Plantar Fasciitis Treatment and Rehabilitation
Plantar fasciitis is a painful condition of the heel which can be stubborn to treat. Our simple two strand solution to curing plantar fasciitis based on treatment and exercises is outlined below.
The aims of plantar fasciitis treatment are to decrease pain and inflammation, identify and correct possible causes, improve flexibility then gradually increase strength and returning to full fitness. Our treatment plan consists of two phases.
Phase 1 treatment
No single treatment method is likely to be successful on its own. However a combination of approaches can be effective at curing plantar fasciitis. The first phase emphasizes rest and aims to reduce initial pain and inflammation to the point where you can walk pain free in the mornings.
Rest - from activities that cause pain. Stay off your feet as much as you can and use crutches if necessary.
Footwear - Wear comfortable trainers with good cushioning. Avoid hard flat soles or high heels. Avoid walking in bare feet, especially on hard surfaces. This will increase the strain on the plantar fascia under the foot.
Ice - 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.
Taping - Tape the foot to protect and support the fascia until you can walk pain free. 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.
Medication - A doctor may prescribe NSAID's (Non steroidal anti-inflammatory drugs) e.g. ibuprofen in the early stages. Always check with a Doctor before taking any medication. Do not take Ibuprofen if you have asthma.
Orthotics - 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 over stretches the plantar fascia causing 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.
Phase 1 exercises
No running - walking or any other activity which causes pain either during, after or the following day.
Night splint - wear a plantar fasciitis night splint for as long as is comfortable, over night if possible but if you can manage 1 hour then gradually increase over time. If it is painful then remove it. Do not give up!
Maintain fitness - by swimming or cycling and use the opportunity to work on upper body strength.
Gentle stretching - if pain allows. 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.
You are ready to move onto phase two when you can walk pain free in the mornings.
Phase 2 treatment
The second phase aims to get the athlete back to full fitness once inital pain and inflammation has gone.
Ice - Continue with ice after activity such as walking.
Massage - massage techniques can be applied to further stretch and improve the elasticity of the plantar fascia. Initially massage may be light on a daily basis but deeper techniques can be used as the condition improves. Deeper techniques may require a days recovery in between sessions.
Ball rolling - If you are unable to see a massage therapist regularly then roll the foot over a ball or rolling pin or similar to help stretch and apply myofascial release. Do this exercise for 10 minutes per day.
Continue with this until foot fitness has been regained. If the pain becomes worse then drop back to phase 1.
Phase 2 exercises
Stretching exercises - should be done daily if pain allows.
Night splint - aim to wear the night splint for at least 5 hours, longer if possible.
Walking - 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.
You are ready to move on when you can walk 30 minutes without any pain during, after or the following day.
Phase 3 - Returning to full fitness
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 program. 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.