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Plantar fasciitis is a painful condition of the heel where no single treatment method is likely to cure plantar fasciitis on its own. However a combination of approaches can be effective at curing plantar fasciitis.
Aims of rehabilitation
The following guidelines regarding Plantar Fasciitis treatment are for information purposes only. We recommend seeking professional advice before attempting any rehabilitation. The aims of plantar fasciitis rehabilitation are to decrease pain and inflammation, improve flexibility and strength then gradually return to full fitness. Any biomechanical problems of the foot must also be looked at to avoid plantar fasciitis recurring in the future.
Reducing pain and inflammation
Rest from activities that cause pain. Stay off your feet as much as you can and use crutches if necessary. Maintain fitness by swimming or cycling and use the opportunity to work on upper body strength.
If you cannot stay off your feet then the next best thing is the plantar fasciitis taping technique. This taping gives excellent support while allowing the foot to heal. If taping is effective then it is likely that orthotics will also be effective in correcting foot biomechanics and helping to prevent the injury returning once normal training has resumed.
Apply cold therapy. Ice massage or application of a cold pack for 10 minutes every hour for the first day reducing to 3-5 times a day as symptoms ease.
If your feet roll in or pronate excessively then this can contribute to the strain on the foot as this tends to flatten the arch and so stretches the plantar fascia more than it is comfortable with. Repeated over-stretching will cause damage to the collagen fibres within the fascia.
This can be corrected by orthotic inserts preferably fitted by a sports injury professional or podiatrist. The inserts should be worn at all times. Not just when training. During rehabilitation, you should wear orthotics from the moment you get out of bed until you get back in again.
You can get an idea of whether you over pronate by looking at your footwear. If you tend to wear out the inside front of your sole then this is a strong indication that something is not quite right.
Gentle stretching should be started as soon as pain will allow - the first day of treatment if possible. Stretching the plantar fascia is essential but in addition all the muscles of the lower leg should be stretched - including the calf muscles and the tibialis anterior at the front of the leg. Continue stretching daily throughout the rehabilitation phase and long after the injury has healed.
Sports massage can be applied as soon as pain will allow but must be gently at first and gradually becoming deeper. Massage should be performed every other day as days recovery is required between sessions, especially if the massage has been deep. Massage should be applied to the fascia itself, but also to the calf muscles to help loosen them and so increase the range of motion at the ankle.
If pain allows strengthening exercises may begin. They should always be done pain free and over time may help prevent the injury recurring. There is no rush to begin plantar fasciitis strengthening exercises. The priority should be reducing pain and inflammation and stretching the fascia to avoid symptoms returning. Long term strengthening can provide more support for the arch of the foot but should not be at the expense of symptoms returning.
See plantar fasciitis strengthening exercises for more detailed information.
Returning to full fitness
When you have gone at least a week with no pain then you can begin to slowly start to increase the stress on the foot. Start off by walking and increasing the distance and speed you walk until you can walk at a fast pace for at least 30 minutes with no pain. This should be a gradual process. If you feel pain at any time then go back a step.
Apply tape to the foot to support it for the first few times, especially if you do not have orthotics. Gradually introduce running by following the program below.
Ensure you have the correct shoes for your running style or sport. After every training session apply ice to the foot for about ten minutes. Ensure you stretch properly before each training session and after. Hold stretches for about 30 seconds and repeat 3-5 times.
Below is an example of a gradual return to running programme. Begin each training session with a 5 minute walk followed by a stretch.
- Day 1 - walk 3 mins, jog 1 min, repeat 4 times
- Day 2 - rest
- Day 3 - walk 3 mins, jog 2 mins, repeat 4 times
- Day 4 - rest
- Day 5 - walk 2 mins, jog 3 mins, repeat 4 times
- Day 6 - rest
- Day 7 - walk 2 mins, jog 4 mins, repeat 4 times
Continue this until you are confident enough to return to full training.