Healthy Living

Plantar Fasciitis: Treatment and Therapy for Plantar Fasciitis

Plantar Fasciitis

Key Takeaways

  • Plantar fasciitis is caused by a strained ligament, which supports the arch of your foot. 
  • The risk of developing this foot condition increases as you age.
  • Rest and medication are often the common treatments for relieving the pain caused by plantar fasciitis.

Meaning of Plantar Fasciitis

One of the most common causes of heel pain is called plantar fasciitis. A flat band of ligament or tissue connects the heel bone to the toes. This ligament is called the plantar fascia, which also provides support to the arch of the foot. If the plantar fascia is strained, it tends to weaken and swell. Hence, the heel or the bottom of the foot hurts when one stands or walks.

Although the condition is quite common in middle-aged people, it also affects younger people, who are continuously on their feet. Plantar fasciitis can affect one foot or both feet.

The condition initially starts with heel pain when the first step is taken in the morning. This pain gets worse if enough rest is not taken. Also, there are chances that the injured ligament will not completely heal if the individual does not stop the ongoing activity, which caused the pain or changes the condition that caused it. The heel pain worsens as plantar fasciitis progresses. Many individuals change their walking style to avoid the pain, which leads to discomfort and other problems that affect the foot, hip, or back. For this reason, carrying out daily activities becomes limited. Eventually, the person will find it difficult to perform any weight-bearing activity. As the plantar fascia pulls on the heel bone due to continuous stress, it results in a heel spur.

Causes of Plantar Fasciitis

A strain on the ligament, which supports the arch causes plantar fasciitis. If this strain is not taken care of in the early stages, it can lead to repeated strains. These strains lead to tiny tears in the ligament, which leads to pain and swelling. This condition would happen because of the following reasons:

  • An individual has very high arches or has a very flat feet
  • Longer duration of standing or running on hard surfaces, which usually happens in athletes and soldiers
  • Overpronation wherein the feet roll excessively inward
  • Obese or being overweight 
  • Shoes that do not fit well on the feet or those that are worn out
  • Carrying out repetitive activities that require standing for a longer duration
  • Natural process of aging
  • Weakened attachment of the fascia to the bone due to tight calves and an inflexible Achilles tendon
  • Walking or running barefoot on hard surfaces

Symptoms 

When you take your first step to get out of bed in the morning, you would notice an initial pain, which is the first symptom of plantar fasciitis. Similar cases can also happen if one sits for a longer duration and then tries to get up. However, as you take further steps, you may experience less stiffness and pain, but it does not mean that you won't be experiencing painful symptoms anymore. As the day passes by, you may experience an increasing pain. It hurts a lot when you climb stairs or when you stand for too long.

Foot pain is not always associated with plantar fasciitis. Pain in the foot during the night means you may be suffering from arthritis or nerve problem.

How to prepare for a doctor's appointment?

Before visiting the doctor, you may want to prepare a list, which would include the following information:

  • The details of the symptoms and when they all started
  • Your personal and family's medical history
  • The activities you have done, which could have contributed to the symptoms
  • All types of medications, supplements, or vitamins you take with dosage details

Who is at risk of developing plantar fasciitis?

The factors that can increase an individual's risk of developing plantar fasciitis include:

  • Age - As people grow older, they become more prone to developing the condition.
  • Poor Foot Mechanics - Individuals with high arches or flat feet, and also those who walk with an inward twist are more susceptible to developing plantar fasciitis.
  • Being Overweight or Obese -Excess weight can put additional stress on one's plantar fascia.
  • Wearing Uncomfortable Shoes - You wear shoes that do not provide enough cushion to your soles.
  • Sudden Change in Training Pattern - Sudden changing of running or walking surfaces from green to hard surface can affect your plantar fascia.
  • Occupation - You have a job, which requires long hours of standing on hard surfaces.

Athletes are more prone to plantar fasciitis due to the nature of their movements, which require them to put a lot of stress on their heel. Improper training and repetitive strenuous activities make them more prone to developing plantar fasciitis.

Runners who run on steep hills, practice for a longer duration without enough breaks, and/or wear ill-fitting shoes or shoes without properly cushioned soles are also at high risk.

Diagnosis

The doctor will conduct a physical examination, which includes letting you walk or stand and checking your feet. There are certain questions the doctor would ask you about:

  • Your daily activities to gauge how active you are.
  • Your daily physical activity, which could be the reason for the strain.
  • More details on your symptoms such as when the pain started, how long it lasts, and the area where you feel the pain.
  • Your health history any past illnesses or injuries.

If required, the doctor would also advise for an X-ray of your foot, if he or she suspect any problems with the bones of your feet.

Treatment 

Every person would have a different treatment plan since no single treatment works best for those suffering from plantar fasciitis. However, there are certain things you can do to reduce the strain on your feet.

