Conditions & Treatments - Plantar Fasciitis (Subcalcaneal Pain Syndrome)

Plantar Fasciitis

Plantar fascia is comprised of a strong band of fibrous tissue whose thick central part is bounded by thinner lateral portions (1, 2). The central portion is attached to the medial calcaneal tubercle while the distal portions extend and attaches to the proximal phalanx of each toe (1, 2). The primary function of the plantar fascia is to support the arch of the foot and enhance the biomechanics of the foot during the stance phase of gait.

Plantar Fasciitis
Plantar heel pain is a common condition seen by physical therapist. It has been estimated to occur in 10% of the American population within a lifetime (1, 3). Various conditions which contribute to heel pain can include: calcaneal stress fracture, arthritis, heel pad atrophy, plantar fascia rupture, lumbar spine disorder, heel contusion, Sever’s disease, infections, nerve entrapment and plantar fasciitis (3). The condition of Plantar Fasciitis can be contributed to overuse or repetitive micro trauma of the tissue which results in an inflammatory reaction (3). Individuals who are obese, have limited ankle dorsiflexion, and are on their feet most of the days are more likely to develop this condition (3). Individuals who present with plantar fasciitis report plantar pain which they describe as dull/achy or sharp. They usually report onset of pain when weight bearing after a period of non weight bearing (ie. Initial weight bearing in AM), pain that eases with initial activity, but then increases with further use as the day progresses (1). Walking barefoot, on toes or up stairs may result in an increase in symptoms as well (3).

Examination for Plantar Fasciitis
A physical examination should include checking for alignment problems at the hip, knee and ankle which may contribute to pes cavus, pes planus or hyperpronation of the foot (4). Upon palpation, tenderness is often localized at the plantar fascial attachment of the calcaneus, in the medial arch area and in the abductor hallucis muscle (4). Hyperextension of the MTP joints will stress the plantar fascia and could result in pain (4). Range of motion of the great toe is usually limited in dorsiflexion and ankle dorsiflexion is often less than 90 degrees (4). Diagnostic imaging is not found to be conclusive with diagnosing plantar fasciitis but should be considered if another diagnosis is suspected (3).

Treatment of Plantar Fasciitis
There are a variety of treatment options for treating plantar fasciitis but research supporting their use are sometimes conflicting (1). The various options include (4):
• ice massage, rest (to include period of non weight bearing), ant-inflammatory medications
• ultrasound / phonophoresis
• iontophoresis
• orthotics / arch support (excessive pronation)
• stretching (plantar fascia and gastrocnemius)
• cross friction massage (plantar fascia)
• joint mobilizations (great toe, hind foot, subtalar joint, navicular)
• strengthening (arch muscles and gastrocnemius)
• closed kinetic chain activities
• proprioceptive control activities
• night splints
• corticosteroid injections

Physical Therapy and Plantar Fasciitis - What the Evidence Shows
General Measures (3) – No studies have specifically examined the effectiveness of ice and NSAIDs alone.

Stretching (1, 3) – There is some evidence that directly stretching the plantar fascia may be more effective than Achilles tendon stretching alone in the short term.

Taping (3) – No studies have adequately evaluated the effectiveness of taping or strapping for managing plantar fasciitis.

Shoe Inserts (3) – Many studies with results that vary. One study showed that prefabricated insoles plus stretching was more effective than custom orthotics and stretching (see 3 ref list 5)

Corticosteroid injections (3) – Results of a Cochrane review (5) showed that corticosteroid injections improved plantar fasciitis symptoms at one month but not at six months when compared with control groups. The same review showed that steroid iontophoresis also improved short term outcomes.

Night Splints (3) – Cochrane review (5) found limited evidence to support the use of night splints to treat patients with pain lasting more than six months. Patients treated with custom-made night splints improved, but patients with prefabricated night splints did not.


Last Revised: March 24, 2014
By: Chai Rasavong, MPT, MBA


1) Sweeting D, Parish B, et al. The Effectiveness of Manual Stretching in the Treatment of Plantar Heel pain: A Systematic Review. Journal of Foot and Ankle Research. 2011, 4:19.
2) Accessed March 24. 2014
3) Cole C, et al. Plantar Fasciitis: Evidence-Based Review of Diagnosis and Therapy. American Family Physician. 2005;72(11):2237-2242.
4) Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods. 4th ed. Philadelphia, PA: Lippincort Williams and Wilkins.;2006. 600-601.
5) CrawfordF, Thomoson C. Interventions for Treating Plantar Heel pain. Cochrane Database Syst Rev 2003;(3):CD000416


Terms & Conditions

Please review our terms and conditions carefully before utilization of the Site. The information on this Site is for informational purposes only and should in no way replace a conventional visit to an actual live physical therapist or other healthcare professional. It is recommended that you seek professional and medical advise from your physical therapist or physician prior to any form of self treatment.