Plantar Fasciitis

Plantar Fasciitis

This page describes the condition of Plantar Fasciitis and the approach to this condition adopted by Mr Bowyer. Other surgeons may use variations on the techniques, for instance with regard to post-operative management. It is important that you understand what your own surgeon intends to do, and how you will be treated after the procedure.

Gavin BowyerDescription

Plantar fasciitis is characterized by stiffness and inflammation of the main fascia (fibrous connective tissue, a bit like a ligament) on the bottom of the foot. It is occasionally associated with a bone spur on the heel, although bone spurs themselves usually do not cause symptoms.

Common Signs and Symptoms

  • Pain and tenderness in the sole of the foot, mostly under the heel bone, with standing or walking
  • Particularly noticeable pain with the first steps when getting out of bed in the morning or after sitting

Causes

  • Stress or injury to the heel tissues, which causes inflammation and calcification of the fascia of the foot
  • Irritation of a small nerve that runs under the foot where the main fascia attaches to the heel bone
  • Tight calf muscles or flat feet
  • Shoes that are poorly fitted, have inadequate arch supports

Risk increases with the following:

  • Sports, including running or jogging, and sudden stops or changes in direction
  • Prolonged standing
  • Poor physical conditioning (strength and flexibility)
  • Inadequate warm-up before practice or play
  • Obesity
  • Flat feet

Preventive Measures

  • Appropriately warm up and stretch before practice or competition
  • Maintain appropriate conditioning
    • Calf, ankle, and foot flexibility
    • Strength and endurance
    • Cardiovascular fitness
    • Ideal body weight
  • Avoid activities that put a constant strain on the foot
  • Wear appropriate shoes with heel cushion and good arches or arch supports

Expected Outcome

This condition is usually curable with appropriate conservative treatment, but can often take several weeks or even months of treatment.

General Treatment Considerations

Initial treatment consists of medications and ice to relieve pain, stretching exercises of the heel cord and achilles tendon, and modification of activities. A heel cup or felt insert in the shoe to relieve pressure on the heel may be recommended. Occasionally, wearing splints at night may be offered. Chronic cases may require referral to a physical therapist or athletic trainer for further evaluation and treatment. Arch supports (orthotics) are helpful for people with flat feet to prevent or treat this problem. Occasionally surgery is needed to release the fascia and nerve.

Medication

  • Nonsteroidal anti-inflammatory medications , such as aspirin and ibuprofen, or other minor pain relievers, such as paracetamol, are often recommended
  • Cortisone injections reduce inflammation. However, these are done only sparingly; there is a limit to the number of times cortisone may be given, because it weakens muscle, fascia, and tendon tissue. Anesthetics temporarily relieve pain

Heat and Cold

  • Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak
  • Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage

Range of Motion and Stretching Exercises: Plantar Fascitis

Your physiotherapist may give you specific exercises. The stretches shown here may be helpful. Flexible tissue is more tolerant of the stresses placed on it during activities.

  • Each stretch should be held for 20 to 30 seconds
  • A gentle stretching sensation should be felt – do not “bounce” in to the stretch

Range of Motion: Toe Extension

  1. Grip your toe(s)
  2. Pull the toe(s) up toward your body. Repeat this exercise by pulling the toe down
  3. Hold this position for _____ seconds
  4. Repeat exercise _____ times, _____ times per day

Range of Motion: Ankle Dorsiflexion

  1. Sit on the edge of a chair as shown
  2. Place your _____ foot closest to the chair
  3. Keep your foot flat on the floor and move your knee forward over the foot
  4. Hold this position for _____ seconds
  5. Repeat exercise _____ times, _____ times per day

Stretch: Gastrocsoleus

  1. Stand one arm length from the wall. Place calf muscle to be stretched behind you as shown
  2. Turn the toes in and heel out of the leg to be stretched
  3. Lean toward wall leading with your waist, allowing your arms to bend. Keep your heel on the floor
  4. First do this exercise with the knee straight, then bend the knee slightly. Keep your heel on the floor at all times
  5. Hold this position for _____ seconds
  6. Repeat exercise _____ times, _____ times per day

Stretch: Gastrocsoleus

Note: This exercise can place a lot of stress on your foot and ankle and should only be done after specifically checking with your physician, physical therapist, or athletic trainer.

  1. Place your toes and the ball of your foot on a book(s) or the edge of a stair. Your heel should be off the ground
  2. Hold on to a chair or stair rail for balance
  3. Allow your body weight to stretch your calf
  4. First do this exercise with the knee straight, then bend the knee slightly
  5. Hold this position for _____ seconds
  6. Repeat exercise _____ times, _____ times per day

Strengthening Exercises: Plantar Fascitis (Heel Spur Syndrome)

These are some of the initial exercises you may start your rehabilitation program with until you see your physician, physical therapist, or athletic trainer again or until your symptoms are resolved. Please remember:

  • Strong muscles with good endurance tolerate stress better
  • Do the exercises as initially prescribed by your physician, physical therapist, or athletic trainer. Progress slowly with each exercise, gradually increasing the number of repetitions and weight used under their guidance

Strength: Ankle Inversion

  1. Attach one end of elastic band to fixed object or leg of table/desk. Loop the opposite end around your foot
  2. Turn your toes/foot inward as far as possible, attempting to push your little toe down and in. Hold this position for _____ seconds
  3. Slowly return to starting position
  4. Repeat exercise _____ times, _____ times per day

Strength: Towel Curls

  1. Sit in a chair and place a towel on a noncarpeted floor. Place your foot/toes on towel. (You may also stand to do this exercise rather than sit)
  2. Curl/pull towel toward you with your toes while keeping your heel on the floor. Move towel with toes only. Do not move your knee or ankle
  3. If this is too easy, place a light weight (book, hand weight, etc.) at the far end of the towel
  4. Repeat exercise _____ times, _____ times per day

Other Treatment Options Include:

Surgery to release the fascia, or radiofrequency “coblation” which also treats the fascia directly, through a small surgical incision.

In some people there may be tightness in one of the calf muscles, the gastrocnemius, which can be associated with Achilles problems and plantar fasciitis; surgical release of this muscle, gastrocnemius recession, can be helpful in selected cases.

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