Exams and Tests

To diagnose plantar fasciitis, your doctor will ask questions about your symptoms and your past health. He or she will also do a physical exam of your feet that includes watching you stand and walk.

X-rays are not helpful in diagnosing plantar fasciitis, because they do not show ligaments clearly. But your doctor might take X-rays if he or she suspects a stress fracture, bone cyst, or other foot or ankle bone problems. X-rays may show whether a heel spur is present, but a bone spur does not necessarily mean that a person has plantar fasciitis.

If the diagnosis is not clear, you may have other tests. Tests that are done in rare cases include MRI, blood tests, bone scans, and vascular testing, which can evaluate blood flow in the foot and lower leg. If your doctor suspects nerve entrapment, you may have neurological testing.

Treatment Overview

The goals of treatment for plantar fasciitis are to:

• Relieve inflammation and pain in the heel.
• Allow small tears in the plantar fascia ligament to heal.
• Improve strength and flexibility and correct foot problems such as pronation so that you don't stress the plantar fascia ligament.
• Allow you to go back to your normal activities.

Most people recover completely within a year. Out of 100 people with plantar fasciitis, about 95 are able to relieve their heel pain with nonsurgical treatments. Only about 5 out of 100 need surgery.¹

Treatment that you start when you first notice symptoms is more successful and takes less time than treatment that is delayed.

Initial treatment

There are many methods you can try to relieve the heel pain of plantar fasciitis. Even though their effectiveness has not been proved in scientific studies, these methods, used alone or in combination, work for most people.²

• Rest your feet. Limit or, if possible, stop daily activities that are causing your heel pain. Try to avoid running or walking on hard surfaces, such as concrete.
• To reduce inflammation and relieve pain, put ice on your heel. You can also try a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil or Motrin, for example), naproxen (Aleve, for example), or aspirin. NSAIDs come in pills and in a cream that you rub over the sore area.
• Wear shoes with good shock absorption and the right arch support for your foot. Athletic shoes or shoes with a well-cushioned sole are usually good choices.
• Try heel cups or shoe inserts (orthotics) to help cushion your heel. You can buy these at many athletic shoe stores and drugstores. Use them in both shoes, even if only one foot hurts.
• Put on your shoes as soon as you get out of bed. Going barefoot or wearing slippers may make your pain worse.
• Do simple exercises such as toe stretches, calf stretches, and towel stretches several times a day, especially when you first get up in the morning. These can help your ligament become more flexible and strengthen the muscles that support your arch. For more information, see:

  Plantar Fasciitis: Exercises to Relieve Pain.

Avoid using only heat on your foot, such as from a heating pad or a heat pack for at least the first 2 or 3 days. Heat tends to make symptoms worse for some people. If you use contrast baths, which alternate hot and cold water, make sure you end with a soak in cold water. If you try a heating pad, use a low setting.

If your weight is putting extra stress on your feet, your doctor may encourage you to try a weight-loss program.

Ongoing treatment

If nonsurgical methods such as rest, ice, and stretching exercises help relieve your plantar fasciitis symptoms, continue using them. If you have not improved after 6 weeks, your doctor may recommend that you continue those methods but add other nonsurgical treatments, such as:

• Custom-made shoe inserts (orthotics). Custom-made orthotics require a prescription. If your foot has an unusual shape or if you have a certain problem that the device will help, then a custom-made insert may fit better and control pain better than a nonprescription one.
• Night splints. A night splint holds the foot with the toes pointed up and with the foot and ankle at a 90-degree angle. This position applies a constant, gentle stretch to the plantar fascia.
• A walking cast on the lower leg. Casting is somewhat more expensive and inconvenient than other nonsurgical treatments. And after the cast is removed, you will need some rehabilitation to restore strength and range of motion. But a cast forces you to rest your foot.

Formal physical therapy instruction can help make sure you properly stretch your Achilles tendon and plantar fascia ligament. Doctors usually consider surgery only for severe cases that do not improve.

Treatment if the condition gets worse

Your doctor may suggest corticosteroid shots if you have tried nonsurgical treatment for several weeks without success.¹ Shots can relieve pain, but the relief is often short-term. Also, the shots themselves can be painful, and repeated shots can damage the heel pad and the plantar fascia.

Out of 100 people with plantar fasciitis, about 95 are able to relieve their heel pain with nonsurgical treatments. Only about 5 out of 100 need surgery.¹ If you are one of the few people whose symptoms don't improve in 6 to 12 months with other treatments, your doctor may recommend plantar fascia release surgery. Plantar fascia release involves cutting part of the plantar fascia ligament in order to release the tension and relieve the inflammation of the ligament. For more information on surgery, see:

Plantar Fasciitis: Should I Have Surgery for Heel Pain?

What to think about

If you are trying to lose weight and you develop plantar fasciitis when you begin exercising, especially jogging, talk with your doctor about other types of activity that will support your weight-loss efforts without making your heel pain worse. An activity like swimming that doesn't put stress on your feet may be a good choice.

If your plantar fasciitis is related to sports or your job, you may have trouble stopping or reducing your activity to allow your feet to heal. But resting your feet is very important to avoid long-lasting heel pain. Your doctor or a sports medicine specialist may be able to suggest a plan for alternating your regular activities with ones that do not make your pain worse.

If you exercise frequently, ask your doctor whether physical therapy or referral to a sports medicine specialist, podiatrist, or orthopedist is appropriate.

Some questions you may want to ask about exercise include:

• Should I cut back on my exercise? How many days per week, how long, and what exercise should I do instead?
• Should I ice my foot after I exercise? If so, for how long each time, and how long should I continue the icing?
• Should I use nonsteroidal anti-inflammatory drugs (NSAIDs) either before or after I exercise?
• Are there exercises I can do to make my foot and ankle more flexible? What are they, and how often and how long should I do them?