Diagnosis & treatment of plantar fasciitis
Plantar fasciitis (disease of the fibrous tissue along the bottom of your foot) is usually diagnosed based on your symptoms and a physical exam. Most people never need a scan. Treatment focuses on calming heel pain in the short term while building long term strength and resilience in the plantar fascia.
How do clinicians diagnose plantar fasciitis?
Most people are diagnosed based on a conversation and a simple exam, not a scan.¹ ² A clinician usually starts by hearing your story, including:
- When the pain started, and whether it flared after a change in walking, running, work shifts, or footwear¹ ²
- Where you feel it (often the inner bottom of the heel), and whether it is worst with your first steps after rest¹ ²
- How it affects your day, like walking the dog, standing at work, or getting back to exercise¹ ²
What clinicians typically look for
A clinician will usually check for a pattern that fits plantar fasciitis and rule out other causes of heel pain. This often includes:¹ ²
- Touching the sore spot on the inner bottom of the heel to see if it reproduces your pain¹ ²
- Checking ankle and foot movement, especially how far your ankle bends upward, and whether pulling your toes upward triggers heel pain¹ ²
- Watching how you walk and stand, and asking about footwear and daily load on your feet¹ ²
When tests or imaging might matter
Most people with classic “first step” heel pain do not need imaging right away.¹ ² A clinician may consider an X-ray, ultrasound, or magnetic resonance imaging if:
- Your symptoms are unusual (for example, constant night pain, significant swelling, or numbness and tingling)²
- You cannot put weight on the foot after an injury²
- Pain is not improving after a well-delivered plan of care²
- There is concern for another problem such as a stress fracture, a plantar fascia tear, or a nerve issue² ⁹
Clinical insight
What are the treatment options for plantar fasciitis?
Plantar fasciitis is usually treated step by step. The goal is to calm symptoms while building the foot and lower leg’s ability to handle daily load again.¹ ² Many plans combine a few options, rather than relying on one “magic fix.”¹ ²
Education and activity changes
These are often the foundation of recovery.¹ ²
- Load management: reducing spikes in walking, running, or standing time, then building back up gradually¹ ²
- Supportive footwear: shoes with cushioning and stable support often feel better during recovery¹ ²
- Simple pacing strategies: short walking breaks, alternating tasks at work, and spreading activity through the day can help symptoms settle¹ ²
Exercise-based rehabilitation
Exercise is often the main driver of longer-term improvement.¹ ²
- Plantar fascia specific stretching: stretching that pulls the big toe and ankle upward can reduce pain and improve function, and has outperformed calf stretching alone in randomized trials.⁶
- Progressive strengthening: a high-load heel raise program (often with the toes propped up to tension the fascia) improved outcomes compared with stretching at key follow-ups in a randomized trial.⁷
Short-term symptom helpers
These can make walking and rehab more tolerable while your tissue capacity builds.¹
- Taping: low-Dye taping can provide small short-term improvement in “first step” pain compared with a sham intervention.⁴
- Foot orthoses or insoles: orthoses can reduce pain in the short term to medium term, with more mixed results over longer time frames, so they are often used as a support rather than a stand-alone cure.⁵
- Night splints: evidence is mixed, and one trial found that adding a tension night splint to a structured home program did not provide meaningful extra benefit.⁸
Medications
Non-steroidal anti-inflammatory medicines may help some people with short-term symptom control, but they do not replace a rehab plan that rebuilds tolerance to load.¹ ²
Injections and shock wave therapy
These are usually considered when symptoms are stubborn and function is still limited after a solid trial of conservative care.¹ ²
- Corticosteroid injections: can reduce pain in the short term, but benefits may fade, and there is a rare risk of plantar fascia rupture or fat pad thinning.² ¹⁰
- Platelet-rich plasma injections: some systematic reviews of randomized trials suggest platelet-rich plasma may improve pain and function more than corticosteroid injection at longer follow-up, but results vary and protocols are not standardized.¹¹
- Extracorporeal shock wave therapy: has evidence of benefit in more persistent cases, and meta-analyses of randomized trials support improvements in outcomes compared with other comparators across studies.¹ ¹²
Surgery
Surgery is usually reserved for the small minority of people who still have severe limits after at least 6 to 12 months of well-delivered non-surgical care.¹ ³ It can help in selected cases, but it has risks and is not the starting point.¹ ³
Sword's approach
Sword Health helps people manage pain and movement issues with expert-guided AI care you can use from home. Our model combines clinical support with modern technology, designed to work around your life.
Sword makes recovery easier and more accessible. You get high-quality care at home, guided by clinicians and supported by smart technology.
- Care that adapts to your progress in real time
- Licensed experts guiding every step
- Simple, non-invasive, evidence-based programs
- Proven results for pain relief, movement, and satisfaction
Did you know?
Heel spurs are common, and they can show up in people with no heel pain at all. Because of that, seeing a spur on an X-ray does not prove it is the cause of your symptoms.¹ ³
How can I find pain relief for plantar fasciitis?
These strategies are low risk and commonly used alongside evidence-based care.¹ ²
- Start your day gently: many people find it helps to do a short foot and calf warm-up before those first steps.¹ ²
- Use pacing on flare days: shorter walks more often can be easier on the heel than one long walk.¹ ²
- Keep moving in ways that feel safer: cycling, swimming, and strength training that does not spike heel pain can help you stay active while your heel calms down.¹ ²
- Choose shoes that reduce irritation: cushioned, supportive shoes often make standing and walking more comfortable during recovery.¹ ²
- Treat flares as manageable: symptom spikes are common during recovery and do not always mean you caused damage, especially if pain returns toward baseline with rest and smart load choices.¹ ²
If your pain is not improving after a few weeks of a structured plan, or if you have red flags like night pain, marked swelling, numbness and tingling, or you cannot bear weight, it is worth checking in with a clinician.² ⁹
