.
  45. Shelley WB, Rawnsley HM. Painful feet due to herniation of fat. JAMA 1968; 205:308.
  46. Shaw RA, Holt PA, Stevens MB. Heel pain in sarcoidosis. Ann Intern Med 1988; 109:675.
  47. Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev 2003; :CD000416.
  48. Donley BG, Moore T, Sferra J, et al. The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study. Foot Ankle Int 2007; 28:20.
  49. Powell M, Post WR, Keener J, Wearden S. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Foot Ankle Int 1998; 19:10.
  50. Probe RA, Baca M, Adams R, Preece C. Night splint treatment for plantar fasciitis. A prospective randomized study. Clin Orthop Relat Res 1999; :190.
  51. Ryan J. Use of posterior night splints in the treatment of plantar fasciitis. Am Fam Physician 1995; 52:891.
  52. Wapner KL, Sharkey PF. The use of night splints for treatment of recalcitrant plantar fasciitis. Foot Ankle 1991; 12:135.
  53. Roos E, Engström M, Söderberg B. Foot orthoses for the treatment of plantar fasciitis. Foot Ankle Int 2006; 27:606.
  54. Pfeffer G, Bacchetti P, Deland J, et al. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int 1999; 20:214.
  55. Caselli MA, Clark N, Lazarus S, et al. Evaluation of magnetic foil and PPT Insoles in the treatment of heel pain. J Am Podiatr Med Assoc 1997; 87:11.
  56. Winemiller MH, Billow RG, Laskowski ER, Harmsen WS. Effect of magnetic vs sham-magnetic insoles on plantar heel pain: a randomized controlled trial. JAMA 2003; 290:1474.
  57. DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am 2003; 85-A:1270.
  58. Digiovanni BF, Nawoczenski DA, Malay DP, et al. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am 2006; 88:1775.
  59. Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord 2007; 8:36.
  60. Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports 2015; 25:e292.
  61. Landorf KB, Radford JA, Keenan AM, Redmond AC. Effectiveness of low-Dye taping for the short-term management of plantar fasciitis. J Am Podiatr Med Assoc 2005; 95:525.
  62. Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of low-Dye taping for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord 2006; 7:64.
  63. Podolsky R, Kalichman L. Taping for plantar fasciitis. J Back Musculoskelet Rehabil 2015; 28:1.
  64. Crawford F, Atkins D, Young P, Edwards J. Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial. Rheumatology (Oxford) 1999; 38:974.
  65. Ball EM, McKeeman HM, Patterson C, et al. Steroid injection for inferior heel pain: a randomised controlled trial. Ann Rheum Dis 2013; 72:996.
  66. Kalaci A, Cakici H, Hapa O, et al. Treatment of plantar fasciitis using four different local injection modalities: a randomized prospective clinical trial. J Am Podiatr Med Assoc 2009; 99:108.
  67. Kamel M, Kotob H. High frequency ultrasonographic findings in plantar fasciitis and assessment of local steroid injection. J Rheumatol 2000; 27:2139.
  68. Li Z, Xia C, Yu A, Qi B. Ultrasound- versus palpation-guided injection of corticosteroid for plantar fasciitis: a meta-analysis. PLoS One 2014; 9:e92671.
  69. D'Ambrosia RD. Conservative management of metatarsal and heel pain in the adult foot. Orthopedics 1987; 10:137.
  70. Sellman JR. Plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int 1994; 15:376.
  71. Acevedo JI, Beskin JL. Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int 1998; 19:91.
  72. Hawke F, Burns J, Radford JA, du Toit V. Custom-made foot orthoses for the treatment of foot pain. Cochrane Database Syst Rev 2008; :CD006801.
  73. Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med 2006; 166:1305.
  74. Wrobel JS, Fleischer AE, Crews RT, et al. A randomized controlled trial of custom foot orthoses for the treatment of plantar heel pain. J Am Podiatr Med Assoc 2015; 105:281.
  75. Oliveira HA, Jones A, Moreira E, et al. Effectiveness of total contact insoles in patients with plantar fasciitis. J Rheumatol 2015; 42:870.
  76. Gudeman SD, Eisele SA, Heidt RS Jr, et al. Treatment of plantar fasciitis by iontophoresis of 0.4% dexamethasone. A randomized, double-blind, placebo-controlled study. Am J Sports Med 1997; 25:312.
  77. Osborne HR, Allison GT. Treatment of plantar fasciitis by LowDye taping and iontophoresis: short term results of a double blinded, randomised, placebo controlled clinical trial of dexamethasone and acetic acid. Br J Sports Med 2006; 40:545.
