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Plantar fasciitis

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Updated Sep 2026
Illustration: foot

What you're feeling

The pain sits in one spot: the underside of your heel, close to where your arch begins. It is usually sharpest with your first steps in the morning, or when you stand up after sitting or resting for a while. Once you have been on your feet a little, it often settles. It tends to come back after long periods off your feet.

This condition is called plantar fasciitis. It is the most common cause of heel pain in adults, and it is most common between the ages of 40 and 60. It often affects just one foot, but about one third of people have it in both feet.

Everyday tasks can become hard work. Getting out of bed and walking to the bathroom can hurt. Standing up from a chair, walking to the letterbox, or getting out of the car after a drive can all bring the pain on. Long stretches on your feet, such as shopping or standing at work, can make it worse.

If the pain is in both heels, it is worth mentioning this to your surgeon. Pain in both heels can sometimes point to an inflammatory condition rather than plantar fasciitis alone, and that is worth checking. Heel pain in older adults, or pain that does not fit the usual pattern, also deserves a closer look to rule out other causes such as a stress fracture in the heel.

You may notice the pain most when you push off your foot while walking, or when you climb steps barefoot on a hard floor. Some people describe it as a bruised or stone-bruised feeling under the heel.

If this sounds like your experience, you are not alone. Around 2 million people in the United States develop plantar fasciitis each year. The good news is that most people improve with simple treatment, and there are clear next steps if the pain does not settle.

What's actually happening

The plantar fascia is a thick band of tissue that runs along the sole of your foot, from your heel bone towards your toes. Think of it as a strong rope that holds up the arch of your foot. When you push off your big toe, the rope tightens and lifts the arch, which helps your foot work like a spring.

Despite the name, this is not really an inflammation problem. The tissue has become worn and degenerated, a bit like an old rope that has frayed from years of load. Small tears build up faster than the body can repair them. That fraying is why the tissue hurts when you first stand on it, and why it settles once it warms up and stretches out.

A few things can load up this rope. A tight Achilles tendon or tight calf muscles at the back of your ankle limit how far your ankle can bend, which puts extra strain on the fascia. Carrying extra body weight and standing for long hours at work both add to the load. A foot that rolls inward when you walk can play a part too.

The plantar fascia barely stretches at all, so it cannot absorb much give. Under your heel sits a pad of fat that works as a shock absorber. Repeated heavy loading can wear that pad down, and steroid injections into the heel can damage it over time.

You may have heard of heel spurs. These are small areas of calcification where the fascia meets the heel bone, and they are found in 10-20% of the population. Many people with heel spurs have no pain at all, so the spur itself is usually not the cause of your pain.

One more thing worth knowing. The plantar fascia sits close to a small nerve on the underside of your heel. Swelling or scarring near the fascia can irritate that nerve, which may add to the discomfort you feel.

What we can do about it

Weight-bearing X-rays are the usual starting point, and an ultrasound or MRI scan can help when the picture is not clear.

Most heel pain settles without surgery, so we usually begin there. Simple changes you can make yourself include adjusting your activities, wearing supportive footwear, and doing regular stretches for the plantar fascia and your calves. Physiotherapy works on these stretches alongside strengthening and load management, and it can take several weeks or months to see the full benefit. Taping the arch of your foot can also ease that first-step pain in the short term. It is worth giving these measures a fair go before moving up a level.

If self-management has not done enough, we can add other treatments. Anti-inflammatory tablets or pain relief may help you stay comfortable while the fascia settles. Shockwave therapy is another option: a hand-held device delivers sound waves to the sore spot, encouraging the tissue to heal. It is a non-invasive treatment, meaning nothing breaks the skin, and it is used for heel pain that has not settled with simpler measures. Injections are also available. A cortisone (steroid) injection can settle pain in the short term, though repeat injections into the heel can damage the natural fat pad that cushions it. A PRP injection uses a sample of your own blood, processed to concentrate its healing factors, and is injected into the fascia.

Surgery comes into the conversation when heel pain has not improved after at least 6 months of these conservative measures. The most common operation is a plantar fascia release, where we cut part of the tight band of tissue to relieve the strain on your heel. This can often be done through small incisions using a camera (endoscopic release), or sometimes through a small needle-based technique. Some people also need a small amount of bone or damaged tissue removed at the same time. We will talk through whether surgery makes sense for you only after a genuine trial of the non-operative options, and it remains a shared decision between you and our team.

What to expect

For most people, plantar fasciitis improves with time and the right treatment. Simple measures such as stretching, supportive footwear and physiotherapy often settle things over weeks or months, though it can take several months before you feel the full benefit. Some people find the pain comes and goes before it finally fades.

