Plantar Fasciitis

Dr Chong Xue Ling
Dr Chong Xue Ling
Senior Consultant Orthopaedic Surgeon

Plantar fasciitis is a common foot condition involving inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot, connecting the heel bone to the toes. This condition causes pain in the heel and sole, often most noticeable with the first steps after waking or following periods of rest. It is more common in physically active people, especially runners and those who spend long periods on their feet. If left untreated, it can restrict mobility and daily activities.

Symptoms of Plantar Fasciitis

Plantar fasciitis presents with distinct symptoms that can vary in intensity throughout the day or depending on activity levels.

Heel Pain

A sharp or stabbing pain near the heel on the bottom of the foot, typically most pronounced with the first few steps in the morning or after sitting for long periods.

Pain Following Activity

Discomfort worsens after exercise or prolonged standing as the fascia becomes irritated when it cools down.

Stiffness and Reduced Flexibility

The affected foot may feel stiff, making it difficult to flex upwards due to tightness in the plantar fascia and Achilles tendon.

Gradual Onset

Symptoms typically develop progressively rather than suddenly, with most individuals unable to identify a specific moment when the pain began.

Pain When Climbing Stairs

Increased discomfort when climbing stairs or standing on tiptoes, as these movements place additional strain on the inflamed fascia.

Causes and Risk Factors

Plantar fasciitis arises from a combination of structural and lifestyle factors, including:

Flat feet, high arches, or abnormal walking patterns alter weight distribution and place additional stress on the plantar fascia.

Most common between 40 and 60 years of age, as the plantar fascia loses elasticity and its ability to absorb shock effectively.

Jobs requiring prolonged standing or walking on hard surfaces, such as teaching, factory work, or retail, increase the risk of developing plantar fasciitis.

Shoes with poor arch support, inadequate cushioning, or improper fit contribute to excessive strain. Regular use of high heels may also shorten the Achilles tendon, increasing stress on the fascia.

Extra body weight increases pressure on the plantar fascia, amplifying strain on the foot during movement.

Running, ballet, and aerobics involve repetitive impact that can overload the fascia. Symptoms often follow sudden increases in training intensity or duration.

Diagnostic Methods

  • Physical Examination: The doctor assesses tender points along the plantar fascia, foot structure, and range of motion. Applying pressure while the patient flexes the foot helps identify areas of discomfort.
  • Patient History: A discussion about pain patterns, activity levels, and symptom progression provides insight into the condition and supports diagnosis.
  • Imaging Tests: X-rays or ultrasounds may be used to rule out other conditions or assess fascia thickness.

 

Treatment Options

Most cases of plantar fasciitis improve with non-surgical management. Treatment approaches vary based on symptom severity and individual factors. Surgery is considered only when conservative treatments fail to provide relief.

Non-Surgical Treatment

  • Rest and Activity Modification: Reducing activities that worsen symptoms allows the plantar fascia to heal. High-impact exercises such as running should be replaced with lower-impact activities like swimming or cycling.
  • Physical Therapy Exercises: Stretching exercises for the plantar fascia and Achilles tendon help improve flexibility and reduce discomfort. A structured programme may include calf stretches, towel curls, toe spreads, and fascia stretches performed consistently.
  • Orthotics and Supportive Footwear: Custom or over-the-counter arch supports help distribute pressure evenly across the foot, reducing strain on the plantar fascia.
  • Night Splints: Worn during sleep, these devices keep the plantar fascia gently stretched overnight, preventing it from tightening and reducing morning pain.
  • Ice Therapy: Rolling the foot over a frozen water bottle or applying ice packs for 15-20 minutes at a time helps decrease inflammation.
  • Medication: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve pain and inflammation during flare-ups.
  • Corticosteroid Injections: In persistent cases, steroid injections may offer temporary relief but are limited due to potential side effects, including fascia weakening.

Surgical Treatment

  • Plantar Fascia Release: A procedure that partially detaches the plantar fascia from the heel bone to relieve tension and pain. It can be performed through a small open incision or using minimally invasive techniques such as endoscopic surgery. This procedure is typically considered only for severe, persistent cases that do not respond to non-surgical treatment over 6-12 months.
  • Gastrocnemius Recession: A surgical technique to lengthen the calf muscles (gastrocnemius) to reduce strain on the plantar fascia. This approach is particularly useful when tight calf muscles contribute to ongoing symptoms and limited ankle flexibility. By increasing ankle dorsiflexion, this procedure helps redistribute pressure across the foot, reducing stress on the plantar fascia during walking and standing.

Prevention and Management

Minimising plantar fasciitis recurrence requires maintaining good foot health. Wearing well-fitted shoes with arch support and cushioning minimises strain, while avoiding prolonged standing on hard surfaces reduces pressure on the fascia. Regular calf and plantar fascia stretching, especially in the morning and before exercise, improves flexibility and reduces tightness. Gradually increasing activity levels helps the feet adapt without excessive stress. For those prone to recurrence, orthotics or night splints may offer extra support. If discomfort persists, medical evaluation can help prevent long-term issues.

Dr Chong Xue Ling

Dr Chong Xue Ling

Senior Consultant Orthopaedic Surgeon

Dr Chong Xue Ling is a Swiss fellowship-trained orthopaedic surgeon specialising in foot and ankle, as well as shoulder and elbow surgery.

She is a member of the European Group for the Study and Research of Minimally Invasive Surgery of the Foot and Ankle. For shoulder and elbow surgery, she completed her fellowship at La Tour Hospital, an accredited Swiss Olympic Medical Centre and learnt innovative techniques in arthroplasty for earlier return to activity as well as the stabilising techniques, developed to have greater strength without extensive fixation.

  • MBBS (S’pore)
  • MRCS (Ireland)
  • MMed Orthopaedic (S’pore)
  • FRCS Orthopaedic (Edinburgh)

Through active involvement in research, she aims to constantly improve existing treatment in the pursuit of quality care for her patients.

Read Full Bio

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    Plantar Fasciitis

    Frequently Asked
    Questions

    Can plantar fasciitis affect both feet at the same time?

    Yes, though it usually affects one foot, plantar fasciitis can develop in both feet simultaneously, especially in individuals with biomechanical issues or repetitive strain from physical activity.

    Can plantar fasciitis cause pain in areas other than the heel?

    Yes, pain can extend along the arch of the foot, particularly if inflammation spreads along the fascia or if gait changes cause strain in other areas.

    Can plantar fasciitis return after successful treatment?

    Yes, recurrence is possible, especially if underlying causes such as poor footwear, tight calf muscles, or overuse are not addressed. Preventative measures help reduce the risk of recurrence.