Plantar Fasciitis

Plantar Fasciitis is a common overuse injury. It is characterized by acute heel pain first thing in the morning or after rest. The plantar fascia is a thick non-elastic band of fibrous tissue that runs from all five metatarsal heads and attaches onto the calcaneus (heel bone). Its main function is to maintain the medial longitudinal arch of the foot.

The problem begins when there is stress applied to the plantar fascia and the fascia pulls away from its weakest insertion, causing microtears. This causes inflammation and thus, pain. A plantar fascial microtear can also occur at mid sole or towards the toes. Since it is difficult to rest the foot, the situation is aggravated with every step taken. The problem progresses rapidly and treatment must start as soon as possible. As the fascia is pulled away from the bone, the body reacts by filling in the space with new bone. This causes the classic “heel spur”. This heel spur is a secondary x-ray finding and is not the problem, but a result of the problem.

Predisposing Factors:

• Flat pronated feet
• High arched rigid feet
• Inappropriate/ Improper shoes
• Increasing age

Prevention and Treatment

1. Rest

Rest is the first and most important part of the treatment. Your feet carry your body weight and with every step the injury gets aggravated. Weight bearing activities should temporarily be put on hold. Long walks or runs should be replaced with swimming or cycling.

2. Shoes

Shoes are an important element to the recovery of foot injuries. Supportive athletic shoes, preferably walking shoes, with extra heel cushioning, rigid heel counters and lace up mechanisms provide the support and balance necessary to assist in healing injured feet.

3. Orthotics

Orthotics are custom plastic devices prescribed by your chiropodist. The orthotics serve to realign your feet and prevent any abnormal compensations due to biomechanical abnormalities. These abnormalities, if left untreated cause “flat feet” or “fallen arches” which result in the pulling of the plantar fascia.

Should Symptoms Persist Conjunctive Therapy Can Be Introduced

Plantar Fasciitis Night Splints

These splints are designed to keep the plantar fascia in an elongated position overnight, therefore reducing the initial stretch that occurs when you take your first morning step.

Laser Therapy/ Ultrasound Therapy

Laser Therapy is a good treatment option. Photochemical responses or sound waves in the tissue helps to control pain and accelerate healing.

Manual Foot Therapy

Manual Foot Therapy is a treatment which involves the realignment of the bony structures of the foot, therefore improving lymphatic drainage and blood flow.

Hot And Cold Therapy

Inflammation is reduced by placing the inflamed heel in hot water ( or heating pad) for 2-5 minutes, then in cold water (or ice packs) for 2-5 minutes. This alternating should continue for a total of ten times per session and done several times throughout the day.

Cortisone

A cortisone injection is usually beneficial if the above therapies have not solved the problem. It is a local injection and it is very safe in this area.

Short Term Relief May Include

Heal Pads

A heel pad made of felt, sponge or silopos can help to absorb the shock as the heel lands and ease the pressure on the plantar fascia. These heel pads are either pre-cut or have softer material centrally, to deflect pressure away from the painful area. Heel pads and heel cups are available at most pharmacies or in your chiropodist’s office.

Taping

Taping your foot to maintain the arch will take some of the tension off the plantar fascia. This will provide short term relief in acute cases.

Medication

Your doctor may prescribe anti-inflammatory pills. These can play an important role in reducing the inflammation in your foot, however this is not a long term answer.

Surgery

Surgery is rarely required for plantar fasciitis.

Exercises

The following exercises are designed to strengthen the small muscles of the foot to help support the damaged area. If performed regularly, they will help prevent re-injury.

A. Tennis Ball Roll

Using a tennis ball, roll your foot back and forth over your arch and heel area for 2 minutes. (You can also use a cold can of pop)

B. Towel Curls

Place a towel on the floor. Curl the towel toward you, using only the toes of your injured foot. Resistance can be increased with a weight on the end of the towel. Repeat 20 times.

C. Shin Curls

Run your foot slowly up and down the shin of your other leg as you try to grab the shin with your toes. Repeat 30 times. A similar exercise can be done curling your toes around a tin can.

D. Toe Grabs

Stand feet together. Rotate your knees outward while attempting to grab the floor with your toes using the muscles of your foot. Hold 10 seconds, then relax. Repeat 20 times.