Plantar fasciitis is a foot condition that develops when repeated activities put a strain on the plantar fascia, a thick band of tissue that supports the arch of the foot. People diagnosed with plantar fasciitis also may have heel spurs, a bony growth that forms on the heel bone.

Plantar fasciitis occurs most frequently in people in their 40s, but can occur in all age groups.

The condition can develop in athletes who run or jump a great deal, and in people who have jobs that require them to be on their feet for most of the day, such as police officers, cashiers, or restaurant workers.

Symptoms of plantar fasciitis often appear with a sudden increase in activity. You might feel a stabbing pain on the underside of your heel, and a sensation of tightness and/or tenderness along your arch.

People with plantar fasciitis may experience pain:

• In the morning, when stepping out of bed and taking the first steps of the day.
• When standing for a long time.
• When standing up after sitting for a long time.
• After intense activity such as running or jumping.
• When climbing stairs.
• When walking barefoot or in shoes with poor arch support.

Your pain can fluctuate during the day, with pain improving as your body warms up and worsening later in the day after activity. As the condition gets worse, you may begin to limp.

The physical therapist's diagnosis is based on your health and activity history, and on a clinical evaluation. Your physical therapist also will take a medical history to make sure that you do not have other conditions that may be causing your pain. Sharing information about your work and recreation, and reporting any lifestyle changes will help your physical therapist diagnose your condition and tailor a treatment program for your specific needs.

To diagnose plantar fasciitis, your physical therapist may conduct the following physical tests to see if symptoms occur:

• Observing, measuring, and assessing your foot, ankle, and arch position in weight-bearing and nonweight-bearing positions. Massaging and pressing (palpation) on the heel area, arch of the foot, toward the toes.
• Gently stretching the ankle to bend the top of the foot toward the leg (dorsiflexion) to assess the flexibility of the muscles in your lower leg.
• Gently pressing the toes toward the ankle.

Physical therapists are trained to evaluate and treat plantar fasciitis.

When you are diagnosed, your physical therapist will work with you to develop a program to decrease your symptoms. Your treatment may include:

Assessment of your gait. Your physical therapist will observe how you walk (your gait) and how this may impact your symptoms.

Stretching exercises. Your physical therapist will design a  program to improve the flexibility of your ankle and the plantar fascia.

Strengthening exercises. Your physical therapist will design an exercise program to improve the strength and endurance of the muscles that support your foot.

Application of ice. Your physical therapist will instruct you on how often and how long to use ice to decrease pain and inflammation.

Taping of the foot. Your physical therapist may tape your foot and instruct you on how to use taping for short-term pain relief.

Orthotics (shoe inserts) and supportive footwear to minimize abnormal foot motion, or to help support your arch, reducing stress to the plantar fascia.

A night splint to help you maintain correct ankle and toe positions while sleeping.

Gait training to help lessen symptoms and improve your walking ability.

Research shows that most cases of plantar fasciitis improve over time with these conservative treatments, and surgery is rarely needed.

A treatment program may begin with these exercises that you can try at home.

Factors that contribute to the development of plantar fasciitis include:

• Age (over 40 years).
• A job, sport, or hobby that involves prolonged standing or other weight-bearing activity.
• Rapid increases in length or levels of activity, such as beginning a new running program or changing to a job that requires a lot of standing or walking.
• Decreased calf muscle flexibility.
• Increased body weight (Body Mass Index greater than 30).
• Flat feet.
• Wearing shoes such as high heels, or those with inadequate arch support.

Guidelines for the prevention or management of plantar fasciitis include:

• Choosing shoes with proper arch support and heel height.
• Replacing your shoes regularly, before they wear out.
• Using a thick mat if you must stand in one place for much of the day.
• Adjusting your exercise program to include a warmup and a gradual buildup, to avoid straining the plantar fascia.
• Stretching your calves and feet before and after running or walking.
• Maintaining a healthy body weight.

Your physical therapist will design a personalized treatment program to help heal your plantar fasciitis and prevent future injury.

All physical therapists are prepared through education and experience to treat plantar fasciitis. However, you may want to consider:

• A physical therapist who is experienced in treating people with orthopedic and sports injuries, particularly those with experience working with the ankle and foot.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy, meaning that this physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or other health care providers.
• Search the internet to find reviews on local clinics and provider backgrounds.
• Contact a physical therapy clinic and ask about the physical therapists' experience in helping people who have heel pain.
• Be prepared to describe your symptoms in as much detail as possible, including when symptoms started, what makes your symptoms worse, and what makes them better.

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