The Orthopaedic Clinic

Plantar Fasciitis


Overview Diagnosis
  Treatment Options

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.

    Diagnosis

    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.

    Treatment Options

    Treatments include:

  • rest
    Avoid running and other activities that may worsen pain.

  • ice
    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.

  • medication
    The following medications can relieve pain and inflammation:
              - ibuprofen (Motrin, Advil)
              - naproxen (Aleve, Naprosyn)
              - acetaminophen (Tylenol)
              - aspirin
              - corticosteroid injections (may be given by a doctor)

  • night splint
    This splint will hold your foot in a neutral position while sleeping.

  • orthotics
    These special shoe inserts provide support for the mid-arch region of your foot.

  • physical therapy
    Begin stretching exercises to lengthen the Achilles tendon and plantar fascia as recommended by a health care professional.

    Prevention
    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 a time.
  • 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
  • increased coordination
  • improved muscular balance and postural awareness
  • reduced stress
  • enhanced enjoyment

    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.

    Rehabilitation exercises
    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.

  • Double-toe raises
    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.

  • Single-toe raises
    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.

    Alternative exercises
    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:

  • swimming
  • water running
  • 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 foot.
  • You have full strength of the injured foot compared to the uninjured foot.
  • 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.




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