Plantar fasciitis refers to an inflammation of the plantar fascia, a thick, fibrous band running along the sole of the foot. Such inflammation results from direct injury to the plantar fascia,
usually, repeated trauma to the tissue where the fascia attaches to the calcaneus or heel bone. The plantar fascia is critical in maintaining the footâs complex arch system, also playing a role in
balance and fine control of certain phases of the athleteâs gait. Injury to the plantar fascia is particularly painful and disabling for runners and can often prove stubbornly resistant to
treatment. Rehabilitation is frequently a lengthy and frustrating process. For these reasons, care should be taken where possible to avoid such injury by means of preventative exercises and
sensitivity to early warning signs.
Plantar fasciitis is the most common injury of the plantar fascia and is the most common cause of heel pain. Approximately 10% of people have plantar fasciitis at some point during their lifetime. It
is commonly associated with long periods of standing and is much more prevalent in individuals with excessive inward rolling of the foot, which is seen with flat feet. Among non-athletic populations,
plantar fasciitis is associated with obesity and lack of physical exercise.
The symptoms of plantar fasciitis include pain in the bottom of your foot, especially at the front or centre of the heel bone, pain that is worse when first rising in the morning (called "first-step
pain"), when first standing up after any long period of sitting, or after increased levels of activity especially in non-supportive shoes. Seek medical advice about plantar fasciitis if you have heel
pain or pain in the bottom of your foot, especially when you get up in the morning, that does not respond to treatment or if there is redness or bruising in the heel.
Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about your past health, including what illnesses or injuries you have had. Your symptoms, such as
where the pain is and what time of day your foot hurts most. How active you are and what types of physical activity you do. Your doctor may take an X-ray of your foot if he or she suspects a problem
with the bones of your foot, such as a stress fracture.
Non Surgical Treatment
Most health care providers agree that initial treatment for plantar fasciitis should be quite conservative. You'll probably be advised to avoid any exercise that is making your pain worse. Your
doctor may also advise one or more of these treatment options. A heel pad. In plantar fasciitis, a heel pad is sometimes used to cushion the painful heel if you spend a great deal of time on your
feet on hard surfaces. Also, over-the-counter or custom-made orthotics, which fit inside your shoes, may be constructed to address specific imbalances you may have with foot placement or gait.
Stretching: Stretching exercises performed three to five times a day can help elongate the heel cord. Ice: You may be advised to apply ice packs to your heel or to use an ice block to massage the
plantar fascia before going to bed each night. Pain relievers: Simple over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in decreasing inflammation
and pain. If you have stomach trouble from such drugs, your health care provider may prescribe an alternative. A night splint: A night splint is sometimes used to hold your foot at a specific angle,
which prevents the plantar fascia from shortening during sleep. Ultrasound: Ultrasound therapy can be performed to decrease inflammation and aid healing. Steroid injections: Anti-inflammatory steroid
injections directly into the tissue around your heel may be temporarily helpful. However, if these injections are used too many times, you may suffer other complications, such as shrinking of the fat
pad of your heel, which you need for insulation. Loss of the fat pad could actually increase your pain, or could even rupture the plantar fascia in rare cases. Walking cast: In cases of long-term
plantar fasciitis unresponsive to usual treatments, your doctor may recommend that you wear a short walking cast for about three weeks. This ensures that your foot is held in a position that allows
the plantar fascia to heal in a stretched, rather than shortened, position. Shock wave therapy, Extracorporeal shock wave therapy which may be prescribed prior to considering surgery if your symptoms
have persisted for more than six months. This treatment does not involve any actual incisions being made rather it uses a high intensity shock wave to stimulate healing of the plantar fascia.
Surgery is considered only after 12 months of aggressive nonsurgical treatment. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles
place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches. In gastrocnemius recession, one of
the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope,
an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage.
Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is
partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an
open incision. In addition, endoscopy has a higher risk of nerve damage.
You may begin exercising the muscles of your foot right away by gently stretching them as follows. Prone hip extension, Lie on your stomach with your legs straight out behind you. Tighten up your
buttocks muscles and lift one leg off the floor about 8 inches. Keep your knee straight. Hold for 5 seconds. Then lower your leg and relax. Do 3 sets of 10. Towel stretch, Sit on a hard surface with
one leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your knee straight. Hold this position for 15 to 30 seconds
then relax. Repeat 3 times. When the towel stretch becomes too easy, you may begin doing the standing calf stretch. Standing calf stretch, Facing a wall, put your hands against the wall at about eye
level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a
stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times. Do this exercise several times each day. Sitting plantar fascia stretch, Sit in a chair and cross one foot over your other
knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold 15 seconds and repeat 3 times. When you can stand comfortably on your injured foot, you
can begin standing to stretch the bottom of your foot using the plantar fascia stretch. Achilles stretch, Stand with the ball of one foot on a stair. Reach for the bottom step with your heel until
you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. After you have stretched the bottom muscles of your foot, you can begin
strengthening the top muscles of your foot. Frozen can roll, Roll your bare injured foot back and forth from your heel to your mid-arch over a frozen juice can. Repeat for 3 to 5 minutes. This
exercise is particularly helpful if done first thing in the morning. Towel pickup, With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy,
add more resistance by placing a book or small weight on the towel. Balance and reach exercises, Stand upright next to a chair. This will provide you with balance if needed. Stand on the foot
farthest from the chair. Try to raise the arch of your foot while keeping your toes on the floor. Keep your foot in this position and reach forward in front of you with your hand farthest away from
the chair, allowing your knee to bend. Repeat this 10 times while maintaining the arch height. This exercise can be made more difficult by reaching farther in front of you. Do 2 sets. Stand in the
same position as above. While maintaining your arch height, reach the hand farthest away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do
2 sets of 10. Heel raise, Balance yourself while standing behind a chair or counter. Using the chair to help you, raise your body up onto your toes and hold for 5 seconds. Then slowly lower yourself
down without holding onto the chair. Hold onto the chair or counter if you need to. When this exercise becomes less painful, try lowering on one leg only. Repeat 10 times. Do 3 sets of 10. Side-lying
leg lift, Lying on your side, tighten the front thigh muscles on your top leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight. Do 3 sets of 10.