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Plantar Fascia Foot Pain: Symptoms, Causes and Treatment

Jo has been an ITU nurse at the London North West NHS Trust for 14 years. She obtained her RN at University College London Hospital.

Plantar Fasciitis


A Healthy Foot

Not everyone is blessed with perfect feet, some people have high arches, while others have low arches or flat feet that can lead to heel pain, leg pain and even back pain.

Not everyone is blessed with perfect feet, some people have high arches, while others have low arches or flat feet that can lead to heel pain, leg pain and even back pain.

A Chinese Woman With Feet Unwrapped


Deformity Caused By Foot Binding, An Ancient Chinese Practice


Be Kind to Your Feet, and it Will be Kind to You

Heel pain is a common condition of the foot; in most cases, pain is the result of damage to the plantar fascia, a disorder known as Plantar fasciitis.

From time immemorial, proud parents have cheered with joy as their toddlers progress from all fours to take those first few vital steps.

A baby's first walk is a landmark event that most mums and dads would hate to miss. A child's first walk is an important milestone like the first feed, the first smile and the first spoken words. Walking is a natural process, we've done it most of our lives without having to think about it, but the big question is, are we doing it right?

Just as a well-built building requires a solid structural foundation to stand firm, the human body needs good healthy feet for a lifetime of support, weight bearing and locomotion. An average moderately active person is said to take 7,500 steps/day. If that person maintains the average and lives to a ripe old age of 80 years, he/she will have walked a distance of 110,000 miles.

The human foot is an incredible feat of bioengineering that took over 4 million years of evolution to perfect. According to the experts, we don't give our feet the respect it deserves. Our feet is what carries us along, taking the full weight of the body, allowing us to go about our daily business.

It's true; humankind no longer walks as many miles as our ancestors once did. Not since the advent of the motor vehicles at any rate. However, we are still finding new ways to punish our feet. We began to wear shoes to protect the feet, but protection has evolved into fashion and more imaginative ways to torture our poor feet.

Women mainly are prepared to tolerate excruciating pain in the name of fashion. As late as 1949 the barbaric culture of foot binding was still practised on young women in China. Foot binding was done to achieve the ideal foot length of 3 inches. The practice began in ancient China around the 10th century, when a woman with tiny feet was a highly prized possession. The men at the time saw these women as beautiful and far more desirable. But it also showed that such women made ideal wives because they were uncomplaining. Known as the " Golden Lotus," young women's feet were tightly bound with cotton or silk bandages. In some cases, the toes were folded under the feet, breaking many of the bones at the top of each foot. The ball of the foot was buckled in, then wrapped to the heel.

Fast forward to the present day, while not as extreme, we are still abusing our feet in the name of fashion. Women continue to force their feet into shoes that are poorly fitted, wear ridiculously high heels that squeeze the foot into a painful and unnatural position resulting in malformation, heel pain, bunions, arthritis, arch pain, the ball of foot pain, and a lot of other conditions.

High heel shoes cause the weight to be transferred to the ball of the foot, stretching and damaging the fascia. The shoes we wear can affect out posture, putting the spine out of its natural alignment. Recently published 3-D scans showed the damage that can be caused by wearing high heels. According to the experts, by wearing shoes, we no longer walk correctly. But walking is easy; even a toddler can do it, I hear you'd think so, wouldn't you? Well, think again.

A South African university published the result of a research study in the podiatry journal "The Foot" found that we still haven't perfected the art of walking, in short, the way we walk is wrong, and this is mostly due to our shoes.

The study titled "Shod Versus Unshod" looked at 180 modern humans from three different population groups (Sotho, Zulu, and European) the feet of each group was compared to each other and also to 2000 years old skeletons. The study concluded that before the invention of shoes, people had healthier feet. In the modern subjects, the Zulu population who often goes bare feet, had the healthiest feet, while the shoes wearing European, had the unhealthiest feet.

