Bay Area Medical Information (BAMI.us)
Plantar Fasciitis

On this page: Symptoms| Treatment| Exercises| References

About plantar fasciitis
The plantar fascia is the thick band of tissue that covers the bones on the bottom of the foot.  Plantar Fasciitis is the most common cause of heel pain. It occurs when the plantar fascia on the bottom of the foot stretches irregularly and develops small tears.  These small tears cause the fascia to become inflamed.  This commonly occurs in athletes and middle-aged adults.

The Causes of Plantar fasciitis: Tight tendons at the back of the heel, tight calf muscles, abnormal inward twisting or rolling of the foot (pronation), high arches, and flat feet can lead to plantar fasciitis. Excessive pronation, which can cause tension in the plantar fascia as the arch lowers during standing or walking, has been found in about 85% of people with plantar fasciitis. Repetitive stress on the ligament, such as jobs or activities that require prolonged walking, running or standing on hard or irregular surfaces can result in plantar fasciitis.  Aggravating factors include obesity and poorly cushioned and improperly fitted shoes. The natural process of aging also contributes to this condition. In rare cases, a single traumatic injury to the foot can result in plantar fasciitis. This condition is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On X-ray, heel spurs are seen commonly both in people with and without plantar fasciitis. 

Symptoms & Progression of Symptoms
Plantar fasciitis usually develops gradually. Initially, heel pain may only occur when taking the first steps after getting out of bed or after sitting for a long period of time.  As plantar fasciitis progresses, the heel pain gradually gets worse. You may change the way you walk to relieve the pain. This eventually may lead to more discomfort and pain and other foot, leg, hip, or back problems.  Over time, there may be pain with all  weight-bearing activity.  A heel spur may form as a result of continued stress as the plantar fascia pulls on the heel bone.     If the condition is not treated, plantar fasciitis can cause constant heel pain while standing or walking. The longer you let heel pain go unresolved, the more likely it will become a chronic and untreatable problem.
Treatment
If you do not rest the plantar fascia ligament, the inflammation and heel pain will get worse. Other conditions or aggravating factors, such as the repetitive stress of walking, standing, running, or jumping, will contribute to inflammation and pain. The inflamed ligament may never heal completely if you are not able to stop the aggravating activity.

1) Rest your foot. Try to stop any activities that may be aggravating heel pain. Avoid exercise that involves repeated motions and pounding of the foot against a hard surface such as running or jogging.

2) Arch support and heel cushioning
Wear supportive footwear with sufficient arch support and heel cushioning. Orthotics (shoe inserts) can be bought or custom made for a more accurate fit. A prescription is not necessary for orthotic purchases.   Orthotics can reduce stress and pulling on the plantar fascia ligament.  Always wear shoes when you get out of bed, even if it is just to go to the bathroom. Wear rubber flip flops in the shower. Walking in bare feet on ceramic tile and cement greatly aggravates plantar fasciitis.

3) Use ice
(20-minutes with an ice pack or 10-min at a time with ice directly on the area in a pillow case) to help reduce inflammation. Contrast baths, which alternate hot and cold water, can also be helpful in reducing inflammation. It is important to end a contrast bath with a soak in cold water.

4) Take nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce inflammation and pain.

5) First thing in the morning:  Stretch your foot
by flexing it up and down 10 times before standing. Use a towel to stretch the bottom of your foot (towel stretch). Massage the bottom of your foot across the width of the plantar fascia before getting out of bed.

6) Before exercise or walks it is very important to warm up and do stretching exercises.  Warm up with a slow walk for about 10 minutes, then do one of the stretches listed below prior to a long walk or workout.  Warm up and stretching will increase the flexibility in your plantar fascia and decrease the chance of injury and inflammation.

7) After exercise or any activity that flares up the symptoms, ice your heel (for 20 min with a thin towel under an ice pack, or 10 min at a time with ice directly on the area in a pillow case)  to help relieve pain and inflammation.

8) A regular routine of stretching and strengthening exercises for the foot (see below) is extremely helpful in relieving pain and preventing recurrence of pain from plantar fasciitis.
Stretching and strengthening exercises will help treat plantar fasciitis
Stretching exercises: Do not bounce; stretching should create a pulling feeling and should not cause pain. Also, stretching should be done after 10 minutes of gently warming up the muscles, such as slow walking. Trying to stretch cold muscles is like trying to stretch cold gum.  
1) Calf stretches. To stretch the Achilles tendon, lean forward against a wall, keep one leg with the knee straight and heel on the ground while bending the knee in the other leg. Hold this position for 30 seconds, then switch legs. Try to do this stretch 3 to 6 times a day, or
2) Use a towel to stretch: Place the rolled towel under the center of your foot, holding the towel at both ends, and gently pull the towel toward you, keeping your knee straight, until you feel a stretch either in your calf or the bottom of your foot. Hold this position for at least 30 seconds.
3) Combination plantar fascia/calf stretch. Stand on a step with only the front part of your feet touching the step. While holding onto the rail, slowly lower your heels. Hold this stretch for 30 seconds, then bring your heels back to a level position. Repeat this stretch 3 times.
4) Use a rolling pin, can of soup (lying on its side) or a tennis ball. While seated, roll the rolling pin, can or ball with the arch of your foot. Progress to doing this exercise while standing as you can tolerate it.
Strengthening exercises:
1) Towel curls. While sitting, place your foot on a towel on the floor and scrunch the towel toward you with your toes. This exercise is best done on a smooth surface, such as a linoleum or hardwood floor, so the towel slides easily. After you pull the towel toward you, push it away again with your toes. This helps to give the different muscles in your foot a balanced workout. As your foot gets stronger, place a soup can or other weighted object on the far end of the towel.
2) Marble pickups.
Put marbles on the floor next to a cup. Using your toes, try to lift the marbles up from the floor and put them in the cup.
Physical Therapy is helpful in treating plantar fasciitis

Physical therapists are well-trained in foot and ankle disorders. Therapists use a wide range of treatment modalities to decrease inflammation, relieve the pain, and initiate an exercise program to treat the cause of the problem and prevent recurrence.

References
Painful Heels from the Arthritis Foundation
Plantar fasciitis
at Medline Plus, A service of the Nat'l Library of Medicine and the National Institutes of Health.
Plantar Fasciitis
at WebMD.com

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