Image of a person walking
Doctor’s offices see over one million patients per year in the United States due to foot pain. Most of those complaints are diagnosed as plantar fasciitis. Now this may sound harmless, but to a very large population it can be painful and often times debilitating. The cause for plantar fasciitis is not completely understood, but some factors may include small tears to the tendon that runs from the heel to the big toe, degenerative changes from wear and tear, bone spurs, lack of ankle and/or big toe mobility, and often times, poor intrinsic muscular strength and control. There may be pain in the ball of the foot but this is less common.
Signs and Risk Factors of Plantar Fasciitis
A person who may complain of foot problems and pain or plantar fasciitis may exhibit signs such as pain with the first few steps when they wake up in the morning and general pain at the heel or the inside arch of the foot. The reason for this is because the covers and blankets we use at night may keep our feet plantar flexed, meaning toes pointing down. This shortens the length of the tissues such as the calf muscles and the plantar fascia itself. Foot pain may resolve after those first several steps in the morning but may return with prolonged standing and walking. A person who has above normal height of the arch or even flat feet may develop plantar fasciitis as well. The plantar fascia plays a very important and specific role in the Windlass Mechanism in the bottom of the foot. This mechanism helps add rigidity to the arch of the foot while plantar flexing and the big toe is pointed up. The purpose is to provide a stable foot while pushing off while walking or running. Poor ankle and big toe mobility are other factors that can cause plantar fasciitis as well as the surfaces we run/walk on, shoes, and training regimen.
Diagnosis of Plantar Fasciitis
Diagnosing plantar fasciitis can be as simple as eliciting pain at the insertion or along the tissue itself through palpation or even just the classical descriptive signs and symptoms. Often times the patient may need an x-ray to check for spurring at the heel that may be causing the pain or an ultrasound that can determine a thickening of the plantar fascia or possible heel or fat pad bruises.
Home Remedy Treatments for Plantar Fasciitis
There are a lot of home remedies and heel pain treatments out there. Not every plantar fascia treatment may work for each individual case. The key is to find what the main cause of your pain is and find what works for you.
- Stretching- Often times calf and achilles stretches against the wall or a slant board, or hanging the heel off of a step can help alleviate symptoms. Stretches are usually held for 30 seconds at a minimum of three repetitions. Try this 2-3 times a day.
- Ice Massage- If pain and inflammation is the main issue, rolling your foot over frozen water bottle or soda can on the ground may help as well.
- Rest- is important for treating plaatar fasciitis.
- Night Splints- Some patients find that a boot which keeps the foot in a toes up position helps keep calf muscles and plantar fascia in a stretched position during sleep which can decrease morning stiffness and eliminate those pesky painful first steps. You may be able to utilize a tall sock leaving an excess of material past the toes and tie it around the lower leg to maintain the foot in that position.
- Orthotics- For those with high or low arches, you may find comfort in a custom fit orthotic or shoe insert. By determining each individual’s foot biomechanics and the sites of greatest pressure while walking/running, we may be able to create an orthotic that can support your deficits and also create a cushion over that sore heel. JOI uses the FOOTMAXX™technology to create a custom orthotic tailored to your needs. To book your orthotics appointment with JOI today click here!
- Modalities- Plenty of patients choose to receive modalities such as ultrasound and/or laser therapy to relieve pain. These useful tools may lessen pain by decreasing inflammation and can jump start the healing process.
- Modify Activity- Unfortunately for some, we may need to modify their workouts or activities that could be the source of their pain. We do not want you to stop exercising forever, but give your body the opportunity to heal and pick up a different form of exercise that may not load the fascia in the meantime. Some activities may include cycling and or swimming. Dr. Hiram Carrasquillo recommends that when beginning walking activity, use a pedometer to count the amount of steps you can take before having pain. Then use the number to limit yourself to avoid over stressing the plantar fascia. Once you are pain free for 4 to 6 weeks, increase the steps by 10% per week until you are back to normal activity.
- Injections- Injections of corticosteroids at the injury site are common, but should not be the first line of defense.
- Surgery- If symptoms are not resolved by conservative treatments for plantar fasciitis within 6-12 months, you may need referral to an orthopedic surgeon for consultation.
JOI Physicians and JOI Rehab are now offering telemedicine or virtual visits. To learn more go to: Telemedicine
By: Ehren Allen, PT, COMT
To schedule an appointment with an Orthopaedic Foot and Ankle Specialist, please call JOI-2000, Schedule Online or Click on the link below.