However, while the Podiatric Medical Association does not suggest that we all go barefoot walking, we need to be conscious of what shoes we wear, since most of the shoes currently on the market are bad for our feet. Most of the shoes we buy provide little or no support, they are often too tight and made from materials that suffocate the feet.

What is Plantar Fasciitis

Plantar refers to the foot, fascia, connective tissue fibre and -itis an inflammatory process.

Plantar fasciitis is the medical term used to describe the painful condition of the plantar fascia. The plantar fascia is a strong, flexible band of connective tissue fibre that runs from the insertion at the heel, where the fascia attaches to the calcaneus or heel bone. The flexible fibre tissue then fans out along the bottom of the foot supporting the arch spreading out to the bones of the midfoot.

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The leading causes of Plantar fasciitis, are usually overuse, injury, or muscular abnormalities. The damaged plantar fascia becomes thickened, resulting in pain when walking. Pain associated with plantar fasciitis is not always experienced at the time of the injury; the onset is often gradual and usually located in the middle or inner aspect of the heel.

What is Fascia

Fascia is material that is woven throughout the body to hold us together. The function of the fascia is both generalised and specialised. Fascia is an intricate structure of connective tissue, a web of collagen fibre rather like a thin membrane of cellophane. It wraps tightly around the muscles holding the content together and consists of several thin layers that extend from head to toes.

There are three main types of fascia:

  • Superficial, associated with the skin
  • Deep, mainly to do with the muscles, bone, nerve and blood vessels
  • Visceral, mostly associated with the internal organs

Fascia binds some structure together but also allow others to move smoothly over each other when we are in motion. The fascia protects, separates, connects, and hold the organs of the body in their rightful place.

Although the fascial tissue plays a significant role in musculoskeletal medicine, most people are unaware of it, in fact, even the medical community has neglected to study this important part of the body until recently. The first International Fascia Research Congress took place at Harvard Medical School in 2007.

The fascia contains nerves when the nerves are damaged or inflamed; we feel pain. Damaged fascia tissue can affect the whole body, it can cause a problem with movement, as in repetitive strain injury, it can cause headaches and chronic pain. Fascia injury is the most common injury sustain by athletes and is now at the forefront of athletic training.

Like muscles, most fascia has an elastic quality, they are smooth and supple, in optimum condition, it is flexible tissue, most of which are capable of being stretched. However, inactivity, stress, dehydration and other factors can have a detrimental effect on the fascia, causing it to become harder and thickened, a state from which it is difficult to recover.

When the fascia is not functioning at its best, when stretched beyond its normal capacity, micro-tearing can occur in individual collagen fibre leading to scarring and adhesion.

Once the fascia is damaged, (i.e., stretched, pulled or torn) microscopic fibres become deranged, losing the average levels of flexibility and elasticity, they become disorganised, running in all three dimensions resulting in pain. The plantar fascia is a robust triangular sheet of inelastic fibrous tissue that acts as a shock absorber in the foot, the healthy plantar fascia is flexible, but it does not stretch, when it does, the result is heel or arch pain.

Fascia Wraps The Entire Body, From Head To Toes


3-D Scan showing the damage we women do to our feet by wearing high heeled shoes


Interesting Facts About the Human Feet

  • There are 26 bones in each foot, 33 joints, 107 ligaments and 19 muscles.
  • 25% of all the bones in the human body are in the feet. When these bones are out of alignment, so is the whole body.
  • Most of the body's weight is carried by the two largest bones in the feet, the calcaneus (heel bone) and the talus situated between the heel bone and the bottom of the shinbone.
  • When walking, the toes are forced to take 50% of the body's weight every time we lift our feet off the ground.
  • Standing is much more tiring on the feet than walking because we are using the same group of muscles for a longer period.
  • The total amount of force exerted on the feet in an average day of walking can total hundreds of tonnes.
  • Walking is the best exercise for our feet and body, it improves circulation and helps to maintain body weight and overall health.
  • Problems of the feet occur four times more frequently in women than in men. The reason for this is mostly due to the wearing of high heeled and poorly fitted shoes.
  • ( 9 out of 10 women wear shoes that are too small for their feet.
  • The pressure exerted on the feet when running can be as much as four times the runner's body weight.

