- Plantar fasciitis is inflammation of the thick ligament along the bottom of your foot, and it causes a sharp pain under the heel that's worst with the first steps of the day.
- It affects runners, people who stand all day at work, and adults whose arches have changed with age — and most cases resolve without surgery.
- First-line treatment is stretching, supportive footwear, custom orthotics, and at-home calf and arch work.
- For stubborn cases, corticosteroid injections and night splints work well. Surgery is rare and only considered after 6–12 months of failed conservative care.
- Routine evaluations book within a few days at any of our 8 locations.
What is plantar fasciitis?
Plantar fasciitis (sometimes spelled "plantar fasciosis" in chronic cases) is inflammation and microtearing of the plantar fascia — a thick band of connective tissue that runs along the bottom of the foot from the heel bone to the base of the toes. When that band is overloaded, it develops tiny tears at the spot where it attaches to the heel, and the area becomes painful, especially with the first weight-bearing steps after rest.
It is the single most common cause of heel pain in adults. Runners and walkers are at higher risk, as are people whose jobs keep them on hard floors all day (nurses, teachers, retail, hospitality). Anatomic factors matter too: very flat feet, very high arches, and tight calf muscles all increase the load on the fascia. It often shows up in midlife as the arch gradually changes shape.
At Northwest Extremity Specialists, we treat plantar fasciitis conservatively first — and that approach works for the vast majority of patients. Our podiatrists build a stepped plan: optimize footwear, address calf tightness, fit custom orthotics if needed, and add night splints or corticosteroid injections when first-line care alone isn't enough.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
The plantar fascia is a thick, fibrous band of tissue that spans the sole of the foot, anchoring at the heel bone (calcaneus) and fanning out to the base of each toe. It works alongside the arch of the foot to absorb shock with every step and to act as a springboard when you push off. When the fascia is repeatedly overloaded — through too much mileage, a hard work surface, or a foot that doesn't support itself well — tiny tears develop at the heel attachment and the surrounding tissue becomes inflamed.
What it feels like
Plantar fasciitis has a very recognizable pain pattern. Common symptoms include:
- Sharp, stabbing pain under the heel, especially with the first few steps in the morning
- Pain that improves after walking around for a few minutes, then returns after prolonged sitting or standing
- Tenderness when you press directly on the bottom of the heel
- A pulling or tight feeling along the arch, especially after exercise
- Pain that's worse after — not during — long runs or long days on your feet
- Mild swelling in the heel area in more inflamed cases
- Worse symptoms walking barefoot on hard surfaces
Why it develops
Plantar fasciitis develops when the fascia is loaded faster than it can recover. Common contributing factors:
- Sudden increase in running mileage, walking, or standing time
- Tight calf muscles and Achilles tendon, which pull on the heel and increase fascial tension
- Flat feet or fallen arches, which stretch the fascia with every step
- Very high, rigid arches that don't absorb shock well
- Unsupportive footwear — old shoes, flat sandals, or barefoot on hard floors
- Being overweight, which increases the load on the fascia
- Jobs that require long hours standing on hard surfaces (hospitality, healthcare, manufacturing)
How we diagnose plantar fasciitis
A typical first visit takes about 30 minutes. Your podiatrist will ask about how the pain started, when it's worst, and what makes it better. Then they'll examine your foot — checking exactly where it hurts, your arch shape, calf flexibility, and your walking pattern. On-site digital X-ray is often used to rule out a stress fracture or to evaluate a heel spur. MRI or ultrasound is rarely needed for a first visit and is reserved for cases that don't respond to treatment. Most patients leave the same day with a clear diagnosis and a written plan.
Non-surgical care
The vast majority of plantar fasciitis cases — well over 90 percent — resolve with conservative care alone. Our typical first-line plan combines several of these together:
- Targeted stretching program for the calf and plantar fascia (we teach you the exact movements at your first visit)
- Supportive shoes with a moderate heel (avoid completely flat or barefoot-style)
- Over-the-counter heel cups or arch supports for milder cases
- Custom orthotics fit in-office for moderate-to-severe cases or when arch issues are contributing
- Night splints to keep the fascia stretched during sleep — particularly helpful for severe morning pain
- A short course of anti-inflammatory medication if appropriate
- Corticosteroid injection in selected stubborn cases that don't respond to 6–8 weeks of the above
- A graduated return-to-activity plan if running or sport is the trigger
Surgical care
Surgery is reserved for the small percentage of patients whose pain persists after at least 6–12 months of well-executed conservative treatment. When considered, the goal is to relieve tension on the fascia or to address a contributing structural problem.
- Plantar fascia release — partial division of the fascia to reduce tension
- Gastrocnemius recession — lengthening of a tight calf muscle that's pulling on the heel
- Endoscopic plantar fasciotomy — minimally invasive approach used in selected cases
Recovery from plantar fascia surgery typically involves protected weight-bearing in a walking boot for 2–4 weeks, transitioning to supportive shoes and gradual return to activity over 6–12 weeks. Most patients return to running and full sport between 3 and 6 months post-op.
When to see a specialist
- Heel pain that has lasted more than 2–3 weeks despite trying supportive shoes and rest
- Morning pain so severe it interrupts your ability to start the day
- Pain that's changing how you walk or beginning to affect your knee, hip, or back
- Sudden onset of severe heel pain after an injury (could be a tear or fracture)
- Pain plus swelling, redness, or warmth — get seen sooner
Plantar fasciitis is treated by any of our board-certified podiatrists across our 8 Portland-area clinics. Dr. Manny Moy and Dr. Todd Galle handle a particularly high volume of cases through our sports medicine program, with extensive experience treating chronic plantar fasciitis that hasn't resolved with standard first-line care.