PLANTAR FASCIITIS

The plantar fascia is the thick connective tissue on the bottom of the foot.  Its function is to support the arch.  It consists mostly of collagen, which is non-living tissue.  This fascia attaches from the lower prominence of the heel bone to the first parts of the toe bones.  In medical terms, this connective tissue extends from the tuberosity of the calcaneus bone to the heads of the proximal phalanges of the toes.  Its initial attachment to the achilles tendon progressively deteriorates with aging (welcome to the Decay Club).

Plantar fasciitis refers to inflammation of this structure.  It is often painful, to varying degrees.  The pain can occur anywhere along the fascia.  However, the most common location is at the attachment to the heel bone.  The pain can be severe.

The diagnosis is usually made when someone has heel pain after periods of immobility.  Sleeping is the longest time most of us are not walking around.  Therefore, patients report pain when they first stand up in the morning.  The pain ordinarily decreases or disappears once the person starts walking.  It can then restart after even short intervals of sitting.  It may also reoccur after prolonged walking.  There are some uncommon and mores serious conditions that can present with similar symptoms.  For safety reasons, a doctor should make the diagnosis.

The cause is trauma to the foot.  A tight plantar fascia predisposes to the development of inflammation.  Trauma to the foot comes from walking, jumping, running, and similar injurious behavior.  It is a consequence of gravity and inflammation.  Those two are definitely problems for us.  They are part of life.

Prevention works for this discomfort. 

A pattern of daily stretching is the key to avoiding plantar fasciitis (the suffix “-itis” is Latin for inflammation.  It is seen a lot in medical nomenclature).  Creating and maintaining a pattern means that it is performed daily.  Patterns take some time to become established.  So, start your stretching program now.  Yes, get out of bed and go stretch if you have not already done that.

The main thing to stretch is the achilles tendon. This fibrous tissue connects the calf muscles to the back of the heel bone.  Despite the natural deterioration of this tendon, it is still an important factor regarding the plantar fascia.

The first rule about beginning any stretching exercise is to be gradual.  Do less than you think you should do.  Start with a wall push-up.  Put both hands flat on a wall.  Extend your arms and stand straight.  Move your left foot back until you are leaning on the wall.  Assure that both heels are flat on the ground.  With the left knee straight and locked, bend the right knee until you feel a pulling in your left calf.  Gently.  Find your own best position.  Discover a comfortable amount of stretch.  This is called the calf stretch. 

While in the calf stretch position, very slowly bend the left knee.  Keep both heels flat on the ground.  You will soon feel the pulling move down to the area just above your foot.  Now you are doing the achilles tendon stretch.  Hold the stretch for 30-60 seconds.

Both the calf and the achilles tendon stretches are valuable for preventing plantar fasciitis.  Ideally, each should be held 30-60 seconds.  The best outcome is to stretch one leg, and then the other leg.  Then repeat the stretches for each leg.  Repeating a stretch is optimal.  It is best to delay a minute before repeating.  A good plan is to go back and forth between legs.

If you do all four stretches for 60 seconds each, the time to finish would be over 8 minutes.  That is a lot of time. 

You can combine the calf and achilles routines.  Elevate the balls of your stretching foot (the one in back) about 1 inch with a thick carpet fragment.  Now, when you pull your calf, you can also feel it in your achilles.

There are many approaches to this exercise.  The main advice is to be careful, stay balanced and sure, and proceed cautiously so you do not injure yourself.  Probably the safest way is to have personal guidance from a physical therapist.

The above program is also a very important part of treating painful plantar fasciitis.  You just have to ease up on how much you stretch when you are symptomatic.  Let your pain be your guide.  Do not allow stretching to increase the pain. 

Regularly stretching of the plantar fascia is also critical.  This is best done by wearing arch support in your shoes.  The insert should function so that you feel some pressure on your instep whenever you are standing.  You may have to try several different brands before you get the best one for yourself. 

To treat plantar fasciitis, you need to stretch the fascia as well as the calf and achilles.  Use a cylindrical object.  A 3-inch diameter water bottle works well.  Fill it most of the way with water and then freeze, allowing for expansion.  Sit on a chair and roll the bottle between your heel and the ball of your foot with a little pressure for 30 seconds.  Then put your foot beneath the chair resting on the toes and the metatarsal heads (the “ball” of the foot).  Slide your foot back for maximum extension of the toes forward, lifting your heel as much as you can.  You can also cross one foot over the other leg , hold your toes, and gently bend them backward.  Hold this for 30 seconds.  Repeat twice.  Do this several times a day.

Either cold or heat may help with the pain.  Soaking in Epsom salts gives some relief. 

Wearing a boot or a splint at night to prevent the foot from pointing down also helps with healing.  These prevent achilles tendon and plantar fascia contracture.  Wearing a heel pad when walking takes some of the pressure off the inflamed area.  Untuck your bedsheets to avoid sleeping with your toes pointed.

Weight loss helps if indicated.

Anti-inflammatory medicines reduce the pain.  But these drugs can be harmful.  It is best to consult with your physician.  Although these medicines reduce inflammation, they also inhibit healing.  Side effects can be severe and without warning.  Many people think they can take NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) safely.  Do not make such assumptions.  Work with your doctor.

Topical pain relievers may help and are generally safe.  These include capsaicin, salicylates, arnica, eucalyptus, menthol, benzocaine, and other ingredients.  Read and heed the warnings and advice on the labels of anything you use.  Oral turmeric (curcumin) is helpful.

If the problem is severe, you may have to change to low impact exercise routines. Like swimming, bicycling, rowing, or an elliptical machine.

It these remedies do not work, then you may need to consult with your physician or a podiatrist.