There are options if the first round of treatment does not do enough. Shockwave therapy and cortisone injections can both ease pain and improve how your foot works at the 3 month mark. A PRP injection may bring greater improvement in pain and function than a cortisone injection, particularly when the pain has been going on for a long time. Orthotic insoles, whether custom made or off the shelf, can improve foot function in the short term too.

If heel pain has not settled after 6 months or more of these measures, surgery is worth discussing. For people who have tried shockwave therapy without success, endoscopic plantar fascia release led to good or excellent results in 85% of patients at 2 years. People who noticed at least some improvement after a cortisone injection tend to do better with this operation than those who felt no change.

It is also honest to say that this condition can be stubborn. Some people still have symptoms years down the track. The long-term outlook tends to be harder for women and for people who have it in both feet. Around 45.6% of people still have plantar fasciitis about 10 years after their symptoms first began, so it is not a condition to simply ignore.

Leaving it alone is not the same as managing it well. Ongoing pain can limit what you do day to day, and the longer it hangs around, the more likely it is to persist. There is also a small chance that heel pain in both feet points to another health condition rather than plantar fasciitis alone, which is one reason it deserves a proper look rather than waiting it out.

The realistic picture is this: most people improve with steady, sensible treatment, some take longer than others, and a smaller group eventually needs surgery. We will keep an eye on how you are tracking and adjust the plan if things are not moving in the right direction.

When to see someone

Most heel pain like this can wait for a routine GP visit. See your GP if the pain has been going on for weeks without settling, or if it is stopping you sleeping or working. Ask for a specialist review if simple measures such as stretching and supportive footwear have not helped after several months, or if the pain keeps you from your normal activities. Some signs need a closer look sooner. Tell your GP if the pain is in both heels, because that can point to an inflammatory condition rather than plantar fasciitis alone. Heel pain in older adults, or pain that does not fit the usual pattern, should also be checked to rule out other causes such as a stress fracture in the heel.

Reviewed by AI synthesis (v2) — pending human review · 9 September 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

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Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Anatomy & Pathophysiology

Plantar Fascia & Heel Anatomy

  • Plantar heel spurs originate in the flexor digitorum brevis [10].
  • The flexor digitorum brevis is innervated by the medial plantar nerve [10].
  • The plantar calcaneonavicular ligament, also known as the spring ligament, attaches proximally to the sustentaculum tali and distally to the navicular [10].
  • The long plantar ligament attaches proximally to the calcaneus and distally to the cuboid and first to fifth metatarsals [10].
  • The short plantar ligament attaches proximally to the calcaneus and distally to the cuboid [10].
  • The medial calcaneal nerve may exit through the abductor hallucis fascia or plantar fascia at the level of a plantar fascia release [2].

Tarsal Tunnel & Neurovascular Anatomy

  • The tarsal tunnel is a fibroosseous tunnel within the posteromedial ankle and hindfoot containing the tibial nerve, posterior tibial artery, accompanying veins, posterior tibial tendon, flexor digitorum longus, and flexor hallucis longus tendons [3].
  • The flexor retinaculum acts as the roof of the tarsal tunnel and extends from the medial malleolus to the medial side of the calcaneal tuberosity [3].
  • The floor of the tarsal tunnel is formed by the medial distal tibia, talus, and calcaneus [3].
  • The tibial nerve divides into three terminal branches before reaching the foot: the medial calcaneal nerve, lateral plantar nerve, and medial plantar nerve [3].
  • The medial calcaneal nerve branches first from the tibial nerve and travels posteriorly to the subcutaneous tissue [3].
  • The lateral plantar nerve passes under the abductor hallucis, over the medial fascia of the quadratus plantae, deep to the plantar fascia, and under the heel to the flexor digitorum brevis [3].
  • The medial plantar nerve innervates the abductor hallucis and continues under the abductor and plantar fascia to form common digital nerves terminating in the first, second, and third web spaces [3].
  • The medial plantar nerve supplies motor branches to the interossei and lumbricals [3].
  • The lateral plantar nerve supplies motor branches to the intrinsic muscles [3].
  • Distal tarsal tunnel syndrome involves entrapment of the distal tibial nerve branches as they enter the foot [3].
  • Sources of constriction beneath and adjacent to the tarsal tunnel include bone fragments, tenosynovitis, ganglia, soft-tissue encroachment in inflammatory arthritis, varicosities, neural tumors, perineural fibrosis, tarsal coalition, and calcaneal osteotomies [3].
  • A fixed valgus hindfoot can predispose to chronic traction neuropathy of the posterior tibial nerve or one of its branches [3].

