There are common questions that you may have when faced with Plantar Fasciitis injuries and issues. The topics listed below will be covered in detail in the following article to help you understand and guide you through diagnosis, treatment, rehabilitation, and prevention of plantar fasciitis.
Plantar fasciitis is a tendonitis that affects the plantar aponeurosis, which is the thick connective tissue that extends from the heel to the toes. This tissue is critical to mobility as it supports the arch of your foot. It’s also the most common culprit to chronic heel pain.
Plantar fasciitis is estimated to affect 1 in 10 people at some point during their lifetime and most commonly affects people between 40-60 years of age. In the United States alone, more than two million people receive treatment for plantar fasciitis. The cost of treating plantar fasciitis in the United States is estimated to be $284 million each year.
Plantar fasciitis is not something to take lightly or ignore – the plantar fascia supports the arch of your foot and is critical to the way our foot functions, our balance, and stability. It was designed to take all the stress and strain we put on our feet every day, but sometimes when there is too much pressure, the fascia tears and becomes inflamed and painful. Plantar fasciitis, although not typically a serious condition, cause pain, and interrupt your normal, active lifestyle. It can also take a long time to heal, especially if ignored.
Causes of Plantar Fasciitis
Plantar Fasciitis is a strain of the plantar fascia ligaments that support your arch. They are located on the bottom of your foot, attached at the base of your heel, connecting to your toes. Repeated strain causes tiny tears in the ligament, which leads to pain and swelling.
Some people are at a higher risk for plantar fasciitis than others, such as runners, but usually plantar fasciitis develops without a specific reason. Here are some additional factors that can make you more prone to developing plantar fasciitis:
• Tight calf muscles or Achilles tendon that make it difficult to move your foot up and down
• High arches or flat feet
• Poor fitting footwear
• High impact activity like running, tennis, racquetball, etc.
• New or increased activity over a short period of time
• Heel spurs
Symptoms and Diagnosis of Plantar Fasciitis
Here are some common symptoms of plantar fasciitis:
• Pain that radiates 4 cm from the front of the heel to the toes
• A stabbing pain at the front of your heel that is typically felt with your first steps in the morning, which can subside after your first few steps. Your foot may or may not experience increasing pain as the day progresses. Pain varies from a dull throb to a sharp burning. The pain can diminish very quickly, which is one reason why the condition can be so chronic – when it doesn’t hurt, people tend to ignore it.
• Pain after extended periods of rest (such as standing after a movie or long car ride). This pain is felt in the heel and can often go away rather quickly.
• Difficulty climbing stairs due to heel stiffness
• Pain after (but not during) prolonged activity
Fortunately, many people with plantar fasciitis don’t need to see a physician in order to treat their pain. Often home treatments for plantar fasciitis can work wonders. However, if after trying to heal your plantar fasciitis for four weeks, there is no improvement, then a trip to the doctor is recommended. Your physician can diagnose whether you have plantar fasciitis, and they may order an x-ray to rule out other causes of heel pain, such as fractures, bone spurs or arthritis.
The doctor will test the tenderness of the foot by stretching the foot and applying pressure to the plantar fascia. The test can be replicated at home by stretching the plantar fascia and tapping the sore area, and here’s how; Using your hand on the same side as the injured foot (left foot, left hand, right foot, right hand) gently pull your toes back, toward your shin. With your other hand, using your fingers, tap the sole of your foot in the area approximately 1-2 inches (2.5 – 5cm) in front of your heel. If you feel pain, you likely have plantar fasciitis.
Non-Surgical Treatment Options for Plantar Fasciitis
Recovery from plantar fasciitis can take a long time, so prepare yourself mentally for the long haul. Many patients with plantar fasciitis will require six to ten months to completely heal. Returning to the activity that caused the injury prior to full recovery can cause recurrence of plantar fasciitis.
Decreasing or ceasing entirely the activities that are causing the condition are the first steps in healing your plantar fascia. Sometimes the best way to do this is to simply stop activities that require pounding on the feet such as running, tennis, basketball, etc.. Sometimes it may require you to be non-weight bearing, meaning not walking on the foot at all. This will require a mobility device that offloads the effected foot entirely. Because plantar fasciitis takes a long time to heal, you want to choose your mobility device carefully.
