What is plantar fasciitis? Probably the most common cause of heel pain. Symptoms come on gradually and are often worse first thing in the morning. The plantar fascia is the tissue under the foot which forms the arch. Treatment includes rest, reducing pain and inflammation and stretching exercises.
Below we explain the condition and ways to treat it including a very effective taping technique and how to use a night splint.
Symptoms of plantar fasciitis consist of a gradual onset of pain under the heel which may radiate forwards into the foot (foot arch pain). There may be tenderness under the sole of the foot and on the inside of the heel when pressing in. The pain can range from being slightly uncomfortable to very painful depending on how badly it is damaged.
Pain is usually worse first in the morning because the foot has been in a relaxed position all night and the plantar fascia temporarily shortens. After walking around this usually eases as the tissues warm up and gradually stretch out. When the condition is present, similar periods of moving around following inactivity such as sitting for long periods can also trigger the pain.
Read more on symptoms and diagnosis.
Plantar fasciitis is an overuse injury caused by repetitive over-stretching of the plantar fascia which is is thick band of tissue / tendon that runs under the foot leads to possible inflammation and thickening of the tendon. Through overuse the fascia can become inflamed and painful at its attachment to the heel bone or calcaneus. The condition is traditionally thought to be inflammation, however this is now believed to be incorrect due to the absence of actual inflammatory cells within the fascia and degeneration is thought to be a more likely cause.
It is more common in sports which involve running, dancing or jumping. Although overuse is ultimately the cause of injury, there are a number of factors which can increase the likelihood of developing it including overpronation, a high arched foot, tight calf muscles, poor footwear, being overweight and previous injury.
Read more on causes and prevention.
Plantar fasciitis treatment
Treatment usually consists of reducing painful symptoms, stretching the tight fascia and lower leg muscles, correcting any causes and a gradual return to full fitness. Often a combination of approaches is best in treating this injury.
Reducing pain and inflammation is the first priority. Applying the PRICE princples of protection, rest, ice, compression and elevation is important. Apply ice or a cold therapy wrap to help reduce pain and inflammation. Cold therapy can be applied for 10 minutes every hour if the injury is particularly painful for the first 24 to 48 hours. This can be reduced to 3 times a day as symptoms ease. Ice should not be applied directly to the skin but through a wet tea towel to avoid skin burns. Commercial gel hot and cold packs and wraps are a more convenient method of application.
Taping the foot is an excellent way of instantly relieving the symptoms and pain under the heel. There are various methods of applying tape for this injury. It works by unloading some of the strain on the plantar fascia allowing the tissues to heal. It may need to be applied regularly until symptoms resolve but many people notice an immediate improvement.
Protect the foot by wearing comfortable shoes or trainers. Hard or flat soled shoes are likely to make symptoms worse. Wearing can provide protection of the painful area under the heal and a simple plantar fasciitis taping technique is ideal for taking the pressure of the plantar fascia and allow the foot to rest and aid healing. Plantar fasciitis stretches are important as soon as pain allows. A night spint is a very effective way of stretching the plantar fascia under the heel. It is worn overnight and helps prevent the arch of the foot tightening up.
A professional therapist can make an accurate diagnosis and may use electrotherapy such as ultrasound to relieve symptoms as well as manual techniques such as massage. A doctor may prescribe anti inflammatory medication such as ibuprofen in the early stages. For more stubborn injuries a corticosteroid injection may be given and if symptoms do not resolve then surgery is an option but this is rare. Gait analysis may be done to identify biomechancial foot problems and orthotic inserts prescribed.
Read more on treatment and rehabilitation.
Plantar fasciitis exercises
Exercises to stretch the plantar fascia and calf muscles take priority initially over strengthening. Calf muscle stretches with the leg straight (to target the larger gastrocnemius muscle) and with the knee bent (targeting the lower soleus muscles) are done 3 to 5 times are day, holding the stretches for up to 30 seconds at a time. The plantar fascia stretch is done by pulling the foot an toes upwards aiming to feel a stretch in the arch of the foot. Rolling the foot over a ball can also help stretch underneath the foot.
Strengthening exercises are not normally needed, however scrunching a towel up with the toes can get the small muscles of the foot working.
Read more on exercises.
Surgery for PF is used in around 5% of people whose symptoms do not improve, even after continuous treatment. However, the success rate is still only estimated at around 70-80%. In most cases now a procedure called a plantar fascia release is performed which releases (cuts) between 30 and 50% of the fascia's fibres. This helps to reduce the pull and stress on the bony attachment, as well as the fascia itself. Complications can include nerve damage, fallen arches, infection and ongoing symptoms. Recovery after surgery if successful is around 9 to 12 weeks before the patient may return to work. Read more on surgery.