Plantar Fasciitis: Overview
Plantar fasciitis is inflammation of the plantar fascia. The plantar fascia
is a thick band of tissue attached to the heel bone that supports the arch
of the foot. Plantar fasciitis is caused by activity that puts extra stress
on the foot, such as:
physical exertion, especially in sports that require running and jumping
such as running, volleyball, or tennis.
sudden increase in exercise intensity or duration
The main risk factor that increases your chance of getting for plantar fasciitis
is physical activity that stresses the plantar fascia.
Symptoms of plantar fasciitis may come on gradually or suddenly. Symptoms
include: burning pain on the sole of the foot
heel pain when taking the first steps in the morning
tenderness when touching the sole or heel
pain when standing on tiptoe
The doctor will ask about your symptoms and medical history, and examine
your foot. Tests may include an x-ray or bone scan of the foot to help
rule out stress fractures or bone spurs.
Avoid running and other activities that may worsen pain.
Apply ice or a cold pack to the heel and arch for 15-20 minutes, 4 times
a day to relieve pain. Wrap the ice or cold pack in a towel. Do not apply
the ice directly to your skin.
The following medications can relieve pain and inflammation:
- ibuprofen (Motrin, Advil)
- naproxen (Aleve, Naprosyn)
- acetaminophen (Tylenol)
- corticosteroid injections (may be given by a doctor)
This splint will hold your foot in a neutral position while sleeping.
These special shoe inserts provide support for the mid-arch region of your
Begin stretching exercises to lengthen the Achilles tendon and plantar fascia
as recommended by a health care professional.
To reduce your risk of getting plantar fasciitis:
Wear appropriate and well-fitted footwear during sports and exercise.
Do stretching exercises for the Achilles tendon and plantar fascia.
Increase intensity and duration of exercise gradually.
How can I prevent plantar fasciitis?
Recurrences of plantar fasciitis may best be avoided by delaying a return
to activity until the activity can be performed with no pain. Cross-training
techniques offer a solution to interruption of training.
Using a personalized, fitted orthotic device may prevent recurrence of plantar
fasciitis. Well-fitting shoes designed for the activity and with appropriate
arch support may serve the same purpose. Orthotic devices and shoes must
be replaced from time to time as wear dictates. Worn-out arch supports and
orthotic devices are of no use and may even be counterproductive.
Tightness of the muscles of the back of the lower leg (calf muscles) exerts
tension through the heel cord (Achilles tendon) to the plantar fascia.
Exercises to stretch the calf muscles are preventive as well as therapeutic.
Here are six steps to reduce your risk of plantar fasciitis: Choose your running shoes carefully. They should provide sufficient cushion
for the heel strike. Using a prescribed orthotic to change the position
of a poorly aligned heel bone may also help. Perhaps the best precaution
is to know your limits and to follow a sensible program when you exercise.
In addition to custom-fitted orthotics, all runners should be encouraged
to wear well-designed shoes that provide good heel stability with a small
amount of additional heel lift. This helps to prevent plantar fasciitis
and is especially important in athletes running more than a few miles at
Walk and stretch to warm up gradually before running. It's better to spend
a few minutes warming up than to spend months on the sidelines.
Focus on stretching and strengthening the muscles in the foot and calf
Increase your running distance and your speed gradually, in increments no
greater than 10 percent a week.
Avoid unaccustomed strenuous sprinting, such as hill running.
Cool down properly by stretching after exercise.
Improving Sports Performance
The key to improving sports performance after a diagnosis of plantar fasciitis
is a proper rehabilitation program, and adhering to some of those same
principles after the injury is gone.
The single most important aspect of improving performance is stretching
before and after you step onto the field, court, ice, or golf course.
Benefits derived from stretching include: increased physical efficiency and performance
decreased risk of injury
increased blood supply and nutrients to joint structures
improved muscular balance and postural awareness
Plantar fasciitis rehabilitation
As an athlete, your number one concern is getting back to full strength
as soon as possible so that you can return to training and competition.
