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What is Plantar Fasciitis?:
Plantar fasciitis is the most common cause of localized heel pain and is the most common
foot problem seen in medical practices. More than 2.5 million new cases of plantar
fasciitis are reported each year.
Plantar Fasciitis is an inflammation of the plantar fascia, a ligament structure that
supports the arch of the foot. The plantar fascia is a tough, fibrous band of connective
tissue that runs from the heel bone to the ball of the foot. It plays an important part in the
normal foot mechanics during walking and running.
Plantar fasciitis occurs when the plantar fascia is strained as a result of increased or over
activity, poor foot biomechanics, or in association with the normal aging process. The
ligament is typically strained repeatedly, over time before the onset of plantar fasciitis.
As the ligament stretches beyond its normal extension it causes the soft tissues of the
fascia to tear, usually at the point where attached to the heel bone. This leads to
inflammation, heel pain, and possible growth of a bone spur (calcaneus) at the heel bone
attachment.
Causes of Plantar Fasciitis:
In active young and middle aged adults plantar fasciitis is typically caused from running,
jumping or walking on hard surfaces. Runners, tennis players and basketball players are
often affected by plantar fasciitis. Biomechanic factors of the foot can cause plantar
fasciitis. People with high arches, flat feet, or tight tendons (Achilles tendons) are
susceptible to developing plantar fasciitis. Excessive inward twisting (pronation) can
cause tension on the plantar fascia as the arch lowers during standing or walking.
Aggravating factors, such as being overweight or wearing poorly cushioned shoes with
no arch support can also contribute to development of plantar fasciitis. In the natural
aging process tendons, ligaments and muscles start to lose their normal elasticity and
resilience making them more prone to strain just during normal daily activities. Plantar
fasciitis is very common in the active elderly.
Common Causes of Plantar Fasciitis:
• Increased or athletic activity
• Running, jumping, walking or standing on hard or uneven surfaces
• Flat feet or high arched, rigid feet
• Poor supporting shoes
• Large weight gain, pregnancy or overweight
• Tight plantar fascia ligament or Achilles tendon
• Normal aging
Symptoms of Plantar Fasciitis:
Generally the first telltale sign of plantar fasciitis is heel pain during the first steps after
getting out of bed or sitting for a long period of time. The degree of heel pain can
sometimes lessen with activity, leading to a false sense of relief. The pain often returns
after prolonged rest or extensive walking. Pain often progresses if the condition is left
untreated and can become excruciating and persistent as the ligament is more severely
strained. Heel pain is usually located on the medial (inside) area of the heel. Symptoms
include:
• Starts as a dull, intermittent heel pain or arch pain, progressing to a sharp, persistent
pain.
• A sharp, piercing pain and/or inflammation through heel and foot that usually occurs
in the morning or after resting and gradually disappears with walking.
• Tightness in calf muscles or Achilles tendon.
• Noticeable heel pain after long periods of standing or walking.
• Heel pain worsens when climbing stairs or standing on the toes.
• Heel pain lessens with activity but returns during rest.
Treatment of Plantar Fasciitis:
Most cases of plantar fasciitis can be treated with relatively simple conservative methods.
Only in rare cases is surgery actually necessary. Conservative methods such as a
combination of night splints, rest and ice, orthotics, and stretching exercises have been
repeatedly proven to be effective in treating plantar fasciitis.
Even though treatment is simple it may take several months for symptoms to resolve
themselves. Remember that a strained ligament occurs after repeated stress and will
take repeated rest and treatment to heal. Also, the longer the symptoms have been
present and the more severe the heel pain, the even longer the treatment course.
The first step is to eliminate the activity that caused the strain. Modify your activity or
exercise patterns to reduce stress on the foot, rest and elevate the foot whenever possible.
Switch from running and walking to activities such as swimming and cycling to relieve
stress. If standing for long periods of time try to use cushioning, anti-fatigue mats if
possible. Regular activity should be increased gradually as tolerated.
A routine of deep massage to the area of heel pain may also help alleviate pain. In the
morning after a warm bath or shower, massage the foot and heel and repeatedly flex the
foot as well. Follow with stretching exercises.
