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. Along with the muscles and bones, this connective tissue - the plantar fascia - forms the arch of the foot. You will usually feel plantar fasciitis pain in your arch near the heel. It can be quite intense, particularly when walking or pressing down on that area, and it is usually worse with the day's first steps. The pain may lessen, but, over the course of the day or with increased. activity, it may worsen.

Weak foot muscles can lead to pressure on the arch, which in turn adds stress to the plantar fascia. This strain can lead to plantar fasciitis - and pain. Tight muscles also cause fasciitis. When the muscles that attach to the Achilles tendon in the back of the heel are tight, the ankle is less flexible. Because the Achilles connects to the plantar fascia, the fascia also tightens. Therefore, stretching the Achilles tendon regularly may help decrease discomfort. Low arches may also contribute to plantar fasciitis. People who have low arches may also have tight calf muscles and may be putting stress on the plantar fascia.

 
The plantar fascia as seen from the bottom of the foot. Arrow indicates common site of pain.

Effective therapy. Cold therapy can help decrease pain. An ice pack or commercially available cold pack can be used. Apply the ice long enough to achieve a numbing effect(approximately 20 minutes). Aspirin or another anti-inflammatory pain reliever can help decrease discomfort. A shoe insert or orthotic device, heel pads, heel cups, or taping the arch can help reestablish the arched shape of the foot. Supportive footwear appropriate for your activity can also help. Good walking shoes may be more comfortable than flimsy, nonsupportive shoes or high heels.

Stretching and strengthening. It is important to begin a gentle, prolonged stretching program with the goals of improving foot flexibility and obtaining pain relief. Proper stretching is gentle. It does not increase pain but provides only a dulling sensation in the muscle and tendon being stretched. The stretch should be held between 30 seconds and 3 minutes. Stretching exercises should focus on the Achilles tendon and both the gastrocnemius muscles in the back of the calf and the soleus muscles on the sides of the calf. Once the foot is flexible and pain free,it is important to continue rehabilitation with exercises to strengthen the foot and the lower leg. Although a stretching program may help relax the more rigid connective tissue, the foot is a dynamic structure. Therefore, it requires strong muscles to help maintain a sound arch despite the increased force placed on the foot during walking or running.

A simple gastrocnemius muscle stretch performed with the rear knee straight. Another gastrocnemius stretch. With one or both heels overhanging a step, support the body weight on the front of the foot and apply steady downward pressure. The soleus stretch is the same as the simple gastrocnemius stretch but with the rear knee bent as well as the front knee.