Plantar Fasciitis is an overuse injury that affects the plantar fascia, connective tissue that connects the heel to the base of the toes. It can cause heel pain, especially in the morning after waking or after sitting for prolonged periods of time. Most people feel as if they are walking on tacks and have a difficult time getting the heel to the floor during the first initial steps. It is common in both athletes and non-athletes. The inflamed plantar fasciitis can be caused or aggravated by the following:
- running or walking too long without rest
- leg length discrepancy
- heel raises or toe walking
- tight calf muscles and/or Achilles tendon
- high arches or flat feet
- increase in age
- weak foot and lower leg muscles
- pronation or supination of the foot
- jumping on the heel too much
- improper loading and foot strike
- poorly padded surfaces
- placing too much pressure on the ball of the foot during activities (walking, exercising, gardening, etc.)
- wearing shoes without sufficient support or shock absorption (house slippers, walking barefoot, flip flops, etc.)
There is a 90 percent healing rate in six to nine months according to a study by the American Orthopedic Foot and Ankle Society. The following conservative measures may help those with chronic pain or to decrease healing time.
- Wear good, supportive, shock absorbing shoes. It may be important to have a foot analysis done to determine over-pronation. A good, soft orthotic with an extra-deep heel cup can often help alleviate symptoms and foster good posture. These should be worn at all times, especially in the morning.
- Use a night splint. This puts the foot in a dorsiflexed (foot to the ankle) position vs. a plantar flexed (toes pointing down) position which can help alleviate pain in the morning.
- Rest and ice. Refrain from activities that aggravate the inflammation which may include plyometrics or jumping activites, running, walking, or putting too much pressure on the ball of the foot or heel during squatting, walking, or other activities. Hard or uneven surfaces should also be avoided. Ice the bottom of the heel and/or foot for 15 to 20 minutes 3 to 5 times a day. You can also roll the bottom of the foot with a frozen ice cylinder (freeze a water bottle or Styrofoam cup) for 5 minutes before sleep or after exercise.
- Roll the calf muscles and bottom of the foot. Tight calf muscles can attribute to plantar fasciitis. Use a foam roller or have a partner roll the calf muscles. Also, rolling a golf ball or other massage ball under the foot can help relieve tightness in the plantar fascia.
- Stretch the calf and hamstring muscles.
- Sitting on the ground with the legs straight, loop a band around the arch of the foot and pull the toes toward the shins. Hold for 10-20 seconds. Repeat 2-3 times.
- Sitting on a chair, cross the injured foot on the opposite knee. Grab the heel using the opposite hand and let the other hand pull the toes back, especially the big toe. A stretch should be felt within the arch. Hold for 10 to 20 seconds. Repeat 2-3 times.
- Lay on your back with one leg flat on the floor (or bent if your flexibility is limited) while you pull the other leg (straight, not bent) toward you with a band. Hold for 10-20 seconds and repeat 2-3 times.
- Stand with your hands against a wall. Place the injured leg slightly behind the other leg. Keeping the injured leg straight and your heels on the ground, gradually lean forward, and bend the uninjured leg until you feel a stretch in the lower part of the injured leg. Hold for 10-20 seconds. Repeat 2-3 times.
Resources and References
Sports Injuries Guidebook. Robert S. Gotlin, DO. 2008
Arnheim’s Principles of Athletic Training A competency- Based Approach. 11th Edition. William E. Prentice. 2003
Pain Free A Revolutionary Method for Stopping Chronic Pain. Pete Egoscue. 1998
Plantar Fasciitis http://www.aofas.org/footcaremd/conditions/ailments-of-the-heel/pages/plantar-fasciitis.aspx
The Hidden Cause of Your Plantar Fasciitis Pain. (PDF) Rick Kaselj http://plantarfasciitisreliefin7days.com
Plantar Fasciitis: Current Concepts to Expedite Healing http://www.isdbweb.org/documents/file/70_plantar.htm