  • Understand when your feet need rest and cut back on activities, which hurt your foot. Running and walking on hard surfaces should be avoided or minimized.
  • Try applying an ice pack on your heel to reduce the pain and swelling. If the pain or swelling does not subside even after applying ice to the affected region for two or three days, then switch to a heating pad, which is usually set on low since heat can also worsen the symptoms of plantar fasciitis.
  • Medications such as ibuprofen (Advil or Motrin) or naproxen, which are available over-the-counter, can also be taken. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also reduce the inflammation caused by the condition. Check with your doctor before trying any medications or creams.
  • Certain exercises can also be carried out to relax the feet muscles. Toe stretches and calf stretches can be done several times a day. Stretches and small exercises should be done first thing in the morning for best results. Certain towel stretches can also be done under the guidance of a trainer. In these exercises, you pull both ends of a rolled towel that you placed under the ball of your foot.
  • Your shoes are also a key contributor that may either provide pain or relaxation to your feet. Hence, get a new pair of shoes if the old ones are worn out. The soles of the shoes should be well-cushioned and they should have good arch support. You can also use shoe inserts made of rubber, plastic or felt, which can be inserted inside the shoes. Remember to use it on both shoes even if the pain is only on one foot.
  • For people who are overweight, try having a weight loss program or consult a nutritionist, who can provide a healthy eating pattern according to your nutritional needs.
  • Running or walking engages gravity by letting your upper body lead and your legs follow. While you are running, lean slightly from the ankles. Keep your strides short and your feet should directly land under the center of your mass. This would minimize the pressure on your feet, thus keeping you safe from plantar fasciitis.
  • Avoid taking the stairs and use elevators instead. Moreover, avoid running or walking on hard surfaces for long periods.
  • Uneven hills, trails, and surfaces should be avoided.
  • Pamper yourself with a foot massage. The deeper the massage, the better you will feel.

Therapy Recommended for Patients with Plantar Fasciitis 

  • Night Splints - The doctor might recommend that you wear a splint that stretches the calf and the arch of the feet while you sleep. This helps to hold the plantar fascia and the Achilles tendon in a lengthened position, thereby facilitating stretching.
  • Physical Therapy - In this case, a physical therapist would recommend a certain series of exercises to be done to stretch the plantar fascia and the Achilles tendon. Such exercises would help stabilize the ankle and heel by strengthening the lower leg muscles.
  • Orthotics - The doctor would prescribe a custom-made arch support to evenly distribute the pressure on your feet.
  • Injections - Medications would be injected into the tender area, which would provide temporary relief. However, doctors do not recommend giving multiple injections since it can weaken the plantar fascia and possibly cause a rupture.
  • Tenex Procedure - This procedure helps to remove the scar tissue that causes pain without conducting any surgery.
  • Shock Wave Therapy - Sound waves are directed at the painful area of the heel. This type of therapy is done to stimulate healing. It is usually carried out on chronic plantar fasciitis patients who have not responded to other treatments. Certain side effects of this treatment include bruising, pain, numbness, and any tingling sensation. This therapy has not been shown to be consistently effective. However, certain studies show that this therapy has promising results.
  • Surgery - This is the last option a doctor would suggest. Individuals who are suffering from plantar fasciitis for the past 6 to 12 months even after trying all medications and therapy are then suggested the option of surgery.

Plantar Fasciitis Exercises

There are certain exercises one can follow as a routine to relieve plantar fasciitis:

  • Face the wall in a standing position with an arm’s length away from the wall. Keep yourself in a relaxed position by ensuring that your lower legs and ankles are relaxed. Position your hands on the wall. They should be parallel to your shoulders and lean towards the wall. Lower yourself towards the wall. Hold this position for 30 seconds and then repeat this process for at least three times as one set.
  • Stand at the edge of a step. The toes should be on the step and the heels hanging off. Slowly lower your heels down past the step. Gradually, raise back up to the starting position. Repeat this process 10 times and carry out three sets. This exercise strengthens the tendons in the heels and calf muscles.
  • If you are in an environment, which requires you to be seated for a prolonged period of time, then follow this small exercise. Stretch your legs and point your toes towards your knees and then point them out. You should feel the stretch in your calf every time you point your toes in and out. By doing this several times a day, your calf and Achilles tendon will get stretched. It will also ease the foot.
  • While sitting, put a small resistance band around your toes. Spread your toes and then release. Do this for some time and then place a toe separator in between the toes. Squeeze the toes in and then release them. This should be repeated 10 times for both feet. By doing this exercise, the interossei muscles of the foot are targeted. These muscles support the arch.

There are certain tips that one can follow to treat acute pain, which often follows plantar fasciitis:

  • If you experience continuous pain even after the intake of medications, then try soaking your heel in a bowl of ice water. This should be done for at least five to ten minutes until the pain subsides. This can be done twice daily. Initially, it will be difficult but you will find it worthwhile.
  • Barefoot walking on grass or coarse gravel surfaces is always recommended. By doing so, it speeds the healing process. It helps to maintain the plantar tendons supple.
  • Try picking up marbles or scrunching towels with your toes.

Prognosis 

Plantar fasciitis takes time to completely heal, and the amount of time will differ for each person. With various treatment, the pain would start reducing over a period of time. Starting from a few months to a year, it will take at times a longer duration for the pain to go away completely. Do not stray away from the treatment. If the treatment is discontinued, the pain will be constant and eventually would cause other damages.

A majority of illnesses go away with time if regular medication and exercises are followed. Also, timely treatment of plantar fasciitis will help you to get rid of the condition early if everything is followed correctly. Early treatments result in quick healing, and the more you wait to start treatment, the longer it will take for your condition to heal.