What are the symptoms of plantar fasciitis?

Plantar fasciitis causes pain in the bottom of your foot, usually a few centimetres forward of your heel.

This pain is usually worst when you wake up in the morning or take the first few steps when walking or running. It tends to increase after being on your feet for long periods of time.

If you think you may have plantar fasciitis find out what to do here. This will tell you if you need to see a doctor and how it is treated.

What are the symptoms of plantar fasciitis?

Heel pain and foot pain

This is the main symptom of plantar fasciitis. People with plantar fasciitis have pain when they stand, walk, or run, all of which put stress on the plantar fascia, causing pain. The pain is felt in the sole of your foot, usually near, or on, your heel. It can be felt at the point where your plantar fascia connects to your heel bone, or sometimes a few centimetres forward in the sole of your foot, over the main part of the plantar fascia.

Plantar fasciitis position in foot

By Injurymap, CC BY 4.0, via Wikimedia Commons

People often find that their first few steps after getting up in the morning are the most painful. They also find that the pain is bad when they start to walk, run, or stand. It usually improves after they have been active for a short time - but then gets worse at the end of the day, or after they stop the activity.

Around one in three people with plantar fasciitis have symptoms in both feet.

Tenderness of the foot

The sole of your foot is often tender to touch at a specific point. It might be tender at the point where your plantar fascia joins your heel bone - or further forward - over the main part of your plantar fascia.

Stiffness of the foot

The heel and sole of your foot can feel stiff in plantar fasciitis. This typically occurs first thing in the morning, and improves after gentle activity.

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Achilles tendinopathy

Achilles tendinopathy is a condition that causes pain, swelling and stiffness of the Achilles tendon that joins the heel bone to the calf muscles. It is thought to be caused by repeated tiny injuries to the Achilles tendon. These may occur for a number of reasons, including overuse of the tendon - for example, in runners. Treatment includes rest, ice packs, painkillers and special exercises to help to stretch and strengthen the Achilles tendon. For most people, the symptoms of Achilles tendinopathy usually clear within 3-6 months of starting treatment.

by Dr Doug McKechnie, MRCGP

What does plantar fasciitis feel like?

People can have different experiences of pain from plantar fasciitis. Some people feel a dull pain or an ache in the sole and the high arch of their foot. Others have sharp pains, and some feel a burning-type sensation. It is often said that it feels like you are walking on pebbles.

When to contact a doctor for plantar fasciitis symptoms

Most people with plantar fasciitis can manage the symptoms themselves.

How is plantar fasciitis diagnosed?

Plantar fasciitis is diagnosed on the basis of reported symptoms and findings on clinical examination. For example, tenderness when pressing around the point where the plantar fascia connects to your heel bone suggests plantar fasciitis, as does pain in your sole that comes on when extending - or straightening - your big toe (the Windlass test).

Imaging tests, such as X-rays and scans, are only useful for detecting other susceptibility factors and causes of the symptoms - so might be done if your healthcare provider suspects a different diagnosis.

X-rays of the foot can sometimes show a bone spur at the point your plantar fascia connects to your heel bone. These are more common in people with plantar fasciitis, due to the plantar fascia being tense and pulling at the bone. However, bone spurs are not the cause of pain in plantar fasciitis, nor do they mean that someone does or doesn't have plantar fasciitis.

Ultrasound scans and MRI scans of the foot can show changes that indicate plantar fasciitis - such as thickening of the plantar fascia. However, this doesn't add anything if the diagnosis is already clear, based on signs and symptoms.

What else could it be?

Plantar fasciitis is usually straightforward to diagnose. However, there are other conditions which can also cause foot and heel pain.

Pain in your foot and heel may also be due to issues that cause soreness further forward in your foot - near the base of your toes.

For instance:

• A fracture of the metatarsal bones.

• Inflammation around the heads of the metatarsal bones.

• Many different types of arthritis can cause foot and ankle pain, such as osteoarthritis, gout, and rheumatoid arthritis.

• Nerve issues - including with the small nerves in the feet (peripheral neuropathies), which can cause numbness and tingling in your feet, and sometimes be painful.