Contributing factors
Flat (pronated) feet
High arched rigid feet
Poor shoe support
Short shoes
Walking/running uphill
Soft terrain (sand)
Increasing age
Sudden weight increase
Tight calf muscles
When the calves are tight, the Achilles tendon pulls the heel bone up, thus pulling the fascia tight (above Left). When the calf muscles are stretched the less pull on the heel bone, thus less pull on the fascia (above Right).
The Injury
The fascia endures tension that is near 2 times body weight during walking at the moment when the heel of the trailing leg begins to lift off the ground. This moment of maximum tension is increased and “sharpened” (it increases suddenly) if there is lack of flexibility in the calf muscles. The problem starts when the fascia is overused, and micro tears within the fascia become inflamed, usually at the insertion at the heel, resulting in pain. The fascia may tear at the midsole and near the toes as well. Plantar fasciitis is an ongoing injury process, since it is difficult to rest the foot, and gradually becomes worse. When sleeping or at rest, the fascia is shortened and tight, as do the calf muscles. Thus upon rising, a painful re-injury occurs. Heel spurs are the body s way of helping the fascia to re-attach to the heel. The bone calcifies toward the torn tissue to help it heal. Heel spurs do not cause the initial pain, nor do they cause the problem, they are a result of the problem. Spurs do not hurt unless they are large, fractured, or if there is fat pad atrophy is present.
What to expect
For most patients, the time period for complete resolution of pain is equal to the time period from when pain started until the treatment begins. However, most people find significant relief four to six weeks after treatment starts.
Treatment
Medication:
Most physicians will prescribe an anti-inflammatory to relieve pain. Over the counter drugs such as Ibuprofen, Alieve, and Motrin could be used.
Do not go barefoot or run or walk up hills while symptoms are present. Keep your treadmill flat.
Rest:
Listen to your body. If the pain is so bad you may have to stay off your feet for a period of time.
Stretching:
It is absolutelynecessary to do the stretches at least 2 times a day to find relief from plantar fasciitis. Stretching the calf muscles without re-injuring the fascia 2 times a day and especially before getting out of bed in the morning as well. Always stretch gently, feel a mild pull, but no pain.
Custom Cushioned Orthoses:
For most people a custom orthotic device is necessary to maintain the long arch to keep the plantar fascia as short as possible and prevent further injury. An over the counter orthotic device may be tried for 6 to 8 weeks, but if no relief is found, a custom orthoses is required.
Shoes:
80% of the US population unknowingly wear their shoes at least one size too small. The fascia attaches to the backsides of the toe bones and short shoes cause the toes to contract, which pulls fascia tighter and causes micro tears while walking. Your shoes need at least from the end of the shoe to the longest toe while standing. Make sure your shoes are in good shape and replace them as needed. Weak unsupportive shoes could be part of the initial problem or part of the continuation of the problem.
Keep a pair of supportive shoes that are easy to get on (like NAOT or Birkenstock sandals) and keep them next to your bed. Put them on before standing up. This will hold your arch up and lessen the chance of injury upon rising. Do not go barefoot while having heel pain.
Ice:
Icing the area for 30 to 60 minutes is very helpful to reduce the inflammation. It is also important to ice the area 15 minutes after activity.
Night Splints:
In chronic cases, a dorsiflexion night splint is used. This is a brace that holds the front of your foot pointed slightly toward your knee and keeps your calf muscles stretched while sleeping. This prevents re-injury upon rising.
Stretching:
It is absolutely necessary to do the stretches at least 2 times a day to find relief from plantar fasciitis. Stretching the calf muscles without re-injuring the fascia 2 times a day and especially before getting out of bed in the morning. Take a towel and toss it across the ball of your foot and pull gently to stretch your calves before getting out of bed. Step directly into a supportive sandal or a pair of shoes with your orthotic upon rising.
Calf Stretches 1. Lean against a wall and bend the knee of the unaffected foot. Keep that foot forward. While keeping your heels on the ground and the back knee straight, lean forward toward the wall. You will feel a mild pull in your calf area but NO pain. Hold for 10-15 seconds and relax. Repeat 10 times. 2. Place the balls of your feet on the edge of a stair, curb, or a phonebook and allow your heels to dip down. Hold for 10 seconds and relax one thousand. Repeat 10 times. Or the ideal stretch is on an incline board. Keep both knees straight and allow the heels to lower toward the ground. This is a prolonged stretch. Hold this position for 1 minute and gradually increase to 5 minutes. Once again, you should feel a mild pull but NO pain.