My Doctor Online The Permanente Medical Group

Symptoms

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Plantar fasciitis causes a number of symptoms that include:

• Sharp, stabbing pain on the bottom or side of the heel or in the arch of the foot.
• Pain that is worse in the morning or after any period of inactivity. As you begin to move around, the pain level usually improves.
• Pain that gets worse after a prolonged period of standing, walking, or running.

Pain can last for several weeks or months and can range from mild to severe. Plantar fasciitis will likely go away on its own, with rest, but it may take several months or longer to resolve completely. There is treatment to help you recover faster.

Screening and Diagnosis

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We usually diagnose plantar fasciitis by asking you about your symptoms and physically examining your foot. We may order an imaging study, such as an X-ray, if we suspect that your symptoms may be caused by another condition, such as a stress fracture, but this is rare.

Causes

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Excessive strain on the plantar fascia causes plantar fasciitis. Over time, this strain can tear the plantar fascia. Repeated stretching and tearing causes pain and inflammation. You may feel pain where the plantar fascia attaches to the heel bone, on the side of your heel, or in the arch area of your foot.

Risk Factors

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There are a number of factors that can increase the likelihood that you will develop plantar fasciitis including:

• Excess weight. Carrying extra weight increases the load on the plantar fascia and your foot as a whole.
• Specific sports activities. Activities that put significant pressure on your foot and require it to stretch repeatedly increase your risk. These activities include running, walking long distances, jumping, tennis, basketball, and aerobics. 
• Age. Middle-aged people, between 40 and 60 years old, are more likely to develop plantar fasciitis.
• Abnormal foot mechanics. Flat feet or high arches can affect the way that pressure is distributed across your foot, placing additional stress on the plantar fascia.
• Tight Achilles tendon and excessive flattening of your feet (pronation). The Achilles tendon links the calf muscle to the back of the heel. A tight calf muscle and Achilles tendon can cause your foot to flatten further, placing additional stress on the plantar fascia.
• Standing all day. Standing or walking on hard floors for a long time increases the load on your plantar fascia.
• Inadequate footwear. Excessively flat shoes that do not support your arch leave the plantar fascia unprotected. A shoe with a medium heel can heighten the arch and decrease stress on the plantar fascia.
• Sudden change in activity. Beginning an exercise program, such as high-impact aerobics, after a period of inactivity can overload the structures in your foot. Similarly, changing your running surface from grass to road can affect your plantar fascia.

Prevention

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There are a number of things you can do to protect your feet and prevent injury to your plantar fascia:

• Wear supportive shoes. We recommend running shoes or "pro" walking shoes. It's a good idea to wear these when you are running or walking a long distance or when you will be on your feet for an extended period of time.
• Wear shoes with slightly higher heels. A moderate heel can shorten the arch, reduce stress on the plantar fascia, and lead to a reduction of pain.
• Do not walk barefoot, even at home.
• Lose weight. Talk to your personal physician about weight management. We have a wide range of resources, including classes that can help you eat healthily and lose weight.
• Stretch. It is important to warm up before you exercise. Stretching your calf muscles will help protect your Achilles tendon, which in turn will ensure that your feet land correctly during walking and running.

Treatment

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It may take 3 to 12 months for your plantar fascia to heal completely. Treatment can help your foot heal faster. We recommend using a number of treatment approaches simultaneously, including home treatments and medical treatments. It is important that you continue treatment until you have been pain-free for at least 3 months.

The majority of people with plantar fasciitis recover within 3 to 9 months without the need for more aggressive treatment. In rare cases (less than 1%), surgical treatment may be considered.

Home Treatment

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Rest

Rest your foot for 2 to 6 weeks. Stand, walk, or run less. 

Change your activities

While your foot is resting, try exercise that does not stretch your arch, like swimming or cycling.

Choose footwear that supports your foot

Shoes and devices that support your foot can help protect your plantar fascia and allow it to heal. We recommend a combination of the following footwear and devices:

• Supportive shoes. Wear shoes with good arch and heel support. A higher heel may also help. Avoid standing or walking barefoot or in unsupportive shoes like slippers or sandals.
• Arch supports. Wearing arch supports inside your shoes reduces strain on the plantar fascia. We recommend the semirigid arch supports that are available at all of our pharmacies. 

Use over-the-counter pain relievers 

• Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help manage your pain or discomfort.
• OTC NSAIDs are effective pain relievers that can be used if you have no health conditions that prevent you from taking them. Even though you do not need a prescription for OTC NSAIDs, you should be careful to consult the package so that you take the correct dose.
• Be aware that OTC NSAIDs can interact with other medicines you may be taking and cause problems for people with various medical conditions. 
• These medications can help reduce the pain while your plantar fascia is healing. If they do not seem to be helping, do not continue taking them.
• If you have a complex medical condition, are pregnant or trying to get pregnant, or have been taking OTC NSAIDs and they do not relieve your symptoms, please let us know so that we can recommend an alternative.

Ice your foot

Massage the painful area with ice for 2 to 3 minutes, several times a day. 

Stretch

Stretch your calf muscles and Achilles tendon. It's important to stretch before and after you exercise. We recommend that you  warm up a little and then stretch at the beginning of your exercise program, if possible.

Nonsurgical Medical Treatments

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If the home treatment methods do not completely resolve your symptoms, we may recommend additional treatments that may include:

Cortisone injections

We may recommend a cortisone injection to reduce inflammation and accompanying pain. Cortisone is a steroid that mimics natural hormones that reduce inflammation. 

Custom orthotic insoles

• If standard inserts are not effective, we may recommend custom orthotic inserts that are made specifically for your foot. 
• We make a cast of your foot in order to create these inserts. 

Surgery

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Nonsurgical treatments are effective for most people. However, if your symptoms are severe and other treatments have not worked for at least 6 to 9 months, plantar fascia release surgery may be an option.

Plantar fascia release surgery

Plantar fascia release surgery involves cutting part of the plantar fascia in order to relieve some of the tension on the ligament. 

We may perform the surgery using tiny incisions (endoscopic surgery) or a traditional open incision on the bottom of your heel. Both types of surgeries are performed in our outpatient surgery center, and you will be able to go home the same day.  

Recovering from surgery

Most people recover within 4 to 12 months. You will need to wear a walking cast for several weeks after surgery. We will also advise you to use foot orthotics after the surgery on an ongoing basis.

Risks and complications

For most people, this surgery is successful and their pain is significantly reduced. However, as with any surgery, there are a number of potential risks and complications that we will discuss with you before your surgery. These include:  

• Nerve injury
• Prolonged recovery
• Continuing or worse pain, including pain on top of the foot
• Lowered arch

Your Care with Me

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Plantar fasciitis is a common cause of foot pain, and there are a number of effective things you can do at home to reduce pain and allow your plantar fascia to heal. We recommend that you try home treatments, including wearing semirigid arch supports and doing calf and plantar fascia stretches regularly, for several months. We may also arrange for you to attend a class about plantar fasciitis that explains the condition and the treatment options that are available.

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you. Surgery is rarely indicated for plantar fasciitis, and we will generally try other treatments, such as cortisone injections and/or custom orthotic inserts, first.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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