Treatments for Plantar Fasciitis

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 FasciitisPlantar Fasciitis can even make walking painful.

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.  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.  

Symptoms of Plantar Fasciitis tear

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.  

Bottom of My Foot is Sore

The bottom of my foot is sore and painful when I get out of bed is the most common complaint with plantar fasciitis.  The reason why this occurs is due to the foot relaxed position when sleeping.  This causes the plantar fascia to stay in a shortened position.  When you first step down on it in the morning it is stretched back out when you step down on it.  This initial soreness or pain is the classic symptom of plantar fasciitis. 

Ruptured Plantar Fascia Symptoms

The plantar fascia can also be prone to a rupture or a complete tear.  This is usually a single event when trauma occurs to the fascia itself.  In my experience the athlete or patient will describe a popping sensation at the bottom of their foot.  They also describe an immediate pain and the inability to walk.  The mechanism of this injury can be a fall from a ladder or roof or during sport activities of tennis, basketball and track and field.  Runners can also rupture the plantar fascia but usually this is related to a gradual weakening of the fascia over time due to repetitive stresses. 

Ruptured Plantar Fascia Symptoms

Diagnosis of Plantar Fasciitis

Diagnosing plantar fasciitis can be as simple as eliciting pain at the insertion or along the tissue itself through palpation. Sometime 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. An ultrasound that can determine a thickening of the plantar fascia or possible heel or fat pad bruises.  Orthopedic surgeons will take a complete history and do a physical exam of the entire foot and ankle.  At times, other diagnostic tests such as an MRI are used to confirm the diagnosis. 

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.

Calf Stretch Against the Wall

• 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- Rest in most cases is a very important remedy for treating plantar fasciitis.  It can also be the hardest remedy to follow.  Often, for an athlete to stop running or playing tennis is very difficult. 
• 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.
• Foot Orthotics or Inserts- 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, Graston, and/or laser therapy to relieve pain.  These useful tools may lessen pain by decreasing inflammation and can jump start the healing process.  

Plantar Fascia Stretch 

• 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.  

Torn Plantar Fascia Recovery or Healing Time

The recovery time or healing time for a torn or ruptured plantar fascia will vary based on the severity of the tear.

• 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 a surgery consultation.
• A torn or complete rupture of the plantar fascia can take several months to heal or completely recover.  The most common group who suffer from ruptures are athletes who run.  Patients who are compliant with the guidelines after surgery, usually recover from 8 to 16 weeks.

To learn more about orthotics and plantar fasciitis, please go to: Foot.  If you would like to learn more about another lower leg issue, go to What Are Shin Splints?, Treating Heel Pain or Foot Arch Pain.

By: Ehren Allen, DPT, COMT

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