In brief
Plantar fasciitis, often called a heel spur, is inflammation or chronic irritation of the plantar fascia that causes pain on the underside of the heel. The pain is felt mainly with the first steps in the morning or after prolonged sitting, and it may last for months.
What is plantar fasciitis?
Plantar fasciitis is inflammation or chronic irritation of the plantar fascia, a thick band of tissue that runs from the heel bone to the base of the toes and supports the arch of the foot. It is one of the common causes of heel pain in adults. Many people know the condition as a “heel spur”. Strictly speaking, a heel spur is a small bony growth on the heel bone that sometimes shows up on an X-ray. It can appear together with plantar fasciitis, but in many cases the source of the pain is the fascia itself and not the bony growth.
What are the symptoms of plantar fasciitis?
Common symptoms include:
- Sharp or stabbing pain on the underside of the heel.
- Pain with the first steps in the morning.
- Pain when standing up after prolonged sitting.
- Pain that increases after long periods of standing or walking.
- Tenderness when pressing on the heel area.
- Pain that appears after exercise, and not necessarily during it.
- Difficulty walking barefoot or on hard surfaces.
The pain usually develops gradually, and sometimes it affects only one foot.
Why does plantar fasciitis develop?
The plantar fascia absorbs load with every step. When that load is repeated over time, tiny changes, irritation and a chronic inflammatory process may develop where the fascia attaches to the heel bone. In many cases there is no single clear cause, but rather a combination of load, foot structure and daily habits.
Who is at higher risk?
Factors that may raise the risk include:
- Prolonged standing on hard surfaces, for example at work.
- Running or other activity with repeated load on the foot.
- A sharp increase in training intensity.
- Excess weight.
- Flat feet or a high arch.
- Tight calf muscles or a tight Achilles tendon.
- Shoes that do not give enough support.
The condition is more common in middle age, but it can also affect active younger people.
How is plantar fasciitis diagnosed?
Diagnosis is based mainly on a medical conversation and a physical examination. The doctor asks about the nature of the pain, when it appears and how long it has lasted, and examines the foot and the tender area. Diagnosis usually includes:
- A conversation about your symptoms and daily activity.
- A physical examination of the foot and ankle.
- Ruling out other causes of heel pain.
- When needed: X-ray, ultrasound or MRI.
It is important to confirm that the pain really fits plantar fasciitis, because heel pain can also come from a stress fracture, nerve compression, an Achilles tendon problem, pain that originates in the lower back or other conditions.
What conservative treatments are available?
Treatment always starts with a conservative approach. In most patients the pain improves gradually, usually over months, with a combination of several measures:
- Reducing load and adjusting activity.
- Stretching exercises for the plantar fascia and calf muscles.
- Supportive footwear, insoles or heel cushions.
- Tailored physiotherapy.
- Medication to relieve pain or reduce inflammation, as advised by a doctor.
- A night splint in suitable cases.
- Local injections in selected cases.
- Shockwave therapy.
Consistency matters. Improvement in plantar fasciitis usually takes time and patience, and it is not always felt in the first weeks.
When is plantar fasciitis considered persistent or chronic?
When the pain lasts for many months, limits walking, work or exercise, and does not improve enough despite well-structured conservative treatment, it is worth re-examining both the diagnosis and the treatment options. At this stage additional options are sometimes considered, and in a small number of cases surgery as well.
When can embolization be considered?
Embolization is a minimally invasive procedure performed by an interventional radiologist through a catheter. During the procedure, small inflamed blood vessels around the heel are selectively blocked, with the aim of helping to reduce pain. This option is considered only in selected patients whose pain continues despite prolonged conservative treatment. Important to know: for plantar fasciitis, this is a relatively new treatment. The data published so far come mainly from small series of patients, and long-term follow-up is still limited. The treatment is not suitable for every patient, the result is not guaranteed, and the decision is made only after an individual assessment and an open conversation about what is known and what is not yet known.
When should you see a doctor?
It is worth seeking a medical examination when:
- Heel pain lasts more than a few weeks.
- The pain interferes with walking, work or sleep.
- There is not enough improvement despite stretching, insoles and reduced load.
- There is swelling, redness, local warmth or fever.
- There is numbness, a burning sensation or weakness in the foot.
- The pain appeared suddenly after an injury.
Living with long-lasting heel pain?
Contact us to schedule a consultation with Dr. Adam Farkas, a specialist in interventional radiology, to find out whether a minimally invasive treatment may be suitable for you.
Further reading
Frequently asked questions
What is plantar fasciitis?
Plantar fasciitis is inflammation or chronic irritation of the plantar fascia, the band of tissue that supports the arch of the foot. It causes pain on the underside of the heel, mainly with the first steps in the morning.
Are plantar fasciitis and a heel spur the same thing?
In everyday language both names are used for the same heel pain. Medically, a heel spur is a bony growth on the heel bone, and in many cases the source of the pain is the fascia itself and not the growth.
Does plantar fasciitis go away on its own?
In most patients the pain improves gradually with conservative treatment such as stretching, suitable footwear and physiotherapy, but in some it lasts for many months and calls for further evaluation.
When should I get it checked?
When the pain lasts more than a few weeks, interferes with walking or function, or when there is not enough improvement after conservative treatment.
Is embolization suitable for everyone with heel pain?
No. It is a relatively new treatment, considered only in selected patients with chronic plantar fasciitis that has not improved enough with conservative treatment, and only after an individual assessment.