Foot Compartments & Musculature

  • The medial compartment of the foot lies on the plantar surface of the hallux and contains the intrinsic muscles of the great toe and flexor digiti minimi [9].
  • The lateral compartment of the foot lies on the plantar surface of the fifth metatarsal and contains the abductor digiti minimi [9].
  • The central compartment of the foot lies on the plantar surface of the foot and is divided into a superficial layer containing flexor digitorum brevis and a deep calcaneal layer containing quadratus plantae [9].
  • The interosseous compartment of the foot lies dorsal to the other compartments between the metatarsals and contains digital nerves [9].
  • Manoli and Weber proposed that there are nine compartments in the foot, with each of the four interosseous muscles and adductor hallucis lying in separate compartments [9].
  • The barrier between the superficial and calcaneal compartments of the foot becomes incompetent at a pressure of 10 mm Hg [9].
  • The peroneus longus inserts on the plantar aspect of the medial cuneiform and base of the first metatarsal [10].
  • The peroneus brevis inserts on the lateral aspect of the base of the fifth metatarsal [10].
  • At the level of the peroneal tubercle, the peroneus brevis lies dorsal to the peroneus longus [10].
  • The extensor digitorum brevis is the only dorsal intrinsic muscle of the foot and is innervated by the lateral terminal branch of the deep peroneal nerve [10].
  • Lumbrical muscles are located plantar to the transverse metatarsal ligament, while interosseous tendons are dorsal [10].
  • The tibialis posterior inserts on the navicular and medial cuneiform [10].
  • The flexor hallucis longus inserts on the distal phalanx of the great toe [10].
  • The flexor digitorum longus inserts on the distal phalanges of the second to fifth toes [10].

Ankle & Hindfoot Ligaments

  • The deltoid ligament is composed of a superficial layer (tibionavicular and tibiocalcaneal) that crosses the ankle and subtalar joint, and a deep layer (anterior and posterior tibiotalar) that crosses the ankle joint only [10].
  • The anterior talofibular ligament is the weakest lateral ankle ligament, is intracapsular, and limits inversion in plantar flexion [10].
  • The calcaneofibular ligament crosses both the ankle and the subtalar joint and limits inversion in neutral or dorsiflexion [10].
  • The posterior talofibular ligament limits posterior talus displacement and external rotation [10].
  • The tibionavicular ligament limits talar external rotation [10].
  • The tibiocalcaneal ligament limits hindfoot eversion [10].
  • The anterior tibiotalar ligament limits lateral displacement of the talus and external rotation [10].
  • The posterior tibiotalar ligament limits lateral displacement of the talus [10].
  • The Lisfranc ligament attaches proximally to the medial cuneiform and distally to the base of the second metatarsal [10].
  • The interosseous talocalcaneal ligament, also known as the cervical ligament, attaches between the talus and calcaneus [10].
  • The bifurcate ligament attaches from the calcaneus to the cuboid and navicular [10].

Vascular Anatomy

  • The dorsalis pedis artery is a continuation of the anterior tibial artery that passes deep under the inferior extensor retinaculum [4].
  • The dorsalis pedis artery lies between the tendons of the extensor hallucis longus medially and the extensor digitorum longus laterally as it passes anterior to the ankle joint [4].
  • The deep peroneal nerve lies immediately lateral to the dorsalis pedis artery [4].
  • The first dorsal metatarsal artery is the continuation of the dorsalis pedis artery and runs distally on the dorsal surface of the first dorsal interosseous muscle [4].
  • The deep plantar, or communicating, artery leaves the dorsalis pedis at the base of the first metatarsal and passes toward the plantar surface of the foot between the heads of the first dorsal interosseous muscle [4].
  • The deep plantar artery communicates with the lateral plantar artery to complete the plantar arterial arch [4].
  • The first dorsal metatarsal artery may lie superficial to or within the substance of the first dorsal interosseous muscle in 78% to 88% of feet [4].
  • The first dorsal metatarsal artery may lie plantar to the first metatarsal in 12% to 22% of feet [4].
  • The diameter of the dorsalis pedis artery may range from 1.8 to 3 mm [4].
  • The plantar surface of the foot is innervated by the digital branches of the medial plantar nerve [4].
  • The first web space is innervated by the deep peroneal nerve [4].
  • The dorsal surfaces of the toes and foot receive sensory innervation through the superficial peroneal nerve branches [4].

