What are the symptoms of plantar fasciitis?

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

The main symptoms of plantar fasciitis are:

• Heel and foot pain.

• Tenderness of the foot.

• Stiffness of the foot.

This pain is usually worst when waking up in the morning or taking the first few steps when walking or running. It tends to get worse after being on your feet for long periods.

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.

In this series of articles centred around plantar fasciitis you can read about symptoms of plantar fasciitis, treatment for plantar fasciitis and causes of plantar fasciitis - all written by one of our expert GPs.

The rest of this feature will take an in-depth look at the symptoms of plantar fasciitis as, at Patient, we know our readers sometimes want to have a deep dive into certain topics.

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 the foot, usually near, or on, the heel. It can be felt at the point where the plantar fascia connects to the heel bone, or sometimes a few centimetres forward in the foot in the sole, 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, and that it 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 the foot is often tender to touch at a specific point. It might be tender at the point where the plantar fascia joins the heel bone, or further forward, over the main part of the plantar fascia.

Stiffness of the foot

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

Patient picks for Heel and foot pain

Foot care

Video: Foot pain exercises

There are two main aims of physiotherapy for plantar fasciitis. The first is to control inflammation; the second is to stretch the muscles and connective tissue in the calf. Symptoms of plantar fasciitis are often brought on or made worse by tightening of these tissues. These exercises should take about 15 minutes a day. Once your symptoms are controlled it's worth getting into the habit of doing them once or twice a day to reduce the risk of symptoms coming back.

by Lilly Sabri

Foot care

Achilles tendon rupture

The Achilles tendon is at the back of the heel. It can be ruptured by sudden force on the foot or ankle. If your Achilles tendon is ruptured you will be unable to stand on tiptoe and will have a flat-footed walk. It is important to diagnose and treat this injury as soon as possible, to help promote healing. Treatment involves wearing a plaster cast or brace (orthosis) for several weeks, and possibly having an operation.

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 the foot. Others experience 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 - see plantar fasciitis treatment.

It is a good idea to contact a doctor, physical therapist/physiotherapist, or podiatrist if:

• You have tried managing symptoms yourself for a few weeks, and there has been no improvement.

• The symptoms are severe - for example, they are stopping you from walking more than a few steps, or they are causing you significant problems in your daily life.

• You have tingling sensations or loss of feeling in the feet - this is unusual with plantar fasciitis, and could be a sign of a nerve problem.

• You have diabetes and pain in the foot. People with diabetes are at risk of getting other foot problems, which can sometimes have similar symptoms to plantar fasciitis.

• The pain is getting worse or keeps coming back.

• You are not sure if your symptoms are due to plantar fasciitis or a different condition - for example, if your symptoms don't fit with the ones described here.

• You are otherwise concerned.

How is plantar fasciitis diagnosed?

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

Imaging tests, such as X-rays and scans, are only really useful to look for other risk factors and causes of the symptoms - so might be done if clinicians suspect a different diagnosis.

X-rays of the foot can sometimes show a bone spur at the point the plantar fascia connects to the 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, such as:

• Achilles tendinitis - inflammation of the Achilles tendon tends to cause pain at the back of the heel instead.

• Fat pad atrophy - the fat pads which cushion the bottom of the feet when walking or running break down or become thinner. This tends to cause pain in the centre of the heel, or over the balls of the feet - metatarsal heads - just beneath the toes.

• Tendinitis (inflammation) of one of the foot muscles (flexor hallucis longus) - starts in the calf muscles, and its tendon runs down the ankle, under the foot and to the big toe. If the tendon becomes inflamed, pain can be felt in the ankle, going forward to the toe, and can mimic plantar fasciitis sometimes. Unlike plantar fasciitis, the pain gets worse by trying to bend (flex) the big toe against resistance.

• A stress fracture of the heel bone (calcaneum) - can also be caused by intense exercise and overuse and usually cause pain in the heel itself, and can also cause swelling and warmth over the heel. The heel bone is tender when squeezed.

• Rupture, a complete tear, of the plantar fascia - usually causes sudden pain and bruising.

• Sever's disease - a condition in children, usually between 8 and 14 years of age, which causes painful inflammation of the heel.

• Problems that cause pain further forward in the foot - near the base of the toes, such as:

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