What is Plantar Fasciitis?
Plantar fasciitis is a common and debilitating condition where the bottom of the foot becomes inflammed and painful. So common in fact that approximately 10% of the population will experience this condition at some point. The plantar fascia is a ligamentous structure that helps support the foot while standing. For the most part, plantar fasciitis is an insidous, or gradually progressing, condition that eventually leads people to seek treatment.
Symptoms of Plantar Fasciitis
1) Tenderness in the affected heel where the plantar fascia inserts.
2) First few steps in the morning are painful.
3) Pain along the arch of the foot.
4) Generally, pain is experienced with prolonged standing or walking; not as much with resting.
Causes of Plantar Fasciitis
With my patients in physical therapy, here are the problems I see most commonly that contribute to this condition:
1) Tight calf muscles - most common issue
2) Weak hip muscles - especially the gluteus maximus/medius (butt muscles and muscles on the side of your hips)
3) Overpronation in standing or walking - i.e. flat feet. Supination (high arches) to a lesser degree can lead to plantar fasciitis but this seems significantly less common.
4) Pelvic Misalignment - makes one leg functionally longer than the other and causes you to put a lot of weight through the leg.
Treatment for Plantar Fasciitis
Stretch Your Calves
Stretching you calves can be the most effective strategy to relieving arch pain. I usually have patients use a step to stretch for about 20-30 seconds for 4-5 repetitions. Make sure you hold your stretches at a tolerable level for the full time without bouncing. This is a pretty effective way to get more flexibility, but we also use an item in the clinic which some patients enjoy as well called the Pro Stretch by Medi-Dyne.
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Strengthen Your Hips
Hip weakness definitely contributes to plantar fasciitis, but this concept is a little difficult to explain. Essentially, weak abductors (the muscles on the outside of the hip) will exacerbate overpronation at the foot. The leg is basically a chain that can be affected at either the foot or the hip; therefore, strengthening the top of the chain helps guide the positioning of the foot..
My two favorite exercises for strengthening the hips are clam shells and single leg bridging. For clamshells, I recommend performing 10 reps on each hip, holding for 10 seconds each. Single leg bridging is effective performing 2-3 sets of 10 on each leg. Pictures can be seen below.
Clam Shells 10 x 10 seconds
Single Leg Bridge 2-3 sets of 10 reps
Overpronation, or excessive flattening of the foot arch, leads to higher levels of stress on the plantar fascia during standing and walking. Correcting this deficit and supporting the foot is extremely important for healing arch pain. This can be accomplished through strengthening the muscles and supporting the foot with appropriate shoe wear.
Practicing scrutching a towel with your toes can help develop the musculature on the bottom of your foot in order to support the plantar fascia. You can also lay a weight on the towel to increase the challenge. Just make sure you do this on a slick surface and not carpet, otherwise you are going to be really frustrated!
Towel Scrutches - practice 3-4 minutes daily
Appropriate Foot Wear and Arch Supports
If you are wearing flip flops on a regular basis with plantar fasciitis, shame on you! This is a terrible way to treat your feet and can also lead to issues such as back pain. Try to find a walking or running shoe with good support for your heel. I also recommend that you use an arch support insert for your shoes to help provide additional support for the plantar fascia. We issue the Medium Arch Aetrex Arch Support to our patients, and we see very good results with these. Most people find them quite comfortable, but occasionally, some do get some foot discomfort for a week or so until their feet adjust.
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Ice seems to be the most effective modality for assisting in decreasing inflammation and pain. Typically iciing 15-20 minutes after activity can help decrease inflammation and pain. DO NOT ice prior to activity as the tissues will also become less flexible for awhile, and this can lead to injury. There are many ice packs available on the market to use, but the Runner's Remedy is a nice device that molds to the foot for excellent contact. Just toss it in the freezer when finished to get it ready for the next treatment.
Path to Healing
Plantar fasciitis is a stubborn condition, as your full body weight is on the foot throughout the day. Healing will come at the cost of hard work and dedication for several weeks (at least 8-12 weeks) in order to get the foot back in fighting shape. Follow the steps above to give yourself the best change to heal, and remember to always check with your physician to make sure your issue is not more serious. Good luck!