Cavus Foot Pathophysiology

  • Cavus foot is defined as a foot with an abnormally high arch [1].
  • Cavus foot frequently accompanies hindfoot varus deformity, known as cavovarus foot [1].
  • Clawing of the toes and demonstrable weakness of ankle or foot muscles may be present in cavus foot [1].
  • Calluses beneath the metatarsal heads and heel skin are common in cavus foot [1].
  • Hindfoot varus in individuals with a cavovarus deformity is nonstructural if it can be corrected with the “block test” [1].
  • The cause of cavus foot is usually muscle imbalance in a growing foot [1].
  • Cavus foot is rarely found in early childhood but is fairly frequent after 8–10 years of age [1].
  • Intrinsic muscle weakness is a major cause of cavus foot, with weakness of the peroneal or anterior tibialis muscles also implicated [1].
  • Cavus foot is rarely found in the absence of an underlying neuromuscular condition [1].
  • Cavus foot is a marker for neuromuscular disease [1].
  • In severe cavus foot, the forefoot is severely plantar flexed on the hindfoot, requiring marked ankle dorsiflexion to compensate [1].
  • When cavus becomes too severe, ankle dorsiflexion is blocked, leading to anterior ankle impingement and pain [1].
  • The inability to dorsiflex further compromises forefoot clearance, eventually allowing only the metatarsals to contact the floor [1].
  • This condition can be misinterpreted as ankle plantarflexion contracture, potentially leading to unnecessary heel cord release [1].

Investigations

Imaging Modalities

  • MRI is a fundamental tool in the workup of a patient with a soft-tissue or bone tumor in the foot [20].
  • MRI allows detection and definition of masses in the foot due to excellent multiplanar anatomic information [20].
  • Plantar fibroma or plantar fibromatosis is usually easily confirmed by MRI by the presence of a signal-poor mass arising from the plantar fascia [20].
  • Interdigital or Morton neuroma is most frequently found in the distal third metatarsal interspace on MRI [20].
  • Unlike most other tumors, interdigital neuroma lacks increased signal on T2-weighted MRI sequences [20].
  • MRI can detect osteomyelitis quite early, well before radiographic abnormalities are visible [20].
  • The sensitivity of MRI for osteomyelitis approaches 100%, but the reported specificity is less [20].
  • In neuropathic patients, the specificity of MR signal abnormalities for osteomyelitis is reduced [20].
  • Normal MRI marrow signal confidently excludes osteomyelitis in almost all cases of pedal osteomyelitis [20].
  • MRI is the modality of choice for the evaluation of surrounding soft-tissue infection in the foot [20].
  • Contrast-enhanced MRI sequences are helpful in defining nonenhancing fluid collections, abscesses, and devascularized or gangrenous tissue [20].
  • MRI and ultrasound are used to demonstrate soft-tissue problems, such as tendon and ligament injuries [17].
  • MRI and ultrasound can be used to diagnose joint effusions and bone infections [17].
  • Computed tomography (CT) scans are important in assessing fractures and for congenital bony coalitions [17].
  • Radio-isotope scanning is excellent for localizing areas of abnormal blood flow or bone remodelling activity, which suggest the presence of covert infection [17].
  • Ultrasonography has been reported to be 85% accurate in diagnosing interdigital neuroma [14].
  • MRI may be useful in diagnosing interdigital neuroma, and the administration of contrast medium may increase its accuracy [14].
  • Weight-bearing radiographs are useful for excluding a stress fracture of the metatarsal neck in the evaluation of interdigital neuroma [14].
  • Injection of the involved web space with local anesthetic that results in relief of neuritic symptoms is diagnostic of interdigital neuroma [14].
  • Injections performed under ultrasound guidance for interdigital neuroma had higher short-term relief compared with blind injections [14].
  • MRI can be useful in the diagnosis of metatarsalgia, such as distinguishing among a neuroma, cyst, bursa, or synovitis [18].
  • The radiographic evaluation for metatarsalgia includes weight-bearing anteroposterior, lateral, and oblique views of the foot [18].
  • The skyline view of the metatarsal heads is helpful to evaluate their overall alignment, particularly in cases resulting from previous surgery [18].
  • MRI of the spine is indicated with unilateral involvement in pes cavus [21].
  • Weight-bearing radiographs are required for the evaluation of pes cavus [21].
  • An increased Meary angle, where the long axis of the talus intersects the long axis of the first metatarsal dorsally on the lateral view, is a radiographic finding in pes cavus [21].
  • The normal value for the Meary angle is 0° to 5° [21].
  • An increased calcaneal pitch, defined as the intersection of a line running along the undersurface of the calcaneus and the floor, is a radiographic finding in pes cavus [21].
  • A calcaneal pitch greater than 30° indicates a calcaneocavus foot [21].
  • Stress X-rays complement the clinical tests for ankle stability [17].
  • If stress manoeuvres are painful, they can be carried out under general anaesthesia [17].
  • In the adult, standard X-ray views of the ankle are AP, mortise (an AP view with the ankle internally rotated 15–20 degrees), and lateral [17].
  • Medial and lateral oblique projections allow better assessment of the subtalar joint [17].
  • The calcaneum is usually X-rayed in axial and lateral views [17].
  • X-ray under load, weight-bearing, is helpful in showing the coronal relationship of heel to tibia in stance [17].
  • The foot, toes, and intertarsal joints are well displayed in standing dorsoplantar and lateral views [17].