• Crutches: Traditional crutches are one option. Though they can cause pain in the arms, hands and underarms, they will allow you to walk while holding your leg up. You must use both hands to operate them, this means your hands and arms will not be free to do normal day-to-day activities. Leading an independent lifestyle will be practically impossible on traditional crutches, and because of these limitations, patients often begin walking on injuries like plantar fasciitis too soon. Walking on an injury too soon can cause complications in healing or even re-injury. Also, crutches will not allow you to keep your leg partially elevated, which is often prescribed by physicians.
• Knee Scooters: Knee scooters or “knee walkers” are another option. They may be more efficient than crutches and require less upper body strength, but they are still quite restricting when performing your daily activities. Besides being bulky and difficult to use in smaller spaces, you cannot use them on stairs, on slopes, or uneven terrain. You also need both hands to operate a knee scooter.
• iWALK2.0 Crutch Alternative: The iWALK2.0 is a hands free and pain free crutch that provides a non-weight bearing option for your plantar fascia rehabilitation. Since the iWALK2.0 is hands free, it allows you to get back to your daily activities while you continue to heal your plantar fasciitis. With the iWALK2.0, you kneel on a platform, much like the knee scooter, but by tightening the straps, it becomes a temporary prosthetic lower leg. The iWALK2.0 feels like an extension of your own leg, functioning like your own leg would. The iWALK2.0 allows you to walk up and down stairs, up and down slopes, over uneven terrain and in small spaces. You can even use the iWALK2.0 in the shower. To learn more about the iWALK2.0, click here.
Having the right shoes is important to your plantar fasciitis recovery, and as a preventative measure to avoid plantar fasciitis. The mechanics of the foot work in such a way that when you step down on your heel a large amount of tension is placed on the fascia under your foot. This can cause tiny tears in the tissue if it is already inflamed. Having your arch well supported, with the right footwear plays a big role in preventing injury to your plantar fascia. You’ll need to know your foot type before selecting the appropriate footwear.
Do you have normal arches, high arches or flat feet? It is important to know this because our plantar fascia is held very differently depending on the shape of our feet. If you have high arches it is important to get a shoe that fills in and supports the arch. If you have a flat foot it is important to get shoes that build up your arch so it is more like the normal foot. You can purchase soft silicone heel pads at any drugstore that are inexpensive and work by elevating and cushioning your heel. In some cases, orthotics can also be very helpful in healing plantar fasciitis.
Rolling your foot over a frozen water bottle or using ice for 20 minutes can be very effective in lessening the inflammation. You’ll need to do this 3-4 times a day. Remember not to apply ice directly onto your skin though. Using a thin piece of fabric between the ice and your plantar fascia, such as wearing a sock, can reduce the chance of injury to your skin.
Medications for Healing and Pain Relief
You may want to take some type of pain reliever to help with pain caused by your plantar fascia. Many over-the-counter medications are used not only for pain relief, but also to reduce inflammation. Common over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs and aspirin, reduce inflammation. Your doctor may recommend that you take pain relievers such as:
• Ibuprofen (Advil and Motrin)
• Naproxen (Aleve)
• Tylenol (Acetaminophen)
• Generic Aspirin
• Topical Creams: Many of these analgesics active ingredients can be found in creams. Direct placement of this cream on the foot can offer immediate pain relief.
Tight muscles in your feet and calves often aggravate plantar fasciitis. Stretching is the most effective way to relieve the pain that comes with a sore plantar fasci. Adding the following stretches can provide a valuable addition to your recovery.
Instructions: Sit in a chair and pull your big toe towards your ankle gently but firmly with your dominant hand and hold for 30-45 seconds then repeat the motion with each toe on the afflicted foot. Carry out the whole exercise 2-4 times daily.
Instructions: Turn towards a wall and place your hands on the wall with your palms open for support, then move back the leg with the injury until a comfortable tension is noticed in the center of the foot, then with the heel planted firmly down, move the knee of the targeted leg forward slowly and gradually without pushing yourself for 2 minutes, repeat 1-2 times daily.
Towel or Band stretches
Instructions: Lie down then move your back to the point where you are sitting upright with your legs flat on the ground, take a towel and wrap it around the ball of your foot then pull gently and within your ability for around 30 seconds repeat 2-4 times daily.