Stretching is a very critical part to rehabilitation. Start routine, daily stretching exercises
to recondition and strengthen the plantar fascia and heel cord. Those with plantar
fasciitis typically show decreased ankle dorsiflexion and tight Achilles tendons.
Stretching both the plantar fascia and heel cord will help decrease the amount of tension
on the fascia, thereby decreasing the amount of inflammation. Stretching should be done
at least twice daily - once in morning after massage and once at night before applying a
night splint. Stretching should be done very slowly and carefully without over-stretching.
The most effective and simplest part of any plantar fasciitis treatment plan is the use of
night splints. Night splints have been proven to speed healing and reduce the associated
heel pain and inflammation from plantar fasciitis. Also, night splints help reduce the heel
pain during those first steps in the morning.
Plantar Fasciitis splints are typically called night splints because they are worn at night
during sleep or during rest after activity. Often the most severe pain and inflammation of
plantar fasciitis is experienced in the morning, which could cause the first few steps to be
excruciating. The position of the feet and ankles as we sleep promotes cramping of the
fascia and calf muscles. When feet are pointed under the weight of blankets the plantar
fascia is contracted (shortened). Those first steps in the morning are painful because the
fascia that as been contracted all night is suddenly stretched and pulled.
Night Splints are designed to comfortably position the foot in a controlled amount of
dorsiflexion to provide a gentle stretch to the plantar fascia and Achilles Tendon. This
gentle stretch helps reduce the muscle contracture, inflammation, and associated heel
pain, and helps promote healing of plantar fasciitis. Night splints have also been
clinically proven to reduce symptoms of plantar fasciitis.
Wear proper shoes at all times. Avoid walking barefoot and always wear a cushioning
sole. Shoes should have no or minimal heel, a well-cushioned sole and soft arch support.
Rigid orthotics are not recommended for the tender plantar fascia. Stress and pressure can
be relieved on the heel and arch with soft viscoelastic heel cushions or ¾ insoles with
slight arch support.
Over-the-counter anti-inflammatory medicines such as aspirin and ibuprofen (Motrin,
Advil, etc.) may help reduce pain and discomfort.
Most cases of plantar fasciitis can be self-treated with conservative methods. Plantar
fasciitis night splints are commonly available through online dealers and home medical
equipment dealers. Remember that conservative treatments must be adhered to for several
weeks to start the healing process.
Plantar Fasciitis Treatment Plan:
• Rest and Modify Activities
Avoid the activities that caused the strain.
• Deep Massage
Massage the area of heel pain - especially in the morning after a warm bath or
shower.
• Perform Routine Stretching Exercising
Stretch the plantar fascia and Achilles tendon at least twice each day.
• Wear Night Splints
Use plantar fasciitis night splints to maintain a gentle, constant stretch across the
plantar fascia during sleep or at rest
• Wear Proper Shoes and Appropriate Foot Orthotics
Ensure shoes have a well-cushioned sole and provide arch support. Avoid walking
barefoot, always where cushioning soles and soft viscoelastic heel cushions or
insoles.
Plantar Fasciitis Stretching Exercises:
Routine stretching is very important to healing plantar fasciitis. Most of those affected by
plantar fasciitis have decreased flexibility and tight Achilles Tendons.
Towel Stretch
Sit on the floor with your legs stretched out in front of you. Loop a towel around the top
of the injured foot. Slowly pull the towel towards to keeping your body straight. Hold for
15 to 30 seconds then relax - repeat 10 times.
Calf/Achilles Stretch
Stand facing a wall place your hands on the wall chest high. Move the injured heel back
and with the foot flat on the floor. Move the other leg forward and slowly lean toward the
wall until you feel a stretch through the calf, hold and repeat.
Stair Stretch
Stand on a step on the balls for your feet and hold the rail or wall for balance. Slow lower
the heel of the injured foot to stretch the arch of your foot.
Toe Stretch
Sit on the floor with knee bent. Pull the toes back on the injured foot until stretch across
the arch is felt. Hold and repeat.
Frozen Can Roll
Roll your bare injured foot back and forth from the tip of the toes to the heel over a
frozen juice can. This is a good exercise after activity because not only stretches the
plantar fascia but also provides cold therapy to the injured area.