Plantar Fasciitis
Plantar fasciitis is a condition which can cause heel pain. It happens when the strong band of tissue on the sole of your foot (fascia) becomes irritated, after repetitive use or due to poor foot posture. Most commonly it occurs in one foot but is possible to have it in both at the same time. What are the symptoms of plantar fasciitis? There is usually a gradual onset of pain, in a small amount of people there can be sudden damage to the fascia during physical activity. The main symptoms of plantar fasciitis include: Pain or tenderness in the heel or arch of the foot Pain with initial steps in the morning or after a period of rest Walking short distances may improve pain but longer distances may increase the symptoms again Pain with sudden stretching of the sole of the foot e.g. going up on your toes or upstairs Pain with prolonged standing or when wearing flat or unsupportive footwear What causes plantar fasciitis? Often there may be no obvious cause for the symptoms. However, certain risk factors can are associated such as: Poor cushioning or poor arch support in your shoes. Tightness in calf muscle. Poor foot posture. Being on your feet for long periods of time, especially on hard surfaces. Being overweight If you are very active it can also be due to sudden stretching or overuse of the sole of the foot; such as when sprinting, jumping and landing on hard surfaces in or after increasing running distance or intensity.
Sedentary and inactive lifestyles increase the risk of developing pain and can also delay your recovery. Being active for 30 minutes in your day can make a big difference in your overall health and improve your pain. How is it diagnosed? Diagnosis is usually made from the patient's history and a simple examination without the need for further investigations. How can I manage plantar fasciitis? Plantar fasciitis usually fully resolves but it can in some cases take up to 12 months. You should avoid excessive activities that aggravate the pain and walking barefoot on hard surfaces. There is self-management advice provided below to help minimise symptoms and facilitate the healing process. Pain relief Painkillers such as paracetamol and ibuprofen or antiinflammatory gels may be helpful to control the pain and allow you to continue exercising. Discuss this with your GP or pharmacist. Some people find ice effective in reducing their heel pain. Apply an icepack for 15 mins regularly. Avoid applying ice directly to your skin, instead use a towel or have a fabric layer in between. Alternatively it can work well to use a frozen water bottle to roll underneath your foot. Footwear Shoes with cushioned heels and good arch support are recommended. Various pads and insoles can be bought to cushion the heel or support your arch. These are recommended to be kept in the shoes for the majority of time.
Exercise Research has shown that exercise can help improve symptoms and stretches are the first line of treatment. Relative rest is recommended to help reduce the pain but you should keep up gentle walking and complete exercises such as on this leaflet. Further management options If there is no response to the self-management information above within four weeks please seek further advice from your physiotherapist, as discussed during your appointment.
Exercises Exercise 1 Gastrocnemius (calf) stretch Place your hands against a wall for stability Stand in a walking position with the leg to be stretched behind you, the other leg bent in front of you and both feet pointed forwards. Ensure you keep your heels on the ground and bend the front knee towards the wall until you feel a stretch in the calf of the straight leg Hold for 30 seconds, repeat six times (three minutes), three times a day Exercise 2 Soleus (calf) stretch Stand in a stride position with the leg to be stretched at the back, the front knee slightly bent and your feet pointed forwards. Push your heels down while bending the knee of the back leg until you feel the stretch in your calf Hold for 30 seconds. Repeat six times (three minutes), three times a day.
Exercise 3 General symptom management If you experience first step pain, i.e. you find it hard to fully weight bear after periods of rest or first thing in the morning, try massaging over the sore point in your heel (where your plantar fascia fastens onto your heel bone) and stretching your plantar fascia for 30 seconds before you take your first step. Repeat three times. (See photo below) Also, repeat this stretch regularly through the day after any period of inactivity/sitting.
You can also gently massage your plantar fascia with a frozen bottle of water for a couple of minutes 2-3 times daily.
Start by exercising gradually and build up over time. As with any physical activity it is normal to feel some discomfort or aching in your muscles after exercising but you should stop if you get any joint pain that does not go away quickly. f you have any questions about exercising, ask your GP or physiotherapist For more information contact: Musculoskeletal Service Therapy Suite, Lower Ground Floor St Helens Hospital Marshalls Cross Road St Helens WA9 3DA Tel: 0151 430 1060 www.nwbh.nhs.uk/msk-physio