Plantar Fasciitis

Plantar fasciitis is a painful foot condition that affects the heel. It occurs when the band of tissue that connects the toes to the heel bone (plantar fascia) becomes irritated. This can happen as the result of exercising too much or doing other repetitive activities (overuse injury).

The pain from plantar fasciitis can range from mild irritation to severe pain that makes it difficult to walk or move. The pain is usually worse in the morning after sleeping, or after sitting or lying down for a while. Pain may also be worse after long periods of walking or standing.

What are the causes?

This condition may be caused by:

• Standing for long periods of time.
• Wearing shoes that do not have good arch support.
• Doing activities that put stress on joints (high-impact activities), including running, aerobics, and ballet.
• Being overweight.
• An abnormal way of walking (gait).
• Tight muscles in the back of your lower leg (calf).
• High arches in your feet.
• Starting a new athletic activity.

What are the signs or symptoms?

The main symptom of this condition is heel pain. Pain may:

• Be worse with first steps after a time of rest, especially in the morning after sleeping or after you have been sitting or lying down for a while.
• Be worse after long periods of standing still.
• Decrease after 30–45 minutes of activity, such as gentle walking.

How is this diagnosed?

This condition may be diagnosed based on your medical history and your symptoms. Your health care provider may ask questions about your activity level. Your health care provider will do a physical exam to check for:

• A tender area on the bottom of your foot.
• A high arch in your foot.
• Pain when you move your foot.
• Difficulty moving your foot.

You may have imaging tests to confirm the diagnosis, such as:

• X-rays.
• Ultrasound.
• MRI.

How is this treated?

Treatment for plantar fasciitis depends on how severe your condition is. Treatment may include:

• Rest, ice, applying pressure (compression), and raising the affected foot (elevation). This may be called RICE therapy. Your health care provider may recommend RICE therapy along with over-the-counter pain medicines to manage your pain.
• Exercises to stretch your calves and your plantar fascia.
• A splint that holds your foot in a stretched, upward position while you sleep (night splint).
• Physical therapy to relieve symptoms and prevent problems in the future.
• Injections of steroid medicine (cortisone) to relieve pain and inflammation.
• Stimulating your plantar fascia with electrical impulses (extracorporeal shock wave therapy). This is usually the last treatment option before surgery.
• Surgery, if other treatments have not worked after 12 months.

Follow these instructions at home:

Managing pain, stiffness, and swelling

• If directed, put ice on the painful area:
  • Put ice in a plastic bag, or use a frozen bottle of water.
  • Place a towel between your skin and the bag or bottle.
  • Roll the bottom of your foot over the bag or bottle.
  • Do this for 20 minutes, 2–3 times a day.
• Wear athletic shoes that have air-sole or gel-sole cushions, or try wearing soft shoe inserts that are designed for plantar fasciitis.
• Raise (elevate) your foot above the level of your heart while you are sitting or lying down.

Activity

• Avoid activities that cause pain. Ask your health care provider what activities are safe for you.
• Do physical therapy exercises and stretches as told by your health care provider.
• Try activities and forms of exercise that are easier on your joints (low-impact). Examples include swimming, water aerobics, and biking.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Wear a night splint while sleeping, if told by your health care provider. Loosen the splint if your toes tingle, become numb, or turn cold and blue.
• Maintain a healthy weight, or work with your health care provider to lose weight as needed.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you:

• Have symptoms that do not go away after caring for yourself at home.
• Have pain that gets worse.
• Have pain that affects your ability to move or do your daily activities.

Summary

• Plantar fasciitis is a painful foot condition that affects the heel. It occurs when the band of tissue that connects the toes to the heel bone (plantar fascia) becomes irritated.
• The main symptom of this condition is heel pain that may be worse after exercising too much or standing still for a long time.
• Treatment varies, but it usually starts with rest, ice, compression, and elevation (RICE therapy) and over-the-counter medicines to manage pain.

Plantar Fasciitis Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your foot. These exercises also help to relieve pain.

Exercise A: Plantar fascia stretch

1. Sit with your left / right leg crossed over your opposite knee.
2. Hold your heel with one hand with that thumb near your arch. With your other hand, hold your toes and gently pull them back toward the top of your foot. You should feel a stretch on the bottom of your toes or your foot or both.
3. Hold this stretch for__________ seconds.
4. Slowly release your toes and return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Gastroc, standing

1. Stand with your hands against a wall.
2. Extend your left / right leg behind you, and bend your front knee slightly.
3. Keeping your heels on the floor and keeping your back knee straight, shift your weight toward the wall without arching your back. You should feel a gentle stretch in your left / right calf.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Soleus, standing

1. Stand with your hands against a wall.
2. Extend your left / right leg behind you, and bend your front knee slightly.
3. Keeping your heels on the floor, bend your back knee and slightly shift your weight over the back leg. You should feel a gentle stretch deep in your calf.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Gastrocsoleus, standing

1. Stand with the ball of your left / right foot on a step. The ball of your foot is on the walking surface, right under your toes.
2. Keep your other foot firmly on the same step.
3. Hold onto the wall or a railing for balance.
4. Slowly lift your other foot, allowing your body weight to press your heel down over the edge of the step. You should feel a stretch in your left / right calf.
5. Hold this position for __________ seconds.
6. Return both feet to the step.
7. Repeat this exercise with a slight bend in your left / right knee.

Repeat __________ times with your left / right knee straight and __________ times with your left / right knee bent. Complete this exercise __________ times a day.

Balance exercise

This exercise builds your balance and strength control of your arch to help take pressure off your plantar fascia.

Exercise E: Single leg stand

1. Without shoes, stand near a railing or in a doorway. You may hold onto the railing or door frame as needed.
2. Stand on your left / right foot. Keep your big toe down on the floor and try to keep your arch lifted. Do not let your foot roll inward.
3. Hold this position for __________ seconds.
4. If this exercise is too easy, you can try it with your eyes closed or while standing on a pillow.

Repeat __________ times. Complete this exercise __________ times a day.