Plantar Fasciitis

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What is plantar fasciitis?

Plantar fasciitis is inflammation of the plantar fascia. The plantar fascia originates at the base of the heel and extends distally towards the end of the plantar surface of the foot.

What causes plantar fasciitis?

Plantar fasciitis is a condition caused by repetitive injury to the plantar fascia. Repetitive injury results in inflammation that can be painful. Longstanding inflammation and repetitive injury leads to chronic pathologic changes, usually near the origin of the plantar fascia. Tightness of the plantar fascia and Achilles tendon/calf musculature are predisposing factors.

What are the symptoms of plantar fasciitis?

People with plantar fasciitis often complain of heel pain with the first steps in the morning or after a period of rest. Prolonged standing or exercise may also provoke the heel pain. Acutely, swelling may be noted. Most people note tightness of the plantar fascia or calf muscles.

Who gets plantar fasciitis?

  • Anyone can get plantar fasciitis, but these are populations where plantar fasciitis is more common:
    • People who spend considerable amounts of time on their feet
    • People with certain foot alignment abnormalities
    • Runners
    • Overweight individuals
    • People with certain rheumatologic conditions

How is plantar fasciitis treated?

There is not a magic bullet for making plantar fasciitis go away. However, there are many non-invasive treatments for plantar fasciitis. This usually begins with certain stretches, shoe modifications, anti-inflammatory medications, and icing. If symptoms persist, the use of night splints, casts, boots or occasionally a steroid injection may lead to resolution. Surgical treatment is a last result for chronic conditions and is rarely needed!  Thus, is important to begin treatment early so as to prevent it from becoming a chronic condition.

The most important aspect of treatment is a regular stretching program. Stretching of the plantar fascia and the Achilles tendon/calf musculature crucial. Stretching is performed four times per day. Hold each stretch for 30 seconds and perform as set of three. Stretching may cause mild increase in pain for 1-2 weeks, but then improvement is usually seen by 4-8 weeks.

Additional treatments:

  • Icing for 20-30 minutes at the end of the day
  • Anti-inflammatory medication (eg. Ibuprofen, naproxen)
  • Night splints
  • Weight loss in overweight individuals
  • Activity modification
  • Heel cups
  • STOP WALKING BAREFOOT (wear supportive shoes)

Stretches:

Stair stretch

Stand on a step or lift and hang your heel off the edge with your leg straight. Hold on to something for support. Lower your heel until you feel a pull in your calf.

Standing wall stretch

With your hands against a stable wall, place one foot back further than the other and keep the rear leg straight and the front leg slightly bent. Make sure toes are pointed towards the wall. Lean forward to feel a pull in your calf/Achilles tendon. Move the rear leg further from the wall to increase the amount of stretching.

Plantar fascia specific stretch

With your foot on the opposite knee, pull back your toes while holding the pressure on the base of the arch of your foot. You should feel a stretch in the arch of your foot.

What to do if prolonged conservative measures fail?

  • Rarely, a corticosteroid is considered
  • Extracorporeal shock wave therapy
  • Surgical release and/or excision of the plantar fascia

*This information is not intended as a substitute for the medical recommendations of your medical provider. Please consult your physician regarding advice about a particular medical condition.