Ask the c.Ped – How to Treat Plantar Fasciitis

Helen Russell is the owner of Metro Run and Walk with her husband Mark. She is a certified pedorthist and has completed several marathons!

The primary goals in the management of plantar fasciitis are:

1. Reduce the inflammation

2. Protect the plantar fascia from further trauma

3. Stretch and strengthen the ankle, foot and calf muscles

During the rehabilitation process, temporary relief can come from oral anti-inflammatories (for their analgesic effect), rest, ice, massage, and gentle stretching.

Many also find relief in protective aides for the painful area, including taping, over the counter orthotics (Superfeet, Spenco, Powerstep), or heel pads (Tulli, Spenco).

A night stretching sock or foot brace (Strassburg Sock, Thermoskin Plantar Fasciitis Stretching Boot) can also aid by gently stretching the fascia during the night, helping to restore flexibility, especially when first arising in the morning.

Some of us in the store (which has an unforgiving concrete floor) have found relief with extremely well cushioned shoes and over the counter orthotics.

Multi-Step Treatment of Plantar Fasciitis

Treatment recommendations include a multi-pronged approach to treating plantar fasciitis:

1. Active rest – reduce but do NOT eliminate daily activity.
2. Do NOT go barefoot or wear unsupported footwear. Footwear with a suitable built-in arch support, or over-the-counter or custom orthotics in a well-cushioned shoe are good alternatives.
3. Inflammation is best managed through icing. It is most effective if you can ice several times a day for up to 15 minutes.  Ice the affected area – rolling the foot with moderate pressure over a frozen water bottle works best. You should feel the area going through the four ―icing stages – cold, burning, aching, and finally numb. You want the area to be numb and red, but be careful not to go too long and give yourself frostbite – wear a sock!
4. Friction massage – in addition to the ―ice massage above, you should vigorously massage the painful area for 5-10 minutes several times a day with your fingers or a tennis or golf ball or foot wheel. This will HURT, but it should also feel better afterwards.
5. Stretching and strengthening of the muscles of the ankle and foot will not only help in your recovery, but will also help to prevent the pain from recurring. The morning before you get out of bed, pull your feet towards you and stretch out your calves to help decrease the pain of that first step.
6. The calf muscles (gastrocnemius and soleus) need to be flexible. This is achieved by slowly leaning forward while facing a wall, with the knee straight and the heel on the ground until you feel a pull in the back of your upper calf. After holding this stretch for 30-60 seconds, allow your knee to bend, and feel the stretch in your lower calf. This should be repeated 3-5 times per day.
7. Protection of the plantar fascia can be achieved through taping and use of shoe inserts. Occasionally, over-the-counter inserts can be effective in reducing strain along the plantar fascia; however, if improvement of symptoms is not noted within the first few days of using over-the-counter inserts, you can assume that the pre-determined shape of that insert does not correspond well to your particular foot type, and consultation with a podiatrist is recommended for evaluation for the possible fabrication of functional foot orthoses.
8. Use night splints to stretch the injured fascia and allow it to heal.
9. Wear properly fitting shoes.

Maintaining good flexibility around the ankle, particularly the Achilles tendon and calf muscles, is probably the best way to prevent plantar fasciitis.

Information Sources and Websites:

http://www.plantar-fasciitis.org/

http://www.aapsm.org/plantar_fasciitis.html

http://en.wikipedia.org/wiki/Plantar_fasciitis

http://www.sportsinjuryclinic.net/cybertherapist/front/foot/plantarfaciitis.htm 

Related articles

• Self-Care Tool for Plantar Fasciitis (charlottesville-massage.com)
• Plantar Fasciitis Causes Serious Heel Pain (everydayhealth.com)