Function of Healthy Fascia

  • Hold and binds muscles together
  • Allows proper alignment of muscle fibres, blood vessels, nerve and tissues within the muscles
  • Transmits forces and loads evenly throughout the body.
  • Provide a uniformly smooth lubricant surface.
  • Allow muscles to change shape as they shorten or lengthen.

Damage to the Plantar fascia is the most common cause of heel pain in adults. “Up to 40% of the population suffer from painful feet problems at least once during their lifetime, more than 10%, suffer from heel pain that is caused by inflammation of the plantar fascia at some time in their life.


Heel and arch Pain due to Plantar Fasciitis

Heel pain characterised by plantar fasciitis is typically felt on the bottom of the heel, and most acutely, with the first few steps of the day, this is known as first-step pain. This type of pain can also occur after long periods of inactivity in the day time and can be quite severe, occurring when weight is placed on the heel. Pain and discomfort build up gradually, becoming worse over time.

Individuals who are affected may limp or adopt an unusual style of walking as they try to avoid shifting full weight to the affected heel.

The condition is often associated with standing for an extended period, with a higher incidence in individuals with an excessive inward rolling of the foot, as seen in people with flat feet. In the non-athletic population, plantar fasciitis is often associated with obesity and lack of exercise.

Plantar fasciitis commonly affects runners, hikers and walkers, even people who earn their living by standing still for lengthy periods of time.

We are now well aware of the tremendous health benefits we can all gain by participating in sports and regular exercise. Exercising not only helps us maintain a healthy body, but also a healthy mind. More people are taking regular exercises now that ever before. Regular exercise can help reduce the risk of serious illness such as heart disease, stroke, diabetes and cancer by as much as 50%, and the risk of early death by up to 30%.

Yes, folks, exercise is the miracle cure, we've ignored for far too long, but like most medicine, when we fail to take the correct dosage we can overdose, and that is never good. There are those who believe that if a little exercise does you good, a lot must be better, but overdoing the workouts can backfire as many athletes have painfully discovered, to their cost.

Causes of Strains and Tears in the Plantar Fascia

  • Age, most common in people between the ages of 40 to 60 years
  • Obesity, extra weight places stress and pressure on the plantar fascia
  • High arch or flat feet (low arch)
  • Tight Achilles tendons or calf muscle
  • Poorly fitted or worn-out shoes
  • Feet that roll inward too much when walking
  • Standing, walking or running for long periods on hard surfaces

1 in 10 people will get plantar fasciitis at some time in their life, the best way to prevent it is to ensure that the ankles, Achilles tendons and calf muscles remain flexible, a state where it is less likely to sustain damage.


Do frequent stretches throughout the day.

 Gentle stretching can helps to prevent stiffness, by relaxing and loosening the ligament and strengthening the muscles around the arch to relieve the pain.

Gentle stretching can helps to prevent stiffness, by relaxing and loosening the ligament and strengthening the muscles around the arch to relieve the pain.

Have you Suffered From Heel Pain?

Home Treatment for Plantar Fasciitis

Treatment for plantar fasciitis ranges from simple stretching to surgery, but the first course of action for an individual exhibiting symptoms of the condition is to get sound medical advice.

Action to help relieve pain includes:

  • Avoid walking or running on hard surfaces, reduce or change activities that can exacerbate the pain. i.e., cycling rather than running, reduce the distance and duration of walks, swimming instead of jumping. Change exercise surface from concrete to grass.
  • Use heel cups, shoe inserts or orthotics in both shoes.
  • Chose new shoes with cushion sole and good arch support.
  • Do calf and towel stretches several times per day, especially first thing in the morning; this may help to relieve pain.
  • Reduce pain and swelling by applying an ice pack to the affected area for 15 to 20 minutes, three to four times a day.
  • Wear a night splint
  • Over the counter, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help to reduce inflammation and pain. However, be aware that NSAIDs can irritate the stomach lining to cause indigestion and in some cases bleeding. Do not take this group of drugs if you have a history of stomach ulcers or bleeding problems.

