Medicine (MD/DO)
Lower Extremity Disorders
Plantar Fasciitis

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Plantar Fasciitis

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Plantar Fasciitis

Fascial fashion dress and Plant on Fire
Plantar fasciitis is a degenerative condition of the plantar fascia that leads to inflammation and sharp pain on the bottom of the foot. The heel pain is worse in the morning and with dorsiflexion. Treatment begins with lifestyle changes (e.g. avoiding barefoot walking) and NSAIDs. Patients with refractory disease may be treated with a single glucocorticoid injection. Surgery is reserved as the last resort treatment.
Inflammation of Plantar Fascia
Plant and Fashion-dress in Flames

Repetitive microtrauma from prolonged use of the foot causes tensile overload and damage to the plantar fascia. This can lead to the inflammation of the fibrous tissue that makes up the plantar aponeurosis.

Heel Pain

The plantar fascia (aponeurosis) is a thick connective tissue that supports the plantar side of the foot. The plantar aponeurosis originates on the calcaneal tuberosity and inserts on the heads of the metatarsal bones. Severe heel pain and tenderness, particularly pronounced with first steps in the morning or with dorsiflexion, is the hallmark feature of plantar fasciitis.

Worse in Morning and with Dorsiflexion
Morning-sun Dorsal-fin-flexing Foot

Heel pain typically is worse in the morning, likely due to reduced blood flow throughout the night. The pain is also worsened by dorsiflexion due to the increased stress on the plantar fascia.

Lifestyle Changes

Treatment usually begins with lifestyle changes. Patients should decrease physical activities that may be causative or aggravating (e.g., strenuous exercise, barefoot walking). Stretching exercises are often recommended.


A short-term trial of nonsteroidal anti-inflammatory drugs (NSAIDs) is sometimes effective in patients with plantar fasciitis. NSAIDs block the synthesis of prostaglandins leading to decreased inflammation and pain.


In some patients who experience significant pain and disability despite the lifestyle modifications and NSAIDs, a single glucocorticoid injection can be attempted to decrease inflammation and relieve pain.

Surgery as Last Resort
Surgery Last Resort

Most patients with plantar fasciitis will improve with conservative therapy. Surgery is the last-resort treatment for patients who do not respond to at least 6-12 months of nonoperative therapy.


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