Plantar Fasciitis

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What is plantar fasciitis?

Plantar fasciitis is a painful inflammation of the bottom of the foot between the ball of the foot and the heel.

How does it occur?

There are several possible causes of plantar fasciitis, including:

  • wearing high heels
  • gaining weight
  • increased walking, standing, or stair-climbing

If you wear high-heeled shoes, including western-style boots, for long periods of time, the tough, tendonlike tissue of the bottom of your foot can become shorter. This layer of tissue is called fascia. Pain occurs when you stretch fascia that has shortened. This painful stretching might happen, for example, when you walk barefoot after getting out of bed in the morning.

If you gain weight, you might be more likely to have plantar fasciitis, especially if you walk a lot or stand in shoes with poor heel cushioning. Normally there is a pad of fatty tissue under your heel bone. Weight gain might break down this fat pad and cause heel pain.

Runners may get plantar fasciitis when they change their workout and increase their mileage or frequency of workouts. It can also occur with a change in exercise surface or terrain, or if your shoes are worn out and don't provide enough cushion for your heels.

If the arches of your foot are abnormally high or low, you are more likely to develop plantar fasciitis than if your arches are normal.

What are the symptoms?

The main symptom of plantar fasciitis is heel pain when you walk. You may also feel pain when you stand and possibly even when you are resting. This pain typically occurs first thing in the morning after you get out of bed, when your foot is placed flat on the floor. The pain occurs because you are stretching the plantar fascia. The pain usually lessens with more walking, but you may have it again after periods of rest.

You may feel no pain when you are sleeping because the position of your feet during rest allows the fascia to shorten and relax.

How is it diagnosed?

Your healthcare provider will ask about your symptoms. He or she will ask if the bottom of your heel is tender and if you have pain when you stretch the bottom of your foot. An X-ray of your heel may be done.

How is it treated?

  • Give your painful heel lots of rest. You may need to stay completely off your foot for several days when the pain is severe.
  • Your healthcare provider may recommend or prescribe anti-inflammatory medicines, such as aspirin or ibuprofen. These drugs decrease pain and inflammation. Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days without their healthcare provider’s approval. Resting your heel on an ice pack for a few minutes several times a day can also help.
  • Try to cushion your foot. You can do this by wearing athletic shoes, even at work, for awhile. Heel cushions can also be used. The cushions should be worn in both shoes. They are most helpful if you are overweight or an older adult.
  • Your provider may recommend special arch supports or inserts for your shoes called orthotics, either custom-made or off the shelf. These supports can be particularly helpful if you have flat feet or high arches.
  • Your provider may recommend an injection of a cortisone-like medicine.
  • Lose weight if needed.
  • A night splint may be recommended. This will keep the plantar fascia stretched while you are sleeping.
  • Physical therapy for additional treatments may be recommended
  • Surgery is rarely needed.

How long will the effects last?

You may find that the pain is sometimes worse and sometimes better over time. If you get treatment soon after you notice the pain, the symptoms should stop after several weeks. If, however, you have had plantar fasciitis for a long time, it may take many weeks to months for the pain to go away.

When can I return to my normal activities?

veryone recovers from an injury at a different rate. Return to your activities will be determined by how soon your foot recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your activities when, starting from the top of the list and progressing to the end, each of the following is true:

  • You have full range of motion in the injured foot compared with the uninjured foot.
  • You have full strength of the injured foot compared with the uninjured foot.
  • You can walk straight ahead without significant pain or limping.

How can I prevent plantar fasciitis?

The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet. This is especially important when you exercise or walk a lot or stand for a long time on hard surfaces. Get new athletic shoes before your old shoes stop supporting and cushioning your feet.

You should also:

  • Avoid repeated jarring to the heel.
  • Keep a healthy weight.
  • Do your leg and foot stretching exercises regularly.

Plantar Fasciitis Rehabilitation Exercises

You may begin exercising the muscles of your foot right away by gently stretching them as follows:

  • Prone hip extension: Lie on your stomach with your legs straight out behind you. Tighten up your buttocks muscles and lift one leg off the floor about 8 inches. Keep your knee straight. Hold for 5 seconds. Then lower your leg and relax. Do 3 sets of 10.
  • Towel stretch: Sit on a hard surface with one leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your knee straight. Hold this position for 15 to 30 seconds then relax. Repeat 3 times.

When the towel stretch becomes too easy, you may begin doing the standing calf stretch.

  • Standing calf stretch: Facing a wall, put your hands against the wall at about eye level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times. Do this exercise several times each day.
  • Sitting plantar fascia stretch: Sit in a chair and cross one foot over your other knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold 15 seconds and repeat 3 times.

When you can stand comfortably on your injured foot, you can begin standing to stretch the bottom of your foot using the plantar fascia stretch.

  • Achilles stretch: Stand with the ball of one foot on a stair. Reach for the bottom step with your heel until you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times.
  • After you have stretched the bottom muscles of your foot, you can begin strengthening the top muscles of your foot.
  • Frozen can roll: Roll your bare injured foot back and forth from your heel to your mid-arch over a frozen juice can. Repeat for 3 to 5 minutes. This exercise is particularly helpful if done first thing in the morning.
  • Towel pickup: With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel.
  • Balance and reach exercises

Stand upright next to a chair. This will provide you with balance if needed. Stand on the foot farthest from the chair. Try to raise the arch of your foot while keeping your toes on the floor.

  1. Keep your foot in this position and reach forward in front of you with your hand farthest away from the chair, allowing your knee to bend. Repeat this 10 times while maintaining the arch height. This exercise can be made more difficult by reaching farther in front of you. Do 2 sets.
  2. Stand in the same position as above. While maintaining your arch height, reach the hand farthest away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 10.
  3. Heel raise: Balance yourself while standing behind a chair or counter. Using the chair to help you, raise your body up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the chair. Hold onto the chair or counter if you need to. When this exercise becomes less painful, try lowering on one leg only. Repeat 10 times. Do 3 sets of 10.
  4. Side-lying leg lift: Lying on your side, tighten the front thigh muscles on your top leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight. Do 3 sets of 10.