  78. Davis PF, Severud E, Baxter DE. Painful heel syndrome: results of nonoperative treatment. Foot Ankle Int 1994; 15:531.
  79. Daly PJ, Kitaoka HB, Chao EY. Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation. Foot Ankle 1992; 13:188.
  80. Sinnaeve F, Vandeputte G. Clinical outcome of surgical intervention for recalcitrant infero-medial heel pain. Acta Orthop Belg 2008; 74:483.
  81. Barrett SJ, O'Malley R. Plantar fasciitis and other causes of heel pain. Am Fam Physician 1999; 59:2200.
  82. Kinley S, Frascone S, Calderone D, et al. Endoscopic plantar fasciotomy versus traditional heel spur surgery: a prospective study. J Foot Ankle Surg 1993; 32:595.
  83. Saxena A. Uniportal endoscopic plantar fasciotomy: a prospective study on athletic patients. Foot Ankle Int 2004; 25:882.
  84. Thomson CE, Crawford F, Murray GD. The effectiveness of extra corporeal shock wave therapy for plantar heel pain: a systematic review and meta-analysis. BMC Musculoskelet Disord 2005; 6:19.
  85. Aqil A, Siddiqui MR, Solan M, et al. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs. Clin Orthop Relat Res 2013; 471:3645.
  86. Dizon JN, Gonzalez-Suarez C, Zamora MT, Gambito ED. Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: a meta-analysis. Am J Phys Med Rehabil 2013; 92:606.
  87. Steffens D, Maher CG. RE.: Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis. Am J Phys Med Rehabil 2014; 93:458.
  88. Porter MD, Shadbolt B. Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy. Clin J Sport Med 2005; 15:119.
  89. Mardani-Kivi M, Karimi Mobarakeh M, Hassanzadeh Z, et al. Treatment Outcomes of Corticosteroid Injection and Extracorporeal Shock Wave Therapy as Two Primary Therapeutic Methods for Acute Plantar Fasciitis: A Prospective Randomized Clinical Trial. J Foot Ankle Surg 2015; 54:1047.
  90. Gollwitzer H, Saxena A, DiDomenico LA, et al. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg Am 2015; 97:701.
  91. Lee TG, Ahmad TS. Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial. Foot Ankle Int 2007; 28:984.
  92. Mahindra P, Yamin M, Selhi HS, et al. Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo. Orthopedics 2016; 39:e285.
  93. Akşahin E, Doğruyol D, Yüksel HY, et al. The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Arch Orthop Trauma Surg 2012; 132:781.
  94. Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int 2014; 35:313.
  95. Babcock MS, Foster L, Pasquina P, Jabbari B. Treatment of pain attributed to plantar fasciitis with botulinum toxin a: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil 2005; 84:649.
  96. Díaz-Llopis IV, Rodríguez-Ruíz CM, Mulet-Perry S, et al. Randomized controlled study of the efficacy of the injection of botulinum toxin type A versus corticosteroids in chronic plantar fasciitis: results at one and six months. Clin Rehabil 2012; 26:594.
  97. Young MA, Cook JL, Webster KE. The effect of topical wheatgrass cream on chronic plantar fasciitis: a randomized, double-blind, placebo-controlled trial. Complement Ther Med 2006; 14:3.
  98. Micke O, Seegenschmiedt MH, German Cooperative Group on Radiotherapy for Benign Diseases. Radiotherapy in painful heel spurs (plantar fasciitis)--results of a national patterns of care study. Int J Radiat Oncol Biol Phys 2004; 58:828.
  99. Allen BH, Fallat LM, Schwartz SM. Cryosurgery: an innovative technique for the treatment of plantar fasciitis. J Foot Ankle Surg 2007; 46:75.
  100. Macias DM, Coughlin MJ, Zang K, et al. Low-Level Laser Therapy at 635 nm for Treatment of Chronic Plantar Fasciitis: A Placebo-Controlled, Randomized Study. J Foot Ankle Surg 2015; 54:768.
  101. Yeung EW, Yeung SS. A systematic review of interventions to prevent lower limb soft tissue running injuries. Br J Sports Med 2001; 35:383.
  102. Milgrom C, Finestone A, Shlamkovitch N, et al. Prevention of overuse injuries of the foot by improved shoe shock attenuation. A randomized prospective study. Clin Orthop Relat Res 1992; :189.
  103. Martin RL, Irrgang JJ, Conti SF. Outcome study of subjects with insertional plantar fasciitis. Foot Ankle Int 1998; 19:803.
  104. Wolgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int 1994; 15:97.