This video, Basic Yoga: Yoga Stretches for the Feet demonstrates the proper strengthening and stretching techniques for the plantar fascia.
A rubber roller used to stretch your arch can also be an effective therapy for plantar fasciitis. You place the roller under your foot and roll forward and back for several minutes. Repeat several times per day.
Cortisone, a kind of steroid, is a powerful anti-inflammatory medication. Cortisone can be injected directly into the plantar fascia to reduce inflammation and pain. It is important not to have too many cortisone injections because they can lead to rupture of the fascia, flat feet and chronic pain.
As is human nature, most of us sleep with our feet pointed down. We don’t even realize we are doing it, but it relaxes the plantar fascia overnight and that is why we have pain in the morning. Wearing a night splint such as a Strassburg sock keeps the plantar fascia stretched while you sleep. Although it can be hard to get used to, a night splint works very well to help alleviate the pain and doesn’t have to be worn once the pain is gone. They are also relatively inexpensive.
If you aren’t healing with the self-help techniques above your doctor may suggest working with a physical therapist on an exercise program to stretch your calf muscles and plantar fascia. A physical therapist may also use ice treatments, massage, ultrasound and medication to decrease inflammation still bothering your foot.
Extracorporeal shockwave therapy
This procedure uses high-energy shock-wave impulses that stimulate healing in plantar fascia tissue. This type of treatment is not commonly performed because it has not shown consistent results.
Sometimes nonsurgical treatment doesn’t get rid of the pain in your foot and your doctor may suggest surgery. It doesn’t happen often and is usually only considered after one year of aggressive nonsurgical treatment.
Surgical Treatment of Plantar Fasciitis
The gastrocnemius is the medical term for your calf muscle. As mentioned, tight calf muscles can put increased stress on the Achilles tendon, and this procedure is done to lengthen those muscles. This procedure will benefit patients who have difficulty flexing their feet even though they’ve been doing constant stretching. During this procedure one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. Some doctors will perform this with a traditional, open incision and some will do it with a smaller incision and an endoscope—an instrument that contains a small camera. Talk to your doctor about how he will be performing the procedure and know the risks. The complications of gastrocnemius recession are low, but can include nerve damage and incision infection.
Plantar fascia release: During this surgery the plantar fascia ligament is partially cut to relieve tension in the tissues of your foot. If you have any bone spurs they will be removed as well. The surgery can be performed endoscopically (small incisions), but it is harder than when done as an open surgery. Sometimes endoscopy has a higher rate of nerve damage in this type of surgery.
The most common complications of these two surgeries include incomplete relief of pain after the foot heals and nerve damage. Most patients, however, have good results from surgery when all other nonsurgical measures have been exhausted and when the foot is given proper time to heal.
After surgery you may be instructed to rest your leg. The best way to do this is to be non-weight bearing. The doctor will tell you for how long, but it can range anywhere from several weeks to several months depending on the procedure. You have several choices of devices to use when you are non-weight bearing, which we discussed earlier.
Tips for Prevention of Plantar Fasciitis
Since plantar fasciitis takes so long to heal, you certainly don’t want a recurrence. Stretching is your best defense. Using the same stretches we mentioned for rehabilitation will also help to prevent initial injury or recurring injury to you plantar fascia. Also, remember to wear the proper footwear daily as well as for specific athletic activities. Other tips to prevent plantar fasciitis include;
• Learning to relax your lower legs
• Landing evenly in the middle of your foot with a midfoot strike when walking, and most importantly, when running
• Let you upper body lead and your legs will follow by engaging gravity and avoiding pulling yourself forward with your legs
• Try to avoid uneven surfaces when running
• Treat yourself to an elevator ride and avoid those stairs when possible
• Indulge! Foot massages will help keep the plantar fascia loose
• Try over the counter orthotics, and if they do not work, see a podiatrist for a custom set
Plantar fasciitis is a painful, yet manageable, condition. It causes pain in front of the heel which can vary from mild to intense. It often takes several months to heal. One of the most important things you can do is listen to your body and your feet. If an activity hurts, stop doing it and try it again in a few months after you’ve treated the plantar fasciitis.