That is why appropriate rehabilitation is extremely important. Rehabilitation
for plantar fasciitis often includes the following:
reduce activity during the acute phase
ice injury multiple times per day (place foot in bucket of ice water)
use 1/8" felt pad heel lifts in both shoes until symptoms are gone
use anti-inflammatory medications such as ibuprofen to reduce
inflammation and speed up recovery
It's important to stretch and strengthen the injured foot 3 to 4 times
a day, beginning when you wake in the morning. For symmetrical development
of both legs, and to prevent plantar faciitis in the uninjured foot, exercises
should be applied to both the right and left foot.
If pain at the heel or sole of the foot occurs during stretching exercises,
back off from the amount of stretch. Pain indicates possible further damage
to the already injured fascia.
Tightness of the calf muscles may contribute to plantar fasciitis, so
stretching the calf muscles is important to rehabilitation, as is stretching
of the plantar fascia itself.
The following exercises stretch the plantar fascia, the calf muscles,
and the Achilles tendon:
Assisted Dorsiflexion/Plantar Fascia Stretch
Sit on the floor or ground with both legs outstretched. Use a towel or
elastic band and wrap it around the affected foot. Use the towel to provide
resistance to upward movement of the forefoot. Pull toes upward with the
help of the elastic band, and then allow them to return to the starting
position. It's recommended to do ten repetitions several times a day.
Calf and Achilles tendon stretch
Face a wall, standing an arm's length away. Place both hands on the wall.
Bend the elbows so that your forehead nearly touches the wall, or until
significant stretch is felt in the muscles of the calves. Hold this position
for 10 to 15 seconds. Extend elbows and maintain this position for 10
seconds. Repeat this cycle 15 to 20 times.
Strengthening the muscles of the calves may contribute to successful rehabilitation
of plantar fasciitis as well as prevent recurrence. The exercises below
strengthen calf muscles.
Stand facing a chair back or other supporting structure, resting fingertips
on the chair back for balance. Press downward with toes and raise heels
fully. Hold this position for 10 to 15 seconds. Relax for 10 seconds.
Repeat 15 to 20 times.
When double-toe raises (exercise 3 directly above) can be easily performed
20 times, begin doing single-toe raises. Stand next to a chair back or
other supporting structure, resting fingertips on the chair back for balance.
Flex the knee of the leg farthest from the chair so that the foot raises
completely from the floor. Press downward with the toes of the opposite
foot, raising the heel fully. Hold this position for 10 to 15 seconds.
Relax for 10 seconds. Repeat 15 to 20 times. Reverse the positions of
the legs and perform single-toe raises with the opposite leg.
During the period when normal training should be avoided, alternative
exercises may be used. These activities should not require any actions
that create or intensify pain at the site of injury. They include:
stationary bicycle (add resistance gradually from one session
to the next, as pain allows)
When can I return to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity
as soon as is safely possible. If you return too soon you may worsen your
injury, which could lead to permanent damage. Everyone recovers from injury
at a different rate. Return to your activity is determined by how soon
your plantar fasciitis recovers, not by how many days or weeks it has
been since your injury occurred.
You may safely return to your sport or activity 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 to the uninjured
You have full strength of the injured foot compared to the uninjured
You can jog straight ahead without pain or limping.
You can sprint straight ahead without pain or limping.
You can do 45-degree cuts, first at half-speed, then at full-speed.
You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
You can do 90-degree cuts, first at half-speed, then at full-speed.
You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
You can jump on both feet without pain and you can jump on the
injured foot without pain.
How long will the effects of the injury last?
With proper rehabilitation, a first occurrence diagnosed and treated in
its early stages usually lasts a month. If the injury has recurred several
times, full recovery may take as long as 6 to 12 weeks.
Recurrences of plantar fasciitis are more difficult to treat. An injury
duration of 6 months is not uncommon in recurrent cases. Sometimes, even
with aggressive treatment, recovery is delayed for a year or more. Unfortunately,
recurrences are fairly common, and a pattern in which plantar fasciitis
reappears every several months may evolve.