What Is Plantar Fasciitis?
Plantar fasciitis is the most common type of heel pain, with about one in 10 people experiencing symptoms at some point in their lives. The overuse injury primarily affects middle-aged and older adults, as well as people who frequently stand or walk on hard floors (Trojian & Tucker, 2019).
What Causes Plantar Fasciitis?
Plantar fasciitis occurs when the plantar fascia breaks down, leading to microtears and strain. While the condition is often described as an overuse injury, it’s actually more of a degenerative condition, as the damaged tissue cannot fully heal itself over time.
The plantar fascia has a fairly limited blood supply, which can slow down healing (Miller & Latt, 2015). Factors like overuse, high-impact activity (e.g., running or dancing), systemic inflammation, poor foot mechanics, such as flat feet or high arches, or overall metabolic or nutritional health — specifically nutrients that support collagen repair like protein, vitamin C, and zinc — can make it more challenging for your body to repair these small injuries, allowing the pain to persist (Buchanan et al., 2024).
Regenerative therapies — which we’ll cover in more detail soon — can be particularly beneficial for plantar fasciitis because they can promote angiogenesis (new blood vessel growth) and repair vascular structures (Leeper et al., 2010).
Who Is At Risk?
Several risk factors exist for plantar fasciitis relating to physical health, lifestyle, occupation, anatomy, and footwear (Trojian & Tucker, 2019).
Systemic Inflammation
Studies suggest that the foot condition may also arise from elevated C-reactive protein (CRP) levels — a protein produced by the liver. This suggests that the pain may signal a broader, systemic (whole-body) inflammation — rather than just a localized problem (Elabd et al., 2024).
Physical Health
People with a higher body mass index (BMI), who are obese, and older people between the ages of 40 and 60 are more likely to develop this form of heel pain.
Occupation and Lifestyle
Jobs that require long hours standing or walking on hard surfaces, such as teaching, healthcare, construction, or retail, are high-risk.
Having a sedentary lifestyle, meaning little to no physical activity, or high-impact exercise like running or dancing, can contribute to plantar fasciitis.
Anatomy
Certain foot structures, such as a high arch (pes cavus) or flat feet (pes planus), affect weight distribution, increasing the risk of plantar fasciitis. Having tight muscles — specifically the calves — can put more tension on your Achilles tendon. This tension can pull on your heel bone, stressing the plantar fascia.
Footwear
Wearing footwear that doesn't provide proper arch support, stability, or cushioning — such as flat or thin-soled shoes, worn-out sneakers, or high heels — is strongly associated with the development of plantar fasciitis.
In addition, wearing improper shoes for prolonged periods of walking or standing can significantly increase pressure on your heels and cause excessive strain on the plantar fascia.
Other Factors
Pregnancy (due to weight gain) and a sudden, intense increase in physical exercise may contribute to plantar fasciitis.
What Are The Symptoms?
The main symptoms of plantar fasciitis are sharp, stabbing pain or a dull ache in or near the heel. This pain typically worsens with the first morning steps, after a long resting period, or after exercise.
Your heel may also feel tight or stiff, and the affected area may be tender to the touch with some mild swelling. Some people also report a burning sensation along the sole.
How Is Plantar Fasciitis Diagnosed?
Plantar fasciitis is commonly misdiagnosed for similar conditions such as tarsal tunnel syndrome and posterior tibial nerve entrapment — highlighting the need for proper evaluation and diagnosis by a provider with specialized training in this condition.
The degenerative condition is typically diagnosed with the following techniques (Thing et al., 2012):
Physical exam: A healthcare provider will check for any pain, swelling, or redness on your soles.
Ultrasound: Measures the thickness of the plantar fascia, which is anything greater than four millimeters.
X-rays: Can help rule out stress fractures or assess heel spurs (although they aren't the direct cause of the foot pain).
Magnetic resonance imaging (MRI): Recommended for chronic foot pain to visualize the inflammation or microtears in the tissue.
The intensity and duration of symptoms can help your provider determine which tests are necessary to diagnose or rule out plantar fasciitis. If you receive a diagnosis, your provider will refer you to a podiatrist — a trained foot specialist — for further evaluation and treatment.
Visiting your provider for a comprehensive evaluation and diagnosis can help you start appropriate treatment and find the relief you deserve.
How Is Plantar Fasciitis Treated With Regenerative Therapies?
Plantar fasciitis is manageable with several treatments, including:
Physical therapy
Night splints
Medication (such as NSAIDs)
Medical procedures, such as surgery
In addition to traditional treatments, people with plantar fasciitis may benefit from regenerative therapies, such as:
Platelet-Rich Plasma (PRP) Injections
Uses your own blood platelets to stimulate collagen production and tissue repair. A meta-analysis of 24 randomized controlled trials involving 1,653 participants discovered that PRP injections provided better pain management than corticosteroids over a medium, three- to six-month treatment period for plantar fasciitis. Ultrasound-guided PRP injections, in particular, can be the best approach in repairing tissue and relieving pain for plantar fasciitis (Zuo et al., 2025).
Extracorporeal Shockwave Therapy (ESWT)
A non-invasive medical procedure that uses high-energy sound waves to treat chronic musculoskeletal pain. In a systematic review and meta-analysis of 236 studies, researchers found that, in the medium- and long-term, ESWT was the most effective treatment for plantar fasciitis compared to other therapeutic methods (Guimaraes et al., 2023). Combining ESWT with PRP injections can yield better results than using either treatment alone (Haddad et al., 2021).
Dextrose Prolotherapy
An injection therapy that uses a mix of dextrose (sugar) and anesthetic (lidocaine) to trigger a healing response in the inflamed foot tissue. It can help stimulate tissue repair to reduce pain. A meta-analysis of six studies involving 388 adults found that dextrose prolotherapy is a safe and effective treatment for plantar fasciitis, potentially offering long-term benefits compared with corticosteroids (Lai et al., 2021).
Low-level Laser Therapy (LLLT)
Also known as cold laser therapy, the non-invasive treatment uses low-intensity laser light to stimulate cell function. It can help reduce inflammation and pain while accelerating tissue repair and healing. A systematic review and meta-analysis of randomized controlled trials discovered that LLLT significantly reduced pain and disability in people with plantar fasciitis in the short and medium term (Naterstad et al., 2022).
Emerging Regenerative Therapies
Other regenerative therapies may be beneficial for managing plantar fasciitis, but research on their effectiveness is limited.
These include:
Ultrasound-guided nerve hydrodissection: Fluid injections that separate trapped or compressed nerves from surrounding tissues to decrease inflammation and pain and restore movement.
Amniotic membrane transplantation: Uses amniotic membrane or fluid to reduce inflammation, relieve pain, and promote tissue regeneration.
Exosome injections: Use stem cell-derived vesicles to accelerate healing, stimulate collagen, and reduce inflammation.
Nutritional Support
A healthy diet can help reduce pain and inflammation from plantar fasciitis. Adopt an anti-inflammatory diet that's rich in omega-3 fatty acids (salmon, walnuts), antioxidants (berries, leafy greens), and vitamin C (citrus, peppers). Avoid or limit refined sugars, processed foods, and trans fat. You can also take supplements, such as collagen and zinc, to get those nutrients. It's best to consult a nutritionist or provider to discuss what supplements are right for you and any diet adjustments.
What Are Possible Complications?
If left untreated, plantar fasciitis can become a chronic condition, causing long-term disability and mild to moderate pain for several months or years.
Other potential complications may include:
Larger plantar fascia tears may lead to a larger rupture.
Heel spurs, or bony calcium deposits that develop on the heel bone to protect the strained area, can cause further pain.
An altered gait to accommodate the pain can cause further injuries and pain in the knees, hips, and lower back.
The development of plantar fibromatosis, which is a rare, benign (noncancerous) condition in which nodules (fibromas) grow in the tissue on the sole of the foot. It can often cause pain in the arch when walking.
To avoid future complications, it's best to visit your provider at the first sign of pain or discomfort. They can provide a proper evaluation, diagnosis, and early intervention to help you find relief and prevent long-term pain.
Can Plantar Fasciitis Be Prevented?
Plantar fasciitis is a preventable condition with a few lifestyle changes, including:
Maintaining a healthy weight: Losing weight through a healthy diet and exercise can help reduce the pressure on your feet.
Wearing the proper footwear: Buy shoes with a strong arch and cushioned heels, and replace them every six to nine months.
Managing physical activity: Try to avoid standing or walking for extended periods by taking occasional breaks. It can also help to switch from high-impact activities to low-impact ones, such as swimming or cycling.
Certain conditions, such as pregnancy or having a high or flat arch, aren't necessarily avoidable. If this is the case for you, it can still be beneficial to speak with your provider to discover ways to lower your risk.
Takeaway
Plantar fasciitis is a common type of foot pain that is highly manageable when the root cause of the issue — the body's inability to repair small tissue damage — is addressed.
Regenerative therapies that support healing, along with lifestyle changes like wearing proper footwear, maintaining a healthy weight, and managing physical activity, can help reduce strain on the plantar fascia.
With the right diagnosis and treatment plan, you can find long-term relief rather than relying on short-term fixes like corticosteroid injections or pain medications.
