In Germany, plantar Fasciitis is managed by podiatrys. Plantar fasciitis is degeneration and microtearing of the plantar fascia at its calcaneal origin, and it is the single most common cause of heel pain in adults — about 1 in 10 people develop it during their lifetime, and US clinicians see roughly 2 million cases each year. The hallmark is a sharp, stabbing pain under the inside of the heel during the first few steps in the morning, easing after walking and returning after long periods of standing.
Plantar fasciitis (ICD-10: M72.2, plantar fascial fibromatosis) is a degenerative enthesopathy of the plantar aponeurosis — the thick band of collagen that runs from the medial calcaneal tuberosity along the sole of the foot to the base of the toes and supports the medial longitudinal arch. The condition was historically labeled an inflammatory tendinitis, but biopsy and histology studies from the 1990s onward consistently show collagen disorganization, mucoid degeneration, fibroblast proliferation, and microtears with little or no acute inflammatory infiltrate. The current preferred term in many sports medicine circles is plantar fasciopathy or plantar heel pain syndrome, though plantar fasciitis remains the dominant clinical and search term. Pathology centers on the proximal insertion at the medial calcaneal tubercle, where repetitive tensile load exceeds the tissue's capacity to repair.
The key symptoms of Plantar Fasciitis are: Sharp, stabbing heel pain with the first few steps after getting out of bed in the morning or after sitting for a long period, easing within 5-15 minutes of walking — the most specific feature of the condition., Tenderness on direct palpation of the medial calcaneal tubercle on the inner side of the heel, often reproducible with a thumb pressed firmly into the spot where the fascia inserts., Pain that returns or worsens after extended standing, walking on hard floors, or at the end of a long workday, particularly in barefoot or unsupportive shoes., A burning, aching, or tight sensation along the arch that radiates forward from the heel, worsening with toe-walking, climbing stairs, or pushing off during running., Stiffness in the calf and Achilles tendon, with reduced ankle dorsiflexion that is typically worse on the affected side and contributes to the cycle of overload., Pain provoked by passive dorsiflexion of the great toe (the windlass test), which stretches the fascia and reproduces the patient's typical heel pain., An antalgic gait pattern, with the patient shifting weight onto the lateral border of the foot or toe-walking to avoid loading the heel..
Plantar fasciitis is a clinical diagnosis. The history of sharp medial heel pain that is worst with the first morning steps and eases with walking, combined with point tenderness at the medial calcaneal tubercle and a positive windlass test (pain reproduced by passive dorsiflexion of the great toe while the ankle is in neutral), is sufficient in most cases. Both the 2014 APTA Heel Pain clinical practice guideline and its 2023 update recommend against routine imaging for typical presentations. Imaging is reserved for atypical features — bilateral disease in a young adult, pain that does not improve at 3-6 months, sudden onset with a popping sensation, neurologic symptoms in the foot, or systemic features such as morning stiffness elsewhere. Diagnostic ultrasound is the imaging modality of choice and shows a thickened (greater than 4 mm) and hypoechoic plantar fascia at the calcaneal insertion, sometimes with intrasubstance tears or perifascial fluid. MRI is reserved for cases where the diagnosis is uncertain, where rupture or stress fracture is suspected, or before surgical planning. Plain radiographs frequently show an incidental calcaneal spur, but the spur is not the cause of pain — 15-20% of asymptomatic adults have one. Laboratory testing is unnecessary unless a systemic inflammatory cause is suspected, in which case HLA-B27, ESR, CRP, RF, and uric acid may be requested. The most important differential diagnoses to exclude are calcaneal stress fracture (positive squeeze test, pain at rest), tarsal tunnel syndrome (radiating burning or tingling into the sole), Baxter's nerve entrapment, and heel fat pad atrophy.
Around 80-90% of patients with plantar fasciitis recover fully within 6-12 months with conservative treatment, and roughly 90% recover by 18-24 months whether or not they undertake formal therapy. Adherence to fascia-specific stretching, supportive footwear, and load management are the strongest modifiable predictors of faster recovery. Negative prognostic factors include obesity, bilateral disease, symptoms over 6 months at first specialist visit, occupational standing more than 6 hours daily, and severe limitation of ankle dorsiflexion. About 10% of patients develop chronic, recalcitrant symptoms that persist beyond 12 months; most of these respond to extracorporeal shockwave therapy, PRP, or surgery. Recurrence after successful treatment occurs in around 15-20% of patients over 5 years, usually triggered by a return to overload, weight gain, or unsupportive footwear. Long-term, plantar fasciitis does not cause permanent disability, joint destruction, or systemic complications when managed appropriately, and the great majority of patients return to their preferred activities.
See a podiatrist or sports medicine physician if heel pain has not improved after 6-8 weeks of supportive footwear, stretching, and load reduction; if the diagnosis is unclear because of bilateral pain, radiating burning, or pain at rest; if you suspect a plantar fascia rupture after a popping injury; or if you are considering injection, shockwave, or surgery. Most uncomplicated cases improve in primary care with a structured stretching and footwear program.
Find specialists →Most patients notice meaningful improvement in first-step morning pain within 6-12 weeks of starting a structured stretching, footwear, and load-reduction program. Full symptom resolution typically occurs between 6 and 12 months. Patients receiving extracorporeal shockwave therapy usually report improvement 4-12 weeks after the treatment course. Recovery from corticosteroid injection is fastest in the short term but tends to plateau by 12 weeks. After surgical fasciotomy or gastrocnemius recession, expect 6-12 weeks before walking comfortably and 3-6 months before return to running or court sports.
During acute symptoms (first 2-6 weeks), reduce or stop weight-bearing impact activity and substitute cycling, swimming, or aqua-jogging for cardio. Continue daily plantar fascia-specific stretching and calf stretching. Once first-step morning pain falls below 3 out of 10, gradually reintroduce walking, then easy running on softer surfaces, increasing volume by no more than 10% weekly. Eccentric heel drops, intrinsic foot strengthening (towel scrunches, toe yoga), and single-leg balance work progress over 8-12 weeks. Avoid hill running, sprints, and barefoot training until pain has been absent for at least 4 weeks.
Look for a podiatrist board-certified in foot and ankle surgery or a sports medicine physician with regular use of musculoskeletal ultrasound. Ask whether the practice offers diagnostic ultrasound, image-guided injection, and shockwave therapy in-house, and whether they routinely work with a physical therapist who delivers DiGiovanni-style fascia-specific stretching. Continuity matters — most plantar fasciitis treatment unfolds over 3-12 months across several visits.
Medically reviewed by AIHealz Medical Editorial Board · May 12, 2026
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