From the weekend warrior to the competitive athlete, the rising participation in physical activity has led to a wide array of overuse syndromes including plantar faciitis.

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Principles of Plantar Fasciitis

Plantar fasciitis is an inflammation of the strong tissue that runs along the bottom of the foot and connects the heel to the base of the toes (see image). This common overuse injury is characterized by heel pain that is worse in the morning with the first few steps. Since it is difficult to rest the foot, this problem gradually worsens. With progression, pain may start interfering with activities of daily living.

Potential Causes Include:

• Weak foot muscles
• Tight Achilles tendon
• Flat or high arches
• Poor shoe support
• Sudden increase in activity level
• Sudden increase in weight

Effective Treatment Will Address:

• Decreasing pain
• Restoring flexibility to tight structures surrounding the arch and ankle
• Strengthening the muscles in and around the foot
• GRADUAL return to full activity

Your doctor and physical therapist can design a rehabilitation program that is the most appropriate, but there are some simple and effective things that you can do.

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Your Role In The Treatment Process

Rest:

Use pain as your guide. Initially, avoid prolonged walking, running or jumping.

Cold Therapy:

Ice can help decrease pain. For best results ice should be applied four times daily to the injured area. Ice massage for 5-7 minutes or ice pack for 15-20 minutes each application.

Medication:

Anti-inflammatory pain relievers available at the drug store can help decrease discomfort.

Shoes:

Use of appropriate footwear for daily activities and sports is very important. Improperly fitting shoes can cause plantar fasciitis. A running shoe with good support through the middle of the arch would be optimal. Experiment with your shoes noting any change in symptoms.

Taping:

Plantar fascia taping can also provide some relief of your symptoms. The tape will decrease your pain by distributing force away from the stressed plantar fascia. (See 'Taping for Plantar Fasciitis,' in our Trainers' Corner)

Orthotics:

Your doctor may suggest using a shoe insert or orthotic device to decrease the forces at the site of the injury. Over the counter heel pads or heel cups can provide force distribution and reduce the pull of a tight Achilles therefore decreasing your symptoms.

Stretching and Strengthening:

As soon as swelling and pain begin to subside it is important to start a proper stretching program. The stretching should be gentle and prolonged, using a slow, static stretch. Each stretch should be performed three times a day holding each stretch for one minute and repeating five times each session. Stretching exercises should include the gastroc, soleus and intrinsic muscles of the foot.

Gastroc Stretch	Soleus Stretch	Intrinsic Stretch

Once muscle flexibility is attained, and you remain pain free, strengthening the involved muscles is your goal. An appropriate strengthening program will help prevent the reoccurrence of this condition. The following exercises performed three times per day for 30 times each session will help provide muscular support to a weakened plantar fascia.

1. towel curls to strengthen intrinsic muscles of the foot
2. calf raises (unilateral and bilateral)

Plantar fasciitis sufferers can return to pain-free, full-activity with proper rehabilitation. Return to activity should be gradual and guided by your pain. Proper footwear, and a stretching and strengthening program can help prevent reoccurrence of this condition.