Medical Treatment for Plantar Fasciitis

In cases where the heel pain does not respond to home treatment, the doctor may administer a corticosteroid injection directly into the damaged ligament. Corticosteroids are also given by placing the drug on the skin of the heel and the arch of the foot before the painless electrical current is applied, allowing the steroids to be absorbed through the skin and into the muscles.


Strengthen Lower leg muscles by exercising; this will help to stabilise walking and lessen the work of the plantar fascia. Applying deep local massage to the painful area where the fascia attaches can be effective when done in the morning after a warm bath.

Extracorporeal Shock Wave Therapy (ESWT)

The heel is exposed to a bombardment of sound waves to stimulate healing within the plantar fascia ligament. However, this method remains controversial, with research both for and against its use. ESWT may cause bruising, pain, swelling and numbness.


Surgery is used only in cases where the pain is extremely severe.


Night splints are a type of brace that holds the foot in a flexed position to lengthen the plantar fascia and Achilles tendon at night and help to prevent morning stiffness and pain.

Orthotics or arch supports

Special supports worn in the shoes can help to relieve some pain by distributing the pressure to prevent further damage to the plantar fascia. A boot cast can help to immobilise the foot and reduce strain thereby allowing the plantar fascia time to heal.

Shock Wave Therapy


Exercise by swimming instead of running


To Reduce Pain, Avoid Walking On Hard Concrete Surfaces

Excessive Wearing Of Flip-Flops Are Linked To Heel Pain


Dangerous Heels


Measure Shoe Size For Perfectly Fitted Shoes


Choose the Best Shoes For Your Feet

HeelHeel CounterUpperInsoleLiningsFasteningsToe Box

No greater than 4cm (1.5 inches) with a broad base

Reenforces the heel cup and stablises the foot on contact with the ground

Should idealy consist of natural materials like leather or fabric that can breathe to maintain comfort

Preferable one that is removable to allow easy insertion of of padding or othoses

Breathable material to keep the feet fresh, should be smooth and seam-free

Laces or straps with buckles or touch fastenings help to hold the foot securely within the shoe

Should have sufficient depth to prevent rubbing and allow the toes to wiggle














Long Gone are the Six Inch Heels of the 80s and 90s I Now Wear Comfy Shoes with the Occasional Touch of Bling


If You Still Want Killer Heels

© 2014 Jo Alexis-Hagues


Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 23, 2014:

shraddhachawla, thank you so much for taking a look and for the lovely comment, I'm glad you found the hub useful. Take care and my best to you.

shraddhachawla on September 23, 2014:

Very informative hub covering the finest of details about Plantar fasciitis. Amazing pictures !

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 21, 2014:

Thanks Frank, The only way of getting the message through is to present the facts. Medical info can be difficult with all the jargons, so I'm happy that people can understand my hubs. Great to see you, hope you're well, my best as always.

Frank Atanacio from Shelton on September 21, 2014:

toobusiness, what I enjoy most about your hubs is the clear detail.. you have a knack in making everything easy to read and follow..bravo

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 21, 2014:

Flourish, ouch!...foot pain is no fun at all. I still get a rush when I see a fabulous pair of shoes, but I buy for comfort every time. I'm glad the steroid shots did the trick. Thank your for the insightful comment, always lovely to see you. Have a brilliant Sunday, my best to you.

FlourishAnyway from USA on September 20, 2014:

I have had this condition and orthotics help a good deal. I've also had steroid shots in the past. Very painful to put any pressure on the heel. Running shoes are now my choice, but no running for me. Very informative health hub, as always. Pinning this!

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 20, 2014:

travel_man1971, so nice to see you! Well now... on the subject of high heels, women can be very obstinate, so tread carefully with the nieces and sisters. It's takes a brave man to separate a girl from her favourite shoes, so you may need some protection when you broach the matter, like a full body armor? :) But if they could see the long term damage they're doing, they may think again.

I dread to think what a pair of heavy iron shoes would do to a person's feet, I guess we like to hold on to some traditions no matter how painful. Thanks for stopping by, take care and my very best to you.

Ireno Alcala from Bicol, Philippines on September 20, 2014:

A very nice hub for most conscious women, hehehe! I will share it with my sisters and nieces, too.

I feel my sympathy to Chinese women who still wear iron shoes.Ugh!That must be hurtful.

Note: I don't care if my woman's feet are bigger than mine. As long as she is comfortable with what she wears, that's okay for me.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 19, 2014:

Jamie, lovely to see you! I'm doing alright, hope you and the family are too. Thank you for taking a look, much appreciated. My very best to you.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 19, 2014:

sallybea, lovely to see you, I'm so glad you enjoyed the hub. You're right about flats, unfortunately, many of them have very little cushioning and no real support. Research shows that women put around 25% more impact on the heel with each step when wearing flats, compared with pumps. In addition to good support, exercise and frequent stretching can help with the pain. Also check your feet, high or flat arches may well be the problem, you can tell by checking your footprint.

Thank you for the visit and superb comment, much appreciated. My very best to you.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 19, 2014:

Hi Kim, so nice to see you! I hope all is well.

Well now... about those mind bending shoes, I guess we've all been there, to a greater or lesser degree. I remember back in the 80s, masses of officer workers wore trainers to work, then they'd slipped back into those heels to show off their fab legs. Not unlike the teachers, but they got the message eventually. I knew someone with a large shoe collection which she displays, rather like works of art. And no.....her first name wasn't Emelda. :)

Thanks for the visit, share and brilliant comment. Take care and my best to you always..

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 19, 2014:

Hello Kim aka, Klidstone1970, Why am I not surprised that you guys are seeing more people with plantar fasciitis? You made a good point about cost also. Prevention is always better than cure, if only we could convince the fashion victims. Thank you for the visit and insightful comment, much appreciate. My best to you.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 19, 2014:

Devika, When we spend a lot of time on our feet, gravity and the anatomy of the vessels of the legs can cause swollen ankles, when this happens, try sitting down and elevate those babies. :)

After 12 hours of dashing around the busy unit where I work, a hot bath and a lovely foot massage from the hubby usually does the trick. :)

Thank you, much appreciated. My very best as always.

Jamie Lee Hamann from Reno NV on September 19, 2014:

Jo, another fantastic medical hub full of helpful information. I hope everything is well on your side? Jamie

Sally Gulbrandsen from Norfolk on September 19, 2014:


A superb hub with loads of good advice in it. Sometimes I do find that my feet ache more in really flat shoes than they do in higher heels - not that mine are high at all! I go for sensible shoes these days:)

ocfireflies from North Carolina on September 19, 2014:


Once again you demonstrate what an exceptional hub looks like. The information you provide is priceless and you explain technical terms so people like me can understand them. Like so many others, I wore heels at one point, but that has been quite awhile ago. When I was still in the classroom, I would have student teachers. For the first week, in an attempt to present themselves professionally, they would wear heels. I would just smile because I knew by week two, they would switch to much more comfortable shoes. When you are in the classroom, you rarely have time to sit. Smiles. Thumbs Way Up and Shared.



இڿڰۣ-- кιмвєяℓєу from Niagara Region, Canada on September 19, 2014:

I work in a chiropractic office and we see quite a large number of people for this. My doctor is a huge believer in orthotics and recommends them constantly. Come to think of it, the past few months I have seen an increase in patients coming in for treatment due to plantar fasciitis. Orthotics are quite the expense and I have yet seen a patient pay for them out of pocket. If they have no extended health coverage - they suffer. Not a good thing. Great information. Take care. Kim

Devika Primić from Dubrovnik, Croatia on September 19, 2014:

Interesting! I used to wear small heeled shoes and even that made my ankles slightly swollen. I have given that up completely. I wear what I know is comfortable to my feet and not what others think I should be wearing. A very helpful hub on such an aspect of foot pain. Flat shoes like you have in the photo are my best of choices. My best to you.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 19, 2014:

shara63, appreciate you stopping by, thanks for taking the time to read and comment, I hope you found the hub useful.

Take care and my best to you.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 19, 2014:

Jackie, I hope it's nothing too serious, but it's always best to have a doctor check it out. Until then, stick with the comfy shoes. Thank you for stopping by, always a pleasure, my best to you.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 19, 2014:

Faith, how nice to see you! Sorry about the painful feet, but glad that this hub proved to be a timely reminder. Those beautiful high heel shoes can be a real temptation, but there are some lovely 3 inch heels out there. The next time you feel the need to possess those heels, just say NO!! :).

As always, you're a real pleasure, take care and my very best to you.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 19, 2014:

MsDora, the things we women do in the name of fashion!! I totally agree, we should show some appreciation for those hard working feet. I remember cringing on seeing photos of a very pregnant Victoria Beckham cutting a dash in her stiletto heels. Maybe we could start a "be kind to your feet day." I don't suppose it would ever catch on. :) Always a pleasure to see you, take care and my best as always.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 19, 2014:

Ruby, I've worn some outrageous shoes in my time, but some of the heels worn these days are just plain silly! When we're young, we think we are indestructible, not so... we pay later. Thank you so much for taking a look, always appreciated.

Have a lovely day and my best to you.

Farhat from Delhi on September 18, 2014:

Wonderful information and useful tips ! ...facts about high heel shoes that they can cause so much damage to our feet .. is really horrable...thanks for your concern and suggestions towards body care and well being!

Jackie Lynnley from the beautiful south on September 18, 2014:

I have lately had weird pain in my feet. I thought maybe it was tendons but maybe it is this. I will have to ask my doctor. Thank you Jo for such an important lesson.

Faith Reaper from southern USA on September 18, 2014:

Oh, Jo, I have had this before several years ago, and I will never forget that pain. I was fine until I had to get up and that is when that terrible pain in my heel hit when I first place my foot on the floor! Ouch!!! I think the culprit in my case was wearing the wrong shoes all day at work. I did a lot of stretching exercises and it helped a lot and now I have not had any pain in several years. I went back to comfortable shoes, and I am so glad I read this as, here of late, I have been wearing those oh so stylish high heeled shoes and suffering, and now I remember why I quit!

Up +++ tweeting and pinning

Blessings always

Dora Weithers from The Caribbean on September 18, 2014:

Jo, again a very informative and helpful article. We really need to give our feet the respect they deserve. I realized that when I put on 50lbs during my first pregnancy, and thanked my feet often for bearing me up. Dangerous shoe heels are gone now, and will pay more attention to walking and selecting shoes. Thanks a million!

Ruby Jean Richert from Southern Illinois on September 18, 2014:

OMG! The heels shown in the pic. are unbelievable. I once wore high heels but never like the ones worn today. I remember wearing spike heels and they hurt like the devil. Would you call that young and foolish?lol..This is really an informative article. I felt like I was back in anatomy 101. I am glad you do medical hubs. I learn something new each time you write. Thank you Jo...

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 18, 2014:

Jay lmz, thanks for taking a look, much appreciated. My best to you.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 18, 2014:

Bill, I guess feet are like most things in life, we cherish them and they look after us, we abuse them and we reap the pain.:) It took me much too long to get the message. Careful as you go, keep those feet safe they still have a long way to go. Take care my best always.

Jeff Lumiri from Canada on September 18, 2014:

A nice hub, i like it

Jeff Lumiri from Canada on September 18, 2014:

A nice hub, i like it

Bill Holland from Olympia, WA on September 18, 2014:

As always, great information and suggestions. I've been relatively lucky with my feet, which is pretty cool considering I've played sports for so many years, and climbed mountains.....yep, very lucky indeed. Having said that, I'll probably trip today and break something. LOL Thanks, Jo, and have a wonderful Thursday.

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