Need plantar fasciitis treatment? It is estimated that more than 2 million Americans receive treatment each year for heel pain (1). Reacting properly to the symptoms of planter fasciitis during the onset of the problem can minimize the pain and time away from training, and can rapidly return the client to pain-free performance.
What is Plantar Fasciitis?
Plantar Fasciitis is an inflammation and/or degeneration of the tissue on the bottom of the foot which supports the longitudinal arches of the foot. The tissue runs along the length of the foot, from the heel bone to just behind the toe bones. Typical symptoms of plantar fasciitis include sharp pain at the heel or in the arches. The onset of symptoms is usually gradual. Often, the client will complain of sharp pain at the heel or in the arches of the feet when first stepping out of bed in the morning. Pain typically diminishes as the tissue gets warmed up and used throughout the day, unless high-impact or heavy weight-bearing activities are performed. If a heel spur is present, a nodule may often be felt at the site of pain.
What Causes Plantar Fasciitis?
The main responsibility of the plantar fascia is to support the arch of the foot. This tissue has to flex and stretch with each step, jump, or foot movement. When the tissue gets overused, it becomes damaged and painful. Some factors contributing to the stress include(2):
- Poor foot mechanics — excessive pronation, flattened arches
- Worn-out shoes with inadequate arch support
- High-heeled shoes
- Tight calf and foot muscles
- Large amounts of high-impact activities like running or jumping
- Knock-kneed (Genu Valgum) or other lower-leg misalignments
- Weak ankle and foot musculature in general
Plantar Fasciitis Treatment
The most important part of treating plantar fasciitis is loosening the tissue (see #1 below).
The mainstay of treatment for plantar fasciitis remains stretching, strengthening, and sometimes non-steroidal anti-inflammatory medications. Icing the feet after use can help. Soaking your feet in an ice bath for 15 minutes works best, but a bag of frozen peas also works well, as does rolling the arch of the foot on a frozen orange juice cylinder. A corticosteroid injection is not recommended, as it temporarily decreases the pain, but offers no long-term solution to the problem(6).
1. Don’t Keep Irritating the Tissue.
You must stop re-tearing the tissue! After the muscles have tightened up – such as after you’ve been sleeping, or if you’ve been sitting for awhile – take 30 seconds to perform some ankle circles and manual stretching. After the tissue gets warmed and loose, it should not pull and re-tear when you stand on it.
Minimize the activities which aggravate your heel pain. High-impact activities should be limited. Swimming and stationary cycling are better choices while the pain and inflammation subside.
Buying a new pair of shoes with better support, or adding an arch support in the existing shoes may relieve some of the stress on the tissue while healing and strengthening take place. Avoid relying on the orthotic crutch permanently, though, for you will not have fixed the problem — you have only masked it.
Don’t sleep with the toes pointed and the covers tucked tight at the bottom of the bed. Try to position yourself so that the toes are pulled up toward the knees (dorsiflexed).
To aid in the don’t-point-your-toes-all-night quest, using night splints can minimize the adaptive shortening of the heel cord while sleeping(3,4,5). Manufactured night splints are available from orthopedic supply companies, or you can experiment with wearing high-top sneakers or boots to bed. Don’t laugh — it helps!
Stretching the plantar fascia and heel cord is imperative to improving this condition. Calf stretches up against a vertical surface or off the edge of a step should be performed as often as possible. From a seated position, manually bending the toes backward while the foot is dorsiflexed will stretch the plantar fascia too. Physical massage should help, either with the heel of the hand, or with a rolling pin or soda can. Sometimes the dorsiflexor muscles are tight, which alters the footstrike. In this case, some foam rolling on the shin muscles would also be helpful. Don’t forget to do your mini-warmup before getting out of bed!
4. Strengthening the Musculature
Specific strength training exercises should be performed in order for the plantar fascia to become strong enough to support whatever level of loading is required. In addition to standard calf and dorsiflexion exercises, some typical strengthening exercises include:
- Walking on the tiptoes.
- When lying down or while seated, alternate these two movements:
1. Make “fists” with your feet and point the toes (plantarflex).
2. Dorsiflex the feet (pull the toes up towards the shin) and fan the toes out, trying to spread the toes as far apart as possible.
- Seated towel crawl — place a bath towel on the floor in front of the seated, shoeless client. Place the ball of the foot on the edge of the towel, and begin curling the toes down to drag the towel under your heel. Continue to a good burn. Stretch well afterward. You can place a book on the towel if you need more resistance.
- Alphabet. Trace the letters of the alphabet in the air with your feet. Move slowly and deliberately.
- Balancing on a wobble board.
- Single-leg tiptoe movements, progressing to an unstable surface such as a trampoline or Airex pad.
- Work towards performing squats, lunges, step ups, and triple extension movements without shoes.
Remember to gradually return to higher impact activities. The amount of activity, not necessarily the type, will have a much greater effect on the speed and success of recovery. You will not be able to start back at the same workload you were performing before you started hurting! Progressively increase the workload until you reach your goals pain-free.
There are many other conditions which can cause heel pain, including calcaneal stress fractures, tarsal tunnel syndrome, flexor hallucis longus tendinitis, and Sever’s Disease. Remember that it is outside the legal scope of practice for a personal trainer to diagnose any injury or condition.
1 Gudeman, Eisele, et al; Treatment of Plantar Fasciitis by Iontophoresis or .4% Dexamethasone. Am J Sports Med 1997; 25(3):312-316.
2 Cornwall, McPoil; Plantar Fasciitis: Etiology and treatment. J Orthop Sports Phys Ther 1999; 29(12):756-760.
3 Batt, Tanji; Plantar Fasciitis: A Prospective Randomized Clinical Trial of the Tension Night Splint. Clin J Sport Med 1996;6(3):158-162.
4 Powell, Post, Keener, et al; Effective Treatment of Chronic Plantar Fasciitis with Dorsiflexion Night Splints. Foot Ankle Int 1998;19(1):10-18.
5 Probe, Baca, Adams, et al; Night Splint Treatment for Plantar Fasciitis. Clin Orthop 1999;368(Nov):190-195.
6 Crawford, Atkins, Young, et al; Steroid Injection for Heel Pain: Evidence of Short-term Effectiveness. Rheumatology 1999;38(10):974-977.
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