The plantar fascia is a thick, fibrous band of ligament that lies directly beneath the skin on the bottom of the foot.

It connects the heel to the front of the foot and helps to support the arch of the foot.

• Pain over the bottom of the foot near the heel
• Pain with the first few steps after getting out of bed in the morning, or after a long period of rest. The pain gradually subsides after a few minutes of walking
• Increased pain after a period of exercise or activity

The factors that may lead to an increased risk of plantar fasciitis include:

• Tends to occur between the ages of 40 to 60
• Obesity leads to excess stress on the plantar fascia
• Repetitive impact activity such as long-distance running
• Abnormal foot mechanics such as flat feet, a high foot arch or an altered walking pattern can lead to increased stress on the plantar fascia
• Occupations that require long hours of standing or walking
• New or increased physical activity that the body is not conditioned for

A diagnosis of plantar fasciitis is usually made after a detailed history and physical examination of the affected foot.

Usually, no investigations are required, but your doctor might suggest an X-ray or magnetic resonance imaging (MRI) scan to ensure that the pain is not due to another problem, such as a stress fracture or nerve impingement.

The treatment for plantar fasciitis depends on the severity and include:

• Avoidance of any strenuous activities for several months
• Painkillers such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs)
• Gentle exercises to stretch the plantar fascia and Achilles tendon, and to strengthen the lower leg muscles.
• Wearing a splint at night to stretch the calf muscle and arch of the foot while sleeping.
• Wearing arch supports can help to distribute weight in the foot more evenly.
• Corticosteroid (H&L) injection. This is injected into and around the area of tenderness and reduces the inflammation. The effect may be temporary, usually around 3 months, but may sometimes last a year or longer.
• Extracorporeal shock wave therapy (ESWT). This painless procedure employs sound waves directed at the area of tenderness and stimulates healing.
• If all else fails, surgery can be considered. The procedure involves detaching the plantar fascia from the heel bone.