Clinical Examination

  • The Mulder sign is elicited by squeezing the foot while palpating the web space, and a painful click is diagnostic of an interdigital neuroma [14].
  • Plantar foot pain just distal to and between the metatarsal heads, often described as “burning,” is characteristic of interdigital neuroma [14].
  • Patients with interdigital neuroma often feel as if they are walking on a marble [14].
  • Symptoms of interdigital neuroma are typically aggravated by activity or by wearing shoes with high heels or a narrow toe box [14].
  • Patients with interdigital neuroma often note that they feel better in their bare feet and get quick relief by removing their shoes [14].
  • The involved ray should be evaluated for metatarsophalangeal (MTP) joint instability, especially if the second web space is symptomatic [14].
  • Neuromas rarely occur in the first and fourth web spaces, so for pain that occurs in these areas, other causes of forefoot pain should be considered [14].
  • Hindfoot flexibility is assessed by placing a 1-inch block under the lateral border of the foot (Coleman block test) [21].
  • A neurologic examination and a family history are essential in the evaluation of pes cavus [21].
  • Unilateral involvement in pes cavus suggests a focal diagnosis, such as spinal cord anomaly or nerve injury [21].
  • Bilateral involvement and a positive family history are common with Charcot-Marie-Tooth disease [21].
  • The physical examination of the foot and lower extremity for metatarsalgia begins with the patient standing [18].
  • The plantar aspect of the foot is carefully evaluated for evidence of callus formation in metatarsalgia [18].
  • The metatarsal heads are palpated individually to assess for generalized plantar fat pad atrophy, a prominent fibular condyle, synovitis, or possibly a transfer lesion beneath a metatarsal head [18].
  • The patient should be evaluated for a postural problem of the foot, such as a flat foot or cavus foot, during the clinical evaluation of metatarsalgia [18].
  • Diagnosis of cavus foot requires a thorough search for the underlying cause and may require neurologic consultation, spinal MRI, and electromyographic (EMG) studies [1].
  • One of the most common symptoms of cavus foot is anterior ankle pain, sometimes associated with toe walking [1].
  • In severe cavus foot, ankle dorsiflexion is blocked, leading to anterior ankle impingement and pain [1].
  • The inability to dorsiflex further compromises forefoot clearance, and eventually, only the metatarsals can contact the floor in severe cavus foot [1].
  • This condition can be misinterpreted as ankle plantarflexion contracture, leading to unnecessary (and possibly harmful) heel cord release [1].
  • Patients with pes cavus may report instability, such as ankle sprains [21].

References

[1] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 10Pediatric Orthopedic Surgery > 4. Cavus Foot.

[2] Aaos Comprehensive Orthopaedic Review 3. Anatomy and Biomechanics of the Foot and Ankle > I. Anatomy.

[3] Campbell S Operative Orthopaedics 4 Volume Set. COMBINED HAMMER TOE AND MALLET TOE DEFORMITY WITH ASSOCIATED DOUBLE CORNS > TARSAL TUNNEL SYNDROME.

[4] Campbell S Operative Orthopaedics 4 Volume Set. RESULTS OF SUTURE OF THE SCIATIC NERVE > NEUROVASCULAR ANATOMY.

[9] Rockwood And Green S Fractures In Adults. Effect of Blast on the Musculoskeletal System > Foot.

[10] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > 2. Arthrology > 3. Muscles.

[14] Aaos Comprehensive Orthopaedic Review 3. Neurologic Disorders of the Foot and Ankle > II. Interdigital Neuroma.

[17] Apley And Solomon S Concise System Of Orthopaedics And Trauma. CONGENITAL ABNORMALITIES.

[18] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 8Foot and Ankle Surgery > METATARSALGIA.

[20] Campbell S Operative Orthopaedics 4 Volume Set. OTHER DISORDERS OF FOOT AND ANKLE.

[21] Aaos Comprehensive Orthopaedic Review 3. Pediatric Foot Conditions > Pes